Side effects
The most important side effects of the macrolides are the effects on the liver. Therapy with macrolides can lead to damage of liver cells. The higher the dose of the active substance, the more likely it is that this damage will occur.
This is mainly due to the fact that the macrolides are metabolised in the liver and are also excreted via the liver. This leads to an accumulation of the macrolides in the liver. Too high a level of active ingredients can become toxic for the liver cells and damage them.
Other side effects occur mainly in the heart. There, the so-called QT time is prolonged, which can lead to disturbances in the heart rhythm. Especially people with previous heart diseases should therefore only be treated carefully or not at all with macrolides.
Other side effects of macrolides are based on their effect against bacteria. For example, treatment with macrolides not only prevents bacteria that cause an infection from growing. The natural skin and intestinal flora, which also consists of bacteria, is also influenced by the macrolides. Therefore, the therapy can lead to side effects in the digestive tract such as nausea, vomiting, diarrhoea and also abdominal pain and cramps. The side effects on the skin often only become noticeable when the immune system is weakened.If the protective skin germs have been killed off by the macrolides, other pathogens such as fungi can adhere to the skin and cause fungal infections.
Interaction
Interactions between macrolides and other drugs can be attributed primarily to its effect on a specific enzyme in the liver metabolism. This is the enzyme CYP3A4, which plays a major role in the processing of many substances. The macrolides inhibit and slow down the action of CYP3A4.
This influences the metabolism of drugs such as statins (fat-lowering agents), steroids, the contraceptive pill, cortisone, immunosuppressants (drugs that down-regulate the immune system), psychotropic drugs (drugs used in psychological disorders) and many other substances. Some drugs are broken down faster than usual, others remain in the body for a particularly long time. Interactions with grapefruit juice can also be triggered by CYP3A4.
