What is the optimal prokinetic dose of erythromycin in adults?

This updated Medicines Q&A evaluates the available evidence for the use of erythromycin as a prokinetic agent in adults

Summary

  • The ideal prokinetic dose of erythromycin is yet to be established but is less than the maximal antibacterial dose of erythromycin.
  • There is not a standard regimen for erythromycin when used as a prokinetic agent and it is unlicensed for this indication.
  • With intravenous erythromycin, the BNF provides a dose of 3mg/Kg three times a day. Satisfactory outcomes have also been achieved with doses of 300 to 400mg daily in divided doses, with 250mg four times a day, and with single doses of 70mg and 200mg.
  • Oral erythromycin has been used effectively as a prokinetic at doses from 50mg three times daily up to 500mg four times daily. The BNF provides a dose of 250 to 500mg three times a day.
  • Short-term use (up to 4 weeks) is recommended. Prolonged therapy can result in down-regulation of motilin receptors resulting in tachyphylaxis.
  • When prescribing erythromycin as a prokinetic, consideration should be given to its potential to interact with other drugs, and the possibility of cardiovascular complications. It has been suggested that the use of lower doses may be as effective as higher doses and reduce the risk of tachyphylaxis, although these concepts require further study.

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