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4451049 tn?1387153437

Has anyone been given Azithromycin?

I don't trust Drs.  So when I'm prescribed anything at all, I will look further into it.  The FDA warns about the possibility of deadly heart rhythms with this medication.  They state that the "overall risk is low".  However, I do have some risk factors.  And after reading some of the reviews of individuals supposedly suffering life long heart related problems from this drug, I was somewhat reluctant.  I have an open mind when reading reviews and so I decided to proceed with caution.  I've been cautiously taking it for over a month now.  I listen to my heart from time to time, and I can certainly hear an arrhythmia when I breathe.  My lips are numb and I just don't feel right.  I don't want to question the Dr and I do want to get better, but I don't even think this medication has much benefit.  I could be wrong, so I'm not sure if I should stop the Azithromycin or continue.  Has anyone had any experience with this drug?

32 Responses
Avatar universal
Drugs ******* says this (and other things) about azithromycin:

"Cardiovascular side effects have rarely included arrhythmias (including ventricular tachycardia), prolongation of the QT interval, torsades de pointes, palpitations, hypotension, and chest pain in postmarketing experience. A causal relationship has not been established."

arrythmia, prolongation of QT interval = irregular heartbeat

ventricular tachycardia = overly fast beating of the lower part of the heart

torsades de pointes = another kind of ventricular tachycardia

palpitations = fast beating of the heart

hypotension = low blood pressure

chest pain = ... well, chest pain

The last part says: "A causal relationship has not been established."  Meaning that it has not been proven that this med actually causes these effects; it could be something else.

You say:
" I don't want to question the Dr and I do want to get better, but I don't even think this medication has much benefit."

I took it with no problems, and I'm very sensitive to meds.  If you have concerns, you should talk with your doc.  

Why do you think the medication is not working?  
Avatar universal
that should say drugs ... [dot]  ... com in the first line of the previous post.
4451049 tn?1387153437
The fda just warned of this problem in March of this year.  Go to their website and type in azithromycin.  

"The U.S. Food and Drug Administration (FDA) is warning the public that azithromycin (Zithromax or Zmax) can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm. Patients at particular risk for developing this condition include those with known risk factors such as existing QT interval prolongation, low blood levels of potassium or magnesium, a slower than normal heart rate, or use of certain drugs used to treat abnormal heart rhythms, or arrhythmias.  This communication is a result of our review of a study by medical researchers as well as another study by a manufacturer of the drug that assessed the potential for azithromycin to cause abnormal changes in the electrical activity of the heart."

"The azithromycin drug labels have been updated to strengthen the Warnings and Precautions section with information related to the risk of QT interval prolongation and torsades de pointes, a specific, rare heart rhythm abnormality. Information has also been added regarding the results of a clinical QT study which showed that azithromycin can prolong the QTc interval."

"Health care professionals should consider the risk of fatal heart rhythms with azithromycin when considering treatment options for patients who are already at risk for cardiovascular events (see Additional Information for Health Care Professionals below).  FDA notes that the potential risk of QT prolongation with azithromycin should be placed in appropriate context when choosing an antibacterial drug: Alternative drugs in the macrolide class, or non-macrolides such as the fluoroquinolones, also have the potential for QT prolongation or other significant side effects that should be considered when choosing an antibacterial drug".

I'm saying without a doubt that this medication is causing my issues.  I think I may have had issues before the drug that could have just been intensified.  When I listen to my heart when I move, it's quite alarming.  

I don't know why I think it's not working.  I guess I just figured that it would have gotten rid of whatever respiratory infection I have, but maybe it's not even a bacterial infection.  I've just never had much luck with this class of antibiotics in the past, they never seem to do anything.

1763947 tn?1334055319

I was on it and went off after that warning.

My dad died at age 53 from a heart attack so my LLMD and I made that decision.
Avatar universal
Ephedra---- I like it that you're researching for yourself. Keep it up!

In my long history of reading medical abstracts/articles I've learned to be a bit suspicious about claims (from the manufacturer AND doctors) that a drug is 'generally well-regarded'; 'has very few side effects'; and my favorite----  'rare'. I did an exhaustive search last year on what, exactly, did 'rare' mean when applied to a disease or drug.  There IS no normal 'rare'. It can mean what the manufacturer or writer or doctor etc wants it to mean.

Here's a bit more---- you may have already seen it---- but others may benefit from reading it.

"FDA Warns of Arrhythmias with Azithromycin
By John Gever, Senior Editor, MedPage Today

Published: March 12, 2013

FDA Warns of Arrhythmias with Azithromycin
By John Gever, Senior Editor, MedPage Today

Published: March 12, 2013

SILVER SPRING, Md. -- Patients with certain risk factors may be subject to life-threatening cardiac arrhythmias when taking azithromycin (Zithromax, Zmax), the FDA said Tuesday.

Existing QT prolongation, bradycardia, and low blood levels of magnesium or potassium are among the risk factors associated with the threat, according to an FDA drug safety communication posted on the agency's website.

In such patients, the drug may exacerbate QT prolongation and lead to torsades de pointes, a potentially lethal form of arrhythmia."

When the warnings about Zith and heart problems first came out (before 2013, btw) I had my heart checked for QT prolongation. It was 'normal'.  My Mg and K was 'normal' also.

But when I was put on another course of Zith and I started having some heart ''thumpies'' I went off  of Zith right away and notified my LLMD that I did and the reason why. He said I'd done the right thing.

It's obvious that many people take Zith and never have a problem.

There are so many back-room negotiations with any drug it would be hard for anyone on the outside to know just what is going on.
Here is a site that has an opposing viewpoint on---- which I always try to read before taking 'sides'.


At the end of the day though----- I won't take Zith.  Although Lyme might kill me eventually that's not likely. But a heart problem? Gone in a second. (grin)
4451049 tn?1387153437
Thanks everyone!    

It helps so much to have other points of view.  Surely my Dr knows about this warning, though I don't really know if she does or not.  The first thing I thought was, why would I be put on something like Zithromax when there are so many other great and less dangerous antibiotics to choose from?

I've discontinued the medication, now I just hope my heart rythym will go back to normal.  Your right cave, that's what I was thinking when I stumbled across the warning, the heart is one organ I can take chances with.  I could be gone in a split second and my kids would be devastated.  I'm glad I did the research.  I just wonder why I wasn't at least warned of this.  I know heart problems run in my family, so I'd have to be careful with a warning like that.  

I could tell just by reading the warning and reviews that this isn't something I would consider rare.  
1763947 tn?1334055319
Ironically, I seem to get every side effect of a medicine there is. For example Levaquin for Barts. I got the very rare side effect of developing tendonitis. Not willing to take the chance with my heart.
Avatar universal
" I just wonder why I wasn't at least warned of this. "

When you filled out your history, when first seen by this doctor, was there a box to check off asking if you or family had history of heart disease? Usually there is.

If there was, this history of familial heart disease should have been flagged on your chart so he would know this before he rx'd Zith. A prudent doctor would.

Let us know if your arrhythmias go back to normal. Then, perhaps have the QT prolongation test performed?
Avatar universal
Every medication, and indeed everything you put in your body, has the potential to harm for all kinds of reasons.  Riding in a car can kill you if it crashes, but we're not banning cars.  There is always a risk/reward balance with everything.  

It is the responsible and necessary thing for drug companies and others to notify the authorities and the public if a new risk is found in the use of a medication, often a risk that didn't show up in early testing and early use.

When used by a large population, however, there are many more data points, and if the adverse results in the larger population show a trend that wasn't evident in the smaller test population, then it is the right (and required) thing to do to notify the medical community and the public.

It doesn't mean the drug is bad or useless or will harm everyone who takes it.  It means that with more experience in the population, trends are seen that were not noticeable in smaller user groups.

I can understand why you would want to stop taking something that has a bad report come out.  There is a risk in stopping medication, however -- it can give the weakened bacteria a chance to survive and reproduce and be immune to the action of that drug ... which can makes the drug eventually useless for not only you, but for everyone, if the surviving strains are no longer susceptible to that drug.  

I would always check with my MD before stopping antibiotics.
Avatar universal
" With the "Z-Pak", this means two 250-mg tablets (a total of 500 mg) on the first day and one 250-mg tablet once daily for the next four days."

" 500-mg tablets are commonly available commercially in a pack of three tablets, or "Tri-Pak,"

"Azithromycin is commonly administered in tablet or oral suspension (a one-dose version was made available in 2005)"
[Often given when someone has had unprotected sex and fears an STD]

Looks like Zithromax can be given in short courses with no danger of antibiotic resistance.
Avatar universal
"Looks like Zithromax can be given in short courses with no danger of antibiotic resistance."

On what do you base that conclusion?  That the dosing schedule is only a few days in some situations?  

Different ailments call for different treatment times even if the same antibiotic is used, due to the susceptibility  particular of the bacteria to that particular antibiotic.  Susceptibility of a particular strain of bacteria is based partly on the length of its reproductive cycle, because it is when dividing that bacteria are most susceptible to antibiotics.  

Azithomycin/Zithromax may be given for a week for an ear infection, but is given for months in the case of Lyme, because Lyme bacteria have a very slow reproductive cycle, compared to the usual bacteria involved in an ear infection.

Failing to take the full dose for the full length of time prescribed risks treatment failure and creation of antibiotic-resistant strains of bacteria which were merely weakened rather than killed, allowing them to flourish rather than die.

If you are driving from California to Florida, you will be in the car for several days.  If you are driving from California to Nevada, you will be in the car for several hours.  If you stop driving after several hours, you will not get to Florida, because it requires travelling a greater distance.  That's just the way it works.  Ditto meds.
4451049 tn?1387153437
Cave, there was a family history section that I honestly filled out at the beginning.   And yes, there should have clearly been red flags.  It didn't specifically ask if I have a family history of heart disease though.  

Your right Jackie, I didn't want to quit the medication because I know how bacteria become immune.  However, it got to the point that I thought my life was seriously in danger.  I couldn't walk without the feeling of my heart going erratic and feeling like I was going to puke and collapse.  My bp was high.  I think I'm a little better today, but I haven't been moving around much either.  Nobody would be around to help had I collapsed.  

Drs are sometimes hard to get ahold of and most of them don't really know what they are doing anyhow.  Maybe I'm just paranoid, but I'm not going to allow anyone to be in charge of my life.  And for the same reason, I won't get in a vehicle when someone else is driving.  I think maybe it's the fear of being in a vegetative state more than it is the fear of death.  

I really really didn't want to stop taking it, but what would you have done if you were in this situation?  

Thanks everyone :)
Avatar universal
I sent you a 'private message' through this system ...  the gist of it being to be careful and check with the doc if you are having symptoms that feel like more than they ought to be.  Take care --
Avatar universal
Ephedra said:

" It didn't specifically ask if I have a family history of heart disease though. "

That's odd, since, as far as I can remember, that has always always been on my med. histories. When I was a dental hygienist it was even on the intake history in my dental office and then the med hist. (not just the heart)  rechecked each time the patient came in!

There are other antibiotics that can help you. I can't begin to think what caused the severe reaction you had; Herx? Allergic reaction? Heart problems? But I  do think you did the right thing and I would have done the same thing.

I assume you've had other 'herxes'---- did any of them affect you like that?
Avatar universal
Jackie, you asked:
"Looks like Zithromax can be given in short courses with no danger of antibiotic resistance."

On what do you base that conclusion?  That the dosing schedule is only a few days in some situations?  "

I based that conclusion from Pfizer's (the manufacturer) site about Zithromax:

-----And from hundreds of other places, some personal accounts and some other valid sources. Wiki was one, but I usually go to their citations to find their sources.

Here's what Pfizer had to say:


Infection* Recommended Dose/Duration of Therapy

*Community-aquired pneumonia (mild severity)
*Pharyngitis/tonsillitis (second line therapy)
*Skin/skin structure (uncomplicated)

500 mg as a single dose on Day 1, followed
by 250 mg once daily on Days 2 through 5.

*Acute bacterial exacerbations of chronic
obstructive pulmonary disease (mild to moderate)

500 mg QD x 3 days
500 mg as a single dose on Day 1, followed
by 250 mg once daily on Days 2 through 5.

*Acute bacterial sinusitis 500 mg QD x 3 days

*Genital ulcer disease (chancroid) One single 1 gram dose

*Non-gonoccocal urethritis and cervicitis One single 1 gram dose

*Gonococcal urethritis and cervicitis One single 2 gram dose


One gram = 2 of the 500mg Zithromax tablets

I did find your explanation about antibiotic resistance interesting and could be right on the mark considering the long replication time of Bb.

I haven't had the time to think about how pulsing antibiotics (which has been promoted by many doctors but also decried by others) factors into the 'resistance' arena.

Dr J, the famous llmd in D.C. whose treatment protocol includes pulsing, said this:

" we have concluded that a treatment protocol employing long-term cyclic, pulse therapy with drugs effective against all forms of the organism might be effective"

I won't give the link because his name is on it.

Do you have an explanation for pulsing being safe?

Avatar universal
No, and my doc didn't 'pulse.'
4451049 tn?1387153437
Thanks cave!  

Yea I know it does seem like that question is specifically asked a lot, but I can't say I have much of a medical history to compare. So I don't really know.  I can definitely understand why that would be so important for a dental office to know though.  

My BP was checked in the office and it was prehypertension then, so IDK if that should have been a red flag or not.  

No, I can't say for certain that I have had other herxes.  I think that's what makes it so much more confusing.  We don't even know if I have Lyme and/or cos yet, so I've been trying to decipher and I really can't tell.  
Avatar universal
"No, and my doc didn't 'pulse.'"

My llmd didn't pulse either. I just thought you might have some thoughts on pulsing. If you ever do, would you post them, please?
Avatar universal
Never really looked into pulsing.  The concern about killing the weakling bacteria and letting the stronger ones survive to become antibiotic-resistant is what makes me skeptical.  And the full frontal assault on the bacteria worked for me, so I didn't need to pursue other approaches.
Avatar universal
It's good to be skeptical. I am. But because I'm skeptical I rarely believe in  any one er, um belief or stance. Doctrinairism is too, er, um, constricting. (grin)

Hassler, 199145 -reported on two patients with antibiotic resistant Lyme disease that were treated with pulsed high-dose cefataxime with 2 days of treatment followed by 6 days without antibiotics over a ten-week period of time. One patient was symptom-free 6 months after antibiotic treatment, the other was improved and skin biopsies showed no evidence of Borrelia."

Some doctors maintain that pulsing with antibiotics (often IV but also often oral) BECAUSE of the slow growing nature of Bb will provide the patient with the same efficacy as the continuous taking of antibiotics; that not coninually 'blasting' us with antibiotis kinder and  yet still accomplishes as much.

Dr David Martz pulsed repeat bouts of antibiotic/antibabesial therapy after continuous tx before. He's the doctor who was given an ALS dx but then went on to treat for Lyme (with the help of his colleague, Dr. Harvey in CO.)

Other doctors don't follow that thinking. But----- what can WE think when experts exist on both sides?
Avatar universal
Perhaps if the full-on approach doesn't work, even if using cystbusters to break through the biofilm, then pulsing may have an effect, but I don't know on what basis.  Full-on worked for me, so I didn't explore pulsing.
4451049 tn?1387153437
I thought pulsing sounds interesting and something that may be very effective, but it'd probably have to be done right for it to work.  
Avatar universal
I took it orally and IV- did OK for 2 years then relapsed badly. It might have drove it temporarily into cyst form or it missed the ones encased in biofilms
Avatar universal
Was the azithromycin paired with something like Flagyl/metroniazole?  Without Flagyl etc. to break through the cysts the bacteria hide in, the 'zith' isn't able to reach the bacteria.
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