20 to 50     : Dose as in normal renal function
10 to 20     : Dose as in normal renal function
<10           : 50–75 % of normal dose; maximum 2 g daily
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Not dialysed. Dose as in GFR <10 mL/min
HD                     :Not dialysed. Dose as in GFR <10 mL/min
HDF/high flux   :Unknown dialysability. Dose as in GFR <10 mL/min
CAV/VVHD      :Unknown dialysability. Dose as in normal renal function
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsAvoid concomitant use with reboxetine and cilostazol
Anti-arrhythmics: increased risk of ventricular arrhythmias with parenteral erythromycin and amiodarone – avoid concomitant use; increased toxicity with disopyramide
Antibacterials: increased risk of ventricular arrhythmias with moxifloxacin and parenteral erythromycin avoid concomitant use; increased rifabutin concentration
Anticoagulants: enhanced effect of coumarins
Anti-epileptics: increased carbamazepine concentration and possibly valproateAntihistamines: possibly increases loratadine concentration; inhibits mizolastine metabolism – avoid concomitant use
Antimalarials: avoid concomitant administration with artemether/lumefantrineAntimuscarinics: avoid concomitant use with tolterodine
Antipsychotics: increased risk of ventricular arrhythmias with amisulpride and parenteral erythromycin avoid concomitant use; possibly increases clozapine concentration and possibly increased risk of convulsions; possibly increased risk of ventricular arrhythmias with pimozide and sertindole – avoid concomitant use; possibly increased quetiapine concentration
Antivirals: concentration of both drugs increased with amprenavir; concentration increased by ritonavirAnxiolytics and hypnotics: inhibits midazolam and zopiclone metabolism; increases buspirone concentration
Atomoxetine: increased risk of ventricular arrhythmias with parenteral erythromycin
Calcium-channel blockers: possibly inhibit metabolism of felodipine and verapamil; avoid concomitant use with lercanidipine
Ciclosporin: markedly elevated ciclosporin blood levels – decreased levels on withdrawing drug. Monitor blood levels of ciclosporin carefully and adjust dose promptly as necessaryColchicine: increased risk of colchicine toxicityCytotoxics: possible interaction with docetaxol; increases vinblastine toxicity – avoid concomitant use
Ergot alkaloids: increase risk of ergotism – avoid concomitant use5HT 1 agonists: increased eletriptan concentration – avoid concomitant useIvabradine: increased risk of ventricular arrhythmias – avoid concomitant use.278 eRYtHROMYCINLipid-lowering drugs: increased risk of myopathy; concentration of rosuvastatin reduced
Pentamidine: increased risk of ventricular arrhythmias with pentamidineSirolimus: concentration of both drugs increased
Tacrolimus: markedly elevated tacrolimus blood levels – decreased levels on withdrawing drug. Monitor blood levels of tacrolimus carefully and adjust dose promptly as necessaryTheophylline: inhibits theophylline metabolism; if erythromycin given orally decreased erythromycin concentration
ADMINISTRATION
Reconstition
1 g with 20 mL water for injection, then dilute resultant solution further to 1–5 mg/mL
Route
IV, oral
Rate of Administration
20–60 minutes using constant rate infusion pump
Comments
Use central line if concentration greater than 5 mg/mL; if >10 mg/mL monitor carefully (some units use 1 g in 100 mL of sodium chloride 0.9%). (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006)
OTHER INFORMATION
May also give one third of daily dose by infusion over 8 hours peripherally at concentration of 1 g/250 mL (4 mg/mL). Repeat 8 hourly, i.e. continuouslyIncreased risk of ototoxicity in renal impairmentAvoid peaks produced by oral twice-daily dosing, i.e. dose 4 times dailyMonitor closely for thrombophlebitic reactions at site of infusion.