Azithromycin may Cause Sudden Cardiac Death

Azithromycin can cause serious cardiac side effects if it is taken by people who have pre-existing cardiovascular conditions and can lead to sudden heart failure and death.

Highlights:

Azithromycin, clarithromycin, and erythromycin have the potential to cause sudden cardiac arrests in previously healthy individuals
73% of the case reports of patients who developed azithromycin-related cardiac arrhythmias are under 65 years old
There is a need for restrictive drug labeling, a proper clinical assessment of the patient, an ECG, and other investigations if necessary before prescribing azithromycin

Recently, a series of studies published in the New England Journal of Medicine by Dr. Ray et al. have shown that azithromycin can cause serious, life-threatening cardiac side effects and deaths in absolutely normal people.

Azithromycin is a macrolide antibiotic that is effective in treating various infections. It is a highly effective drug and is widely used by practitioners to treat various infections successfully.

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‘Though azithromycin is popularly prescribed for various infections, recently it has been found to have effects on the heart like irregular heartbeats leading to sudden cardiac failures, especially for older people, heart disease patients, and women.’
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Further studies in people with already existing heart conditions show that the risk goes up quickly and is considerably high.

Why do Sudden Cardiac Deaths Occur?

The risk is because azithromycin interferes with the rhythm of the heart and causes it to beat irregularly. It has been shown to cause two types of arrhythmias: QTc prolongation and Torsades de pointes (,). These are fatal, and they have a risk of sudden cardiac death.

This side effect is noted in patients otherwise healthy patients. In the study, 73% of those who developed this change were under the age of 65. This result is not dosage related. Any dose from 500 mg to 1500 mg can cause this change in the heart ().

Erythromycin and clarithromycin fall under the same class, and they have a higher risk of this dreaded side effect compared to azithromycin. There are no healthier alternatives.

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The established percentages of risk for this condition are 59% with azithromycin, 45% with clarithromycin, and 89% with erythromycin ().

Female sex, elderly age group (> 65 years), and diabetes are additional risk factors for azithromycin (macrolide)-related cardiac arrhythmias. These conditions include coronary artery disease, angina, stroke, heart diseases or defects present from birth, low levels of potassium in the body, and drugs that are used to treat arrhythmias like propranolol, dofetilide, sotalol, and others (,).

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The top ten quality and performance measures to prevent sudden cardiac death can help healthcare professionals and family members to provide care for those at high risk.

Azithromycin can be safe and effective for treating a wide range of infections, but it is important to be aware of the potential side effects.

How to Prevent Cardiac Deaths due to Azithromycin

There are also some precautions to take when taking azithromycin. For example, people with pre-existing cardiovascular conditions should consult with their healthcare provider before taking azithromycin.

To prevent this, pharmaceutical companies should reconsider their labeling and make sure the side effect is mentioned, and it should be categorized under restrictive labeling.

Risk Factors for Sudden Cardiac Death
Diabetes is associated with sudden cardiac death, although the exact direct relationship is unclear.

Practitioners should be aware of this fatal side effect and, keeping it in mind, they should thoroughly examine the patient clinically to rule out any potential risk factors for azithromycin-induced arrhythmias.

After a thorough clinical exam, they should order investigations like a complete blood picture, ECG, peripheral smear, and serum electrolytes to identify any underlying risk factors with appropriate clinical correlation.

To ensure the best possible results, it is important to follow the guidelines for taking azithromycin outlined by your doctor. These guidelines may include taking the medication with a full glass of water, eating a light meal before taking it, and taking it for the shortest possible period.

Remember, azithromycin can be a powerful antibiotic and should only be used if it is necessary. Always consult your doctor before taking azithromycin if you have any pre-existing medical conditions.

If you are taking azithromycin and experience any of the following symptoms, please consult with your healthcare provider immediately: chest pain, shortness of breath, extreme fatigue, or palpitations.

Other drugs that are known to cause similar effects are levofloxacin, gatifloxacin, and other fluoroquinolone group of antibiotics. It is highly recommended to consult with a doctor before taking antibiotics.

References:

Azithromycin, cardiovascular risks, QTc interval prolongation, torsade de pointes, and regulatory issues: A narrative review based on the study of case reports - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040726/)
FDA Drug Safety Communication: Azithromycin (Zithromax or Zmax) and the risk of potentially fatal heart rhythms - (https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-azithromycin-zithromax-or-zmax-and-risk-potentially-fatal-heart)

Source-Medindia