The main problem due to interactions
between some macrolides and the cytochrome
P 450 system, especially the CYP3A subclass of enzymes
Finally results in lowered metabolism of CYP3A-dependent
drugs
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drug azi clari diri ery josa mid roxi spira
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thιophyllin 0 0 0 ++ + ND 0/+
0
ciclosporin ND ND ND +++ +++ +++ + 0
carbamazepin ND 0/+ ND +++ + + 0/+ 0/+
midazolam 0 ++ ND ++ ND ND + ND
warfarin 0 ND ND + ND ND 0 ND
terfenadin 0 ++ ND +++ 0/+ ND 0 ND
cisapride ND ++ ND ++ ++ ND ND 0
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From Petitjean et al. N=undocumented
Mainly considered as a class-effect,
resulting from what is known for erythromycin, except for spira and azithromycin