Spiramycin

Spiramycin, like other macrolides, should be used with caution in patients receiving drugs known to prolong the QT interval (e.g. Class IA and III antiarrhythmics, tricyclic antidepressants, some antiinfectives, some antipsychotics).

Caution should be exercised when using spiramycin, in patients with known risk factors for prolongation of the QT interval such as:

• uncorrected electrolyte imbalance (e.g. hypokalemia, hypomagnesemia).
• congenital long QT syndrome.
• cardiac disease (e.g. heart failure, myocardial infarction, bradycardia).
• concomitant use of drugs that are known to prolong the QT interval (e.g. Class IA and III antiarrhythmics, tricyclic antidepressants, some anti-infectives, some antipsychotics).

Elderly patients, neonates and women may be more sensitive to QTc-prolonging effect.

Inhibition of carbidopa absorption with decreased plasma concentrations of levodopa. Clinical monitoring and possible adjustment of levodopa dosage, if required.

Very rare cases of hemolytic anemia have been reported in patients with glucose-6-phosphatedehydrogenase deficiency. Spiramycin is therefore not recommended for such patients.

Spiramycin can be used during pregnancy if necessary. Extensive use of spiramycin during pregnancy has shown no evidence of malformation or fetotoxicity to date.

Spiramycin is excreted into breast milk. Gastrointestinal disorders in neonates have been reported. Consequently, breast-feeding is not recommended to women taking spiramycin.

Not relevant.