Propofol and Azithromycin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Propofol
Azithromycin
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
An increased risk of QT interval prolongation
Interaction Deep Dive
Consider the risk of QT prolongation, which can be fatal, when initiating azithromycin in patients taking drugs that may prolong the QT interval due to the potential for additive effects on the QT interval and an increased risk of serious cardiovascular effects1. Prolongation of the QT interval has been reported with the use of propofol 23. Caution is warranted when administering propofol to patients with exposure to known QT-prolonging risk factors 2; consider monitoring of ECGs in high-risk patients receiving propofol 3.
Why it happens (mechanism)
Additive effects on QT interval prolongation
Literature reports
2 reports — tap to read
a) In a single-center, retrospective, observational study involving 96 patients who received a propofol infusion for 3 or more hours with sequential ECG monitoring from 2006 to 2012, a mean prolongation of the QTc interval of 30.4 +/- 55.5 msec (95% CI, 18.7 to 14.2 msec) was observed during the propofol infusion. In addition, 43.8% of cases reported an on-infusion QTc of 500 msec or more, representing a 25% increase in proportion compared to baseline. Multivariable regression analysis suggest that prolongation in on-propofol QTc was independently associated with baseline QTc interval and amiodarone (a known QT prolonging drug) use 3.
b) In a retrospective observational study involving 628,784 patients who received propofol during the study period of 17.3 years, 21 patients developed torsades de pointes (approximately 1 in 30,000 patients). Exposure to at least 1 factor associated with QT-prolongation was noted in 17 patients, including QT-prolonging medications in 8 patients, bradycardia in 8 patients, hypokalemia in 4 patients, hypomagnesemia in 2 patients, and subarachnoid hemorrhage in 2 patients. The number of patients with QTc greater than 500 msec using Fridericia correction was significantly higher from baseline following exposure to propofol; however, no significant difference was observed using the Framingham correction 2.
Common questions
Can I take Propofol and Azithromycin together?
An increased risk of QT interval prolongation Always confirm with your pharmacist or prescriber before making any change.
How serious is the Propofol and Azithromycin interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
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 "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Propofol or Azithromycin 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 (3)
- Product Information: ZMAX(R) oral extended-release suspension, azithromycin oral extended-release suspension. Pfizer Inc (per FDA), New York, NY, 2021. DailyMed
- Abrich VA, Ramakrishna H, Mehta A, et al: The possible role of propofol in drug-induced torsades de pointes: a real-world single-center analysis. Int J Cardiol 2017; 232:243-246. PubMed
- Scalese MJ, Herring HR, Rathbun RC, et al: Propofol-associated QTc prolongation. Ther Adv Drug Saf 2016; 7(3):68-78. PubMed
Keep reading about Propofol
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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