Discussing The Interaction Between Azithromycin And Hydroxychloroquine

In our latest question and answer, the pharmacist discusses the drug interaction between azithromycin and hydroxychloroquine.

Question

I stopped taking Hydroxychloroquine 200mg yesterday and was prescribed Azithromycin today. Nothing was mentioned about interactions, but I see there is a risk of prolonged QT intervals. Should I wait to take the antibiotics?

Asked by Lucy On Mar 04, 2024

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Mar 06, 2024
Last updated Apr 12, 2024

Answer

Thank you for contacting us!

It's great that you're being mindful of potential interactions between your medications. I'm happy to help.

There is indeed an interaction between hydroxychloroquine and azithromycin, which poses the risk of 'QT prolongation'.

We (HelloPharmacist) categorize this interaction as 'major', though other sources may assign it a different severity level.

Interaction Details

You can find a detailed explanation of the interaction on the drug interaction section of our website. In summary, both azithromycin and hydroxychloroquine increase the risk of QT prolongation.

QT prolongation occurs when the QT interval on an electrocardiogram (ECG) is longer than normal. This can lead to a higher risk of developing a specific type of irregular heartbeat called torsades de pointes, which can be life-threatening.

As a general rule, it's not recommended to use hydroxychloroquine with other drugs that have the potential to prolong the QT interval (such as azithromycin).

However, it's important to note that the combination of hydroxychloroquine and azithromycin can be used at times, depending on the situation.

We are particularly concerned about this interaction in individuals at high risk for QT interval prolongation, such as those with COVID-19 infection, older adults, individuals with existing heart problems, low potassium levels, etc. If you are healthy and don't have these risk factors, it is generally considered safe to use the combination if the indication is justified and the benefits outweigh the risks. You may just have to be monitored more closely.

It's very important to discuss your concerns with your doctor and assess your individual risk before taking this combination of drugs, as everyone's medical situation is different. Your doctor can provide you with specific guidance and discuss with your whether or not you need specific monitoring.

Waiting After Stopping Hydroxychloroquine

I'd like to address the point you made about stopping hydroxychloroquine. You mentioned that you've recently stopped hydroxychloroquine and are considering waiting to take azithromycin. Unfortunately, as taking antibiotics is time-sensitive to treat your infection, waiting isn't an option here.

Hydroxychloroquine has a VERY long half-life, between 30 and 50 days after a single dose, so the drug remains in your system for a significant amount of time. Even waiting a few days after stopping it won't prevent an interaction with azithromycin.

Once again, please consult your doctor about your options.

Final Words

Thank you once again for reaching out. Please don't hesitate to contact us anytime. I hope this answer was informative.

References

  • Azithromycin Prescribing Information, AccessFDA
  • Plaquenil Prescribing Information, AccessFDA
  • Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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