Azithromycin and Pimozide: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Pimozide
No brand names on recordAzithromycin
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased pimozide exposure and an increased risk of QT interval prolongation
Interaction Deep Dive
The concomitant use of pimozide (CYP3A4 substrate) with azithromycin (CYP3A4 inhibitor) is contraindicated, as it may increase pimozide exposure and may also increase QT interval prolongation. Ventricular arrhythmias have been rarely associated with the use of macrolide antibiotics, such as azithromycin in patients with prolonged QT intervals, as might be produced by pimozide1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of pimozide; additive QT interval prolongation
Literature reports
1 report — tap to read
a) Specifically, two sudden deaths have been reported when clarithromycin (macrolide antibiotics) was added to ongoing pimozide therapy 1.
Common questions
Can I take Azithromycin and Pimozide together?
Increased pimozide exposure and an increased risk of QT interval prolongation Always confirm with your pharmacist or prescriber before making any change.
How serious is the Azithromycin and Pimozide interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Azithromycin or Pimozide need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: Pimozide oral tablet, pimozide oral tablet. Endo USA, Inc (per DailyMed), Malvern, PA, 2017. DailyMed
Keep reading about Pimozide
Keep reading about Azithromycin
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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