E.E.S. Granules Oral

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of erythromycin in children.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of erythromycin in the elderly. However, elderly patients are more likely to have erythromycin-induced hearing loss, heart rhythm problems, and bleeding problems.

Pregnancy

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Amifampridine
• Amisulpride
• Astemizole
• Bepridil
• Cisapride
• Colchicine
• Dihydroergotamine
• Dronedarone
• Ergoloid Mesylates
• Ergonovine
• Ergotamine
• Flibanserin
• Fluconazole
• Grepafloxacin
• Levomethadyl
• Lomitapide
• Lovastatin
• Mesoridazine
• Methylergonovine
• Methysergide
• Pimozide
• Piperaquine
• Posaconazole
• Saquinavir
• Simvastatin
• Sparfloxacin
• Terfenadine
• Thioridazine
• Ziprasidone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acecainide
• Afatinib
• Ajmaline
• Amiodarone
• Amitriptyline
• Amoxapine
• Anagrelide
• Apixaban
• Apomorphine
• Aprepitant
• Aprindine
• Aripiprazole
• Aripiprazole Lauroxil
• Arsenic Trioxide
• Asenapine
• Atorvastatin
• Azimilide
• Azithromycin
• Bedaquiline
• Bosutinib
• Bretylium
• Brexpiprazole
• Buserelin
• Carbamazepine
• Ceritinib
• Cerivastatin
• Chloral Hydrate
• Chloroquine
• Chlorpromazine
• Cholera Vaccine, Live
• Cilostazol
• Ciprofloxacin
• Citalopram
• Clarithromycin
• Clindamycin
• Clomipramine
• Clozapine
• Cobicistat
• Cobimetinib
• Conivaptan
• Crizotinib
• Cyclobenzaprine
• Dabrafenib
• Darunavir
• Dasatinib
• Deflazacort
• Degarelix
• Delamanid
• Desipramine
• Deslorelin
• Deutetrabenazine
• Dibenzepin
• Digoxin
• Diltiazem
• Disopyramide
• Dofetilide
• Dolasetron
• Domperidone
• Donepezil
• Doxepin
• Doxorubicin
• Doxorubicin Hydrochloride Liposome
• Droperidol
• Efavirenz
• Eliglustat
• Encainide
• Enflurane
• Eplerenone
• Escitalopram
• Fingolimod
• Flecainide
• Fluoxetine
• Fosaprepitant
• Foscarnet
• Gatifloxacin
• Gemifloxacin
• Gonadorelin
• Goserelin
• Granisetron
• Halofantrine
• Haloperidol
• Halothane
• Histrelin
• Hydrocodone
• Hydroquinidine
• Hydroxychloroquine
• Hydroxyzine
• Ibrutinib
• Ibutilide
• Idelalisib
• Ifosfamide
• Iloperidone
• Imipramine
• Isoflurane
• Isradipine
• Ivabradine
• Ivacaftor
• Ketoconazole
• Lapatinib
• Leuprolide
• Levofloxacin
• Lidoflazine
• Lopinavir
• Lorcainide
• Lumacaftor
• Lumefantrine
• Lurasidone
• Mefloquine
• Methadone
• Metronidazole
• Mifepristone
• Morphine
• Morphine Sulfate Liposome
• Moxifloxacin
• Nafarelin
• Naloxegol
• Netupitant
• Nilotinib
• Norfloxacin
• Nortriptyline
• Octreotide
• Ofloxacin
• Olaparib
• Ondansetron
• Oxycodone
• Paliperidone
• Panobinostat
• Pasireotide
• Pazopanib
• Pentamidine
• Pimavanserin
• Pirmenol
• Pitavastatin
• Pitolisant
• Pixantrone
• Prajmaline
• Probucol
• Procainamide
• Prochlorperazine
• Promethazine
• Propafenone
• Protriptyline
• Quetiapine
• Quinidine
• Quinine
• Ranolazine
• Ribociclib
• Risperidone
• Sematilide
• Sertindole
• Sevoflurane
• Simeprevir
• Sodium Phosphate
• Sodium Phosphate, Dibasic
• Sodium Phosphate, Monobasic
• Solifenacin
• Sonidegib
• Sorafenib
• Sotalol
• Spiramycin
• Sulfamethoxazole
• Sulpiride
• Sultopride
• Sunitinib
• Tacrolimus
• Tadalafil
• Tedisamil
• Telaprevir
• Telavancin
• Telithromycin
• Tetrabenazine
• Theophylline
• Tizanidine
• Tolvaptan
• Topotecan
• Toremifene
• Trazodone
• Trifluoperazine
• Trimethoprim
• Trimipramine
• Triptorelin
• Troleandomycin
• Vandetanib
• Vardenafil
• Vasopressin
• Vemurafenib
• Venetoclax
• Verapamil
• Vinblastine
• Vincristine
• Vincristine Sulfate Liposome
• Vinflunine
• Voriconazole
• Warfarin
• Zolmitriptan
• Zotepine
• Zuclopenthixol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Alfentanil
• Alprazolam
• Anisindione
• Avanafil
• Bexarotene
• Budesonide
• Buspirone
• Cyclosporine
• Diazepam
• Dicumarol
• Methylprednisolone
• Midazolam
• Phenprocoumon
• Roflumilast
• Salmeterol
• Sildenafil
• Sirolimus
• Suvorexant
• Tolterodine
• Triazolam
• Trimetrexate
• Valproic Acid
• Zafirlukast

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Bradycardia (slow heartbeat) or
• Heart rhythm problems (e.g., QT prolongation) or
• Hypokalemia (low potassium in the blood), uncorrected or
• Hypomagnesemia (low magnesium in the blood), uncorrected—Use is not recommended in patients with these conditions.

• Congestive heart failure—The granules and tablet dosage forms of this medicine contains sodium, which can make this condition worse.

• Elevated liver enzymes or
• Liver disease (including cholestatic hepatitis) or
• Myasthenia gravis (severe muscle weakness)—Use with caution. May make these conditions worse.

Nausea, vomiting, diarrhea, stomach pain/cramping, and loss of appetite may occur. Taking this medication with food may lessen these symptoms. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: signs of liver disease (such as persistent nausea/vomiting, yellowing eyes or skin, dark urine, severe stomach/abdominal pain), unusual tiredness, muscle weakness, slurred speech, blurred vision, drooping eyelids, hearing loss.

Get medical help right away if you have any very serious side effects, including: severe dizziness, fainting, fast/irregular heartbeat.

This medication may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a type of resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: persistent diarrhea, abdominal or stomach pain/cramping, blood/mucus in your stool.

Do not use anti-diarrhea products or narcotic pain medications if you have any of these symptoms because these products may make them worse.

Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge or other new symptoms.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Before taking erythromycin, tell your doctor or pharmacist if you are allergic to it; or to other macrolide antibiotics (such as azithromycin, clarithromycin); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, a certain type of muscle disease (myasthenia gravis).

Erythromycin may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using erythromycin, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using erythromycin safely.

Erythromycin may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Some erythromycin products may contain sodium. Ask your doctor or pharmacist for more information if you are on a salt-restricted diet or if you have a condition such as congestive heart failure that could be worsened by an increase in salt intake.

Older adults may be more sensitive to the side effects of this drug, especially hearing loss and QT prolongation (see above).

Infants may be more sensitive to the side effects of this drug, especially an uncommon stomach problem called IHPS (infantile hypertrophic pyloric stenosis). Tell your child's doctor right away if your child has persistent vomiting or increased irritability with feeding.

Tell your doctor if you are pregnant before using this medication.

This medication passes into breast milk. Consult your doctor before breast-feeding.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include: clindamycin, digoxin.

Many drugs besides erythromycin may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, cisapride, pimozide, procainamide, propafenone, quinidine, sotalol, among others.

Other medications can affect the removal of erythromycin from your body, which may affect how erythromycin works. Examples include azole antifungals (such as itraconazole, ketoconazole), certain calcium channel blockers (such as diltiazem, verapamil), certain anti-seizure medications (such as carbamazepine, phenytoin), quinupristin-dalfopristin, among others.

Erythromycin can slow down the removal of other drugs from your body, which may affect how they work. Examples of affected drugs include bromocriptine, colchicine, certain benzodiazepines (such as midazolam, triazolam), eletriptan, ergot alkaloids (such as ergotamine, dihydroergotamine), certain drugs to treat erectile dysfunction-ED or pulmonary hypertension (such as sildenafil, tadalafil), certain "statin" drugs (such as lovastatin, simvastatin), vinblastine, among others.

Although most antibiotics are unlikely to affect hormonal birth control such as pills, patch, or ring, a few antibiotics (such as rifampin, rifabutin) can decrease their effectiveness. This could result in pregnancy. If you use hormonal birth control, ask your doctor or pharmacist for more details.

This medication may interfere with certain laboratory tests (urine tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Erythromycin is a macrolide antibiotic. Erythromycin fights bacteria in the body.

Erythromycin is used to treat or prevent many different types of infections caused by bacteria.

Erythromycin may also be used for purposes not listed in this medication guide.

You should not take erythromycin if you are allergic to it.

Some medicines can cause unwanted or dangerous effects when used with erythromycin. Your doctor may need to change your treatment plan if you use any of the following drugs:

• cisapride;

• pimozide;

• ergotamine; or

• dihydroergotamine.

To make sure erythromycin is safe for you, tell your doctor if you have:

• liver or kidney disease;

• myasthenia gravis;

• a heart rhythm disorder;

• an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

• a history of Long QT syndrome; or

• if you take medicine to treat a heart rhythm disorder.

FDA pregnancy category B. Erythromycin is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Erythromycin can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Do not give this medicine to a child without a doctor's advice.

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

If a child is using this medicine, tell your doctor if the child has any changes in weight. Erythromycin doses are based on weight in children.

Do not crush, chew, or break a delayed-release capsule or tablet. Swallow it whole.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Erythromycin will not treat a viral infection such as the common cold or flu.

This medicine can cause unusual results with certain lab tests of the urine. Tell any doctor who treats you that you are using erythromycin.

Store at room temperature away from moisture, heat, and light.

You may need to store liquid medicine in a refrigerator. Carefully follow the storage directions on your medicine label. Liquid medicine expires after a short period of time. Throw away any unused liquid as directed.

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.