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| Interactions: | Alprazolam
Adverse Effect: increased alprazolam toxicity (CNS depression, ataxia, lethargy) Clinical Management: Observe patients receiving Roxithromycin and alprazolam for enhanced CNS effects. Warn patients regarding potential for drug hangover.
Astemizole
Adverse Effect: cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) Clinical Management: The concurrent use of astemizole and roxithromycin is not recommended.
Diazepam
Adverse Effect: Increased Diazepam toxicity (CNS depression, ataxia, lethargy) Clinical Management: Observe patients receiving Roxithromycin and Diazepam for enhanced CNS effects. Warn patients regarding potential for drug hangover. Smaller Diazepam doses (dose reduction by 50% to 75%) may be required after two to four days of concurrent macrolide antibiotic dosing.
Digoxin
Adverse Effect: possible digoxin toxicity (nausea, vomiting, arrhythmias) Clinical Management: Serum digoxin levels should be carefully monitored when roxithromycin is added to or withdrawn from therapy. Patients should be observed for signs and symptoms of digoxin toxicity (nausea, vomiting, arrhythmias).
Midazolam
Adverse Effect: increased Midazolam toxicity (CNS depression, ataxia, lethargy) Clinical Management: Observe patients receiving concurrent macrolide antibiotics and Midazolam for enhanced CNS effects. Warn patients regarding the potential for drug hangover.
Pimozide
Adverse Effect: Increased risk of cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) Clinical Management: Concurrent use of pimozide and roxithromycin is contraindicated.
Warfarin
Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulant therapy with warfarin, the prothrombin time ratio or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with roxithromycin, and should be reassessed periodically during concurrent therapy.
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