Hydroxychloroquine and Azithromycin.

[Biddy47]

Hi everyone, I would just like to have your thoughts on the following.....I was diagnosed with Cutaneous Lupus an Sjogren's Syndrome 8yrs. ago. I was prescribed Hydroxychloroquine 200mg.

I also have Bronchiectasis, which is a lung disease and recently have had breathing problems. To cut a long story short my chest consultant has suggested that I start on a course of Azithromycin for 1 month to reduce the inflammation that I have but I would have to stop taking the Hydroxy because of the drug interactions.

Would be interested in what you think.

Thanks.

[Spanielmadlady]

Hi Biddy. I take both and have done for a few years.i take azithromycin prophylacticly 3 x a week for lung issues. The MHRA issued a safety warning about taking both together saying there was an increase in heart issues. My rheumy reduced my hcq to the days when I don't take azIthromycin so im not taking them both at the same time. I'm currently flaring and my rheumy is seeking advice from respiratory about changing the azthromycin to something else so he can increase my hcq again. Kind regards SML xx

[Biddy47 in reply to Spanielmadlady]

Thanks for the info. Spanielmadlady, that sounds like an interesting alternative.

[Spanielmadlady in reply to Biddy47]

I was originally diagnosed with bronchiectasis but now the general concensus is the lupus is to blame.im prone to pleurisy and pneumonia. Ive taken the azithromycin and hcq for about 5 years x

[KnitSewPurl in reply to Spanielmadlady]

Do you know when was this safety net was issued? Because I have been on this drug for many years . Now there has not been any issues of me taking them.

[Spanielmadlady in reply to KnitSewPurl]

If i remember correctly it was march last year. X

The product information for hydroxychloroquine and chloroquine already contains warnings about cases of cardiomyopathy resulting in cardiac failure, in some cases with fatal outcome. Clinical monitoring for signs and symptoms of cardiomyopathy is advised for patients taking hydroxychloroquine or long-term chloroquine. If signs and symptoms of cardiomyopathy occur during treatment with either hydroxychloroquine or chloroquine, then treatment should be stopped.

Evidence suggests both hydroxychloroquine and chloroquine can prolong the QT interval, especially in overdose or when used in combination with other medicines with the potential to induce cardiac arrhythmias. Warnings are also in place across the product information for azithromycin, clarithromycin, and erythromycin to use caution in patients with a history of QT interval prolongation or in patients receiving a medicine known to cause QT prolongation.

an observational study has shown that co-administration of azithromycin with hydroxychloroquine in patients with rheumatoid arthritis is associated with an increased risk of cardiovascular events (including angina or chest pain and heart failure) and cardiovascular mortality.15 Feb 2022

gov.uk › hydroxychlor...

Hydroxychloroquine, chloroquine: increased risk of cardiovascular ..

[KnitSewPurl in reply to Spanielmadlady]

Ok what it means is if you have in the Hydroxchoriquine bit cardiomyopathy is just a precautionary advisory for those on Hydroxchoriquine. As for the Hydroxchoriquine it is definitely if the patient is a cardiac patient then they will have to consider alternative meds.

And the Azithromycin- you do need to do an ECG prior to commencing the drug it is the only way they can find out if you have a cardiac condition then yes they will have to reconsider the medication you take ie, changing the Azithromycin to an alternative antibiotics.

Whether or not you are on Hydroxchoriquine or not .

Azithromycin you need to have an ECG before starting the drug

[Betty909090]

Azithromycin is actually an antibiotic not an anti inflammatory ? drug:

nhs.uk/medicines/azithromyc...

nhs.uk/medicines/azithromyc...

[Suvi8901 in reply to Betty909090]

Hi,

Just wondering but in view of preventing “antibiotic resistance “ should Azithromycin be prescribed long term? Or does this concept not apply to patients with constant lung infections?

[KnitSewPurl in reply to Suvi8901]

I raised this question to my consultant before commencing this drug along time ago as I knew I will be on it for a long time. Azithromycin protocol you are supposed to be on it in the winter months then come off it one the summer months to help the meds not get too Dependent to the body. So this is actually ok. Even with this protocol I was ok with it.no problems.

Since Covid happened I have been on continuous antibiotics now for 2 years . No chest infection. Or colds .

Before I when on the Azithromycin regime I was on a different regime it was a 3 different type of antibiotics regime it was quite a complex regime . It was a rotational every 2 weeks I change antibiotics. So I am not on the same antibiotics. I was on that regime for 6 months. Yes I was sceptical at first whether it would work at that time Azithromycin then was a new drug on the market that just came out. There was no report on how well it worked on people with brochiatisis. So yes , glad it worked out well for me then and now.

[KnitSewPurl]

Hi Biddy 47,I have been on Hydroxchoriquine and Azithromycin- for many years following after a course of regime of 3 different antibiotics in rotation for my bronchiachitis. I have never been told to come off my Hydroxchoriquine. Let just say there is no advisory any where in the BNF any where to say that you should come off it .Azithromycin is an antibiotic to help your chest. Hydroxchoriquine is for your SLE. There is nothing in the leaflet that says any thing contradictory . Unless he can prove that other wise. I have always taken my Hydroxchoriquine at night . And the Azithromycin- in the morning. X3 a week. Come off in the summer and go back on again in the winter . Since being on it I had not had a chest infection . It has been a long time.

Before you go on to it you will need to have an ECG done to check you heart . To make sure all is ok before commencing it . As Azithromycin- is known to effect the heart. So those with any form of cardiac issues will not be able to take it.

Spanialmadlady said about safely warning when was this safety warning issued??

[Biddy47 in reply to KnitSewPurl]

Thanks for your input KnitSewPurl and Thanks to everyone who answered my questions, it has been very helpful.xx

[Dottie11 in reply to Biddy47]

Azithromycin is an antibiotic with good anti inflammatory properties. I too have Sjogrens , Bronchectasis and under Immunology for Pan hypogammaglobuanemia. I take Azithromycin in Winter. Low dose Hydroxycloroquine. ECG before started . The idea is low as can on my Hydroxy but also find a balance between drug warnings and manage conditions well. I think they call it the trade off. These decisions made by my Consuntants. Hope that helps a bit.

[Svete]

Hi Biddy47. From my personal experience when I was given azythromycin for the cough I had my pulse rate up to 170 and lost my heart rhythm since then I'm under a cardiology team. I believe that combining these two drugs caused my current heart problem.

[Biddy47 in reply to Svete]

Thanks Svete. I have been treated for tachycardia in the past and take bisoprolol for it I also take medication for high blood pressure. I have had and ECG and it has been fine. I have taken Azithromycin in the past along with Hydroxychloroquine and have had no problems. It seems to be my age (76) that has changed his mind in prescribing both together.