Azithromycin (Z-pack)

Azithromycin (Zithromax Z-pack) is a pre-packaged form of a macrolide antibacterial Azithromycin (brand name; Zithromax or Zmax). Zithromax should only be used in mild to moderate infections that are strongly suspected or proven when culture information is available to be caused by susceptible bacteria, e.g., Chlamydia trachomatis. 

Macrolide antibiotic drug is a class of antibiotics that include Erythromycin, Biaxin, Clarithromycin, Ery-Tab.

Indications for Zithromax:
  1. Non-gonococcal cervicitis and urethritis due to Chlamydia trachomatis
  2. Prophylaxis of disseminated avian complex (MAC) disease
     in person with advanced HIV infection
Zithromax - tablet
Active ingredient is Azithromycin Dihydrate 600 mg in 1 tablet
Inactive ingredients:
  • Sodium croscarmellose
  • Magnesium stearate
  • Dibasic calcium phosphate anhydrous
  • An aqueous film coat consisting of hypromellose
  • Titanium dioxide
  • Lactose
  • Triacetin 
  • Pregelatinized starch 
  • Sodium lauryl sulfate
Zithromax - Oral suspension
Active ingredient is 1 gm Azithromycin Dihydrate in a single-dose package of 5ml
Inactive ingredients:
  • Colloidal silicon dioxide
  • Sodium phosphate tribasic
  • Dried artificial banana flavor
  • Dried artificial cherry flavor
  • Sucrose

In March 2013, FDA issued a warning concerning a potential risk of Azithromycin (Zithromax or Zmax).  Azithromycin can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm. Patients who are at high risk of developing this condition include those with the conditions stated below:
  • QT interval prolongation
  • Low blood levels of magnesium
  • Low blood levels of potassium
  • Slow heart rate   
  • Using certain drugs to treat abnormal heart rhythms
  • Arrhythmias
On May 17, 2012, FDA released a Statement about a study that compared the risks of cardiovascular death in patients treated with the antibacterial drugs Azithromycin, Amoxicillin, Ciprofloxacin (Cipro), and Levofloxacin (Levaquin), or no antibacterial drug. 

The result of this study showed an increase in cardiovascular deaths and in the risk of death in patients treated with a 5-day course of Azithromycin (Zithromax) and Levofloxacin compared to persons treated with Amoxicillin, Ciprofloxacin, or no drug.

Side effects reported in adults and pediatric patients include:
  1. Angioedema (deep skin layer hives-liked)
  2. Arthralgia (joint pain)
  3. Cholestatic jaundice
  4. Nausea, vomiting, diarrhea
  5. Abdominal pain
  6. Chest pain
  7. Palpitation (irregular/forceful beating of the heart)
  8. Dyspepsia (indigestion)
  9. Flatulence (excessive gas in the intestinal tract)
  10. Melena (stool or vomit that is black due to blood pigment)
  11. Vaginitis
  12. Nephritis (inflammation of the kidney)
  13. Dizziness, headache, vertigo, convulsion
  14. Semnolence (sleepiness)
  15. Rash
  16. Photosensitivity
  17. Arthralgia (joint pain)
  18. Urticaria (hives)
  19. Arrhythmias
  20. Tachycardia (rapid heart rate greater than 100 beats)
  21. Hypotension
  22. Anorexia (an eating disorder, markedly reduce appetite
  23. Constipation
  24. Pseudomembranous colitis (severe inflammation of the inner lining of the colon)
  25. Pancreatitis
  26. Oral candidiasis
  27. Pyloric stenosis (narrowing passage between the stomach and duodenum)
  28. Tongue discoloration
  29. Asthenia (weakness, lack of energy and strength)
  30. Paresthesia (numbness, tingling, burning sensation)
  31. Anaphylaxis (allergic reaction)
  32. Thrombocytopenia (low platelets count)
  33. Hepatic necrosis (death of liver cells or tissues)
  34. Hepatic failure
  35. Nervousness, agitation
  36. Syncope (partial or complete loss of consciousness)
  37. Anxiety and aggressive reaction
  38. Pruritus (itching)
  39. Erythema multiforme
  40. Stevens-Johnson syndrome
  41. Toxic epidermal necrolysis
  42. Hearing loss, deafness, tinnitus

Before taking this pharmaceutical, consider the potential benefits and risks to other alternative options.

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