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Antibiotics and Sudden Death?

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The New England Journal of Medicine (NEJM) published a provocative article this week titled "Azithromycin and the Risk of Cardiovascular Death." It stimulated dramatic headlines:

"Popular Antibiotic May Raise Risk of Sudden Death." New York Times, May 16, 2012

"Antibiotic Z-Pak may pose risk of sudden death." NBC Nightly News, May 17, 2011

"Could a common antibiotic increase risk of cardiac death?" WebMD, May 17, 2012

With such headlines, it is hardly any wonder there are a lot of confused patients and prescribers this weekend. Azithromycin (Z-Pak, Zithromax) is one of the most popular drugs in the pharmacy. At last count, more than 50 million prescriptions for it were dispensed from retail pharmacies last year. It is prescribed for lung infections, sinusitis, earaches, sore throats caused by strep, skin infections and urinary tract infections, to name just a few of the many uses for this broad-spectrum antibiotic.

How could such a useful drug be killing people?

A little-known fact is that the class of antibiotics called macrolides (including clarithromycin and erythromycin as well as azithromycin) can increase the risk for serious irregular heart rhythms and sudden cardiac death. These dangerous arrhythmias have been noted in the medical literature for more than a decade. For reasons that are not entirely clear to us, doctors thought that azithromycin did not share this class effect.

In the NEJM study, researchers analyzed data from more than 500,000 Medicaid patients in Tennessee. Patients who took azithromycin were compared to patients who took amoxicillin (a penicillin-type antibiotic) or ciprofloxacin or levofloxacin (fluoroquinolones) or no antibiotics. Those taking azithromycin were roughly two and a half times more likely to experience sudden cardiovascular death compared to those taking amoxicillin. Interestingly, deaths linked to levofloxacin (Levaquin) were comparable to deaths associated with azithromycin, suggesting that Levaquin might also pose a risk for serious irregular heart rhythms.

The absolute risk was relatively small: about 65 deaths attributed to azithromycin out of one million antibiotic treatments. There were 22 deaths out of a million courses of amoxicillin. The greatest risk was for patients with heart disease. That is to say, people with underlying heart rhythm problems, heart failure, clogged coronary arteries, stents or prior heart attacks were most likely to die while taking azithromycin.

Nevertheless, this study gives a glimpse at another secret that many health professionals prefer to keep under wraps: a surprising number of drugs can cause serious heart rhythm abnormalities. These arrhythmias can lead to stroke or sudden death. These medications are taken by tens of millions of Americans every day!

Let's start with NSAIDs (non-steroidal anti-inflammatory drugs). You can buy ibuprofen (Advil, Motrin IB, etc) and naproxen (Aleve) over the counter. Then there are the prescription strength NSAIDs that doctors prescribe:

celecoxib (Celebrex)
diclofenac (Cataflam, Voltaren)
etodolac (Lodine)
ibuprofen (Motrin)
indomethacin (Indocin)
ketorolac (Toradol)
naproxen (Anaprox, Naprosyn)
meloxicam (Mobic)
oxaprozin (Daypro)
piroxicam (Feldene)
sulindac (Clinoril)

Such drugs can cause atrial fibrillation or flutter (BMJ, online July 4, 2011). People don't always realize that they have such arrhythmias because symptoms may be subtle or nonexistent. Be on the lookout for lightheadedness, heart palpitations, chest pain or fainting. A potentially serious or even deadly consequence of these irregular heart rhythms is stroke.

The list of other medications that can cause serious heart rhythm irregularities is amazingly long. Here is just a partial list:

Amiodarone (Cordarone)
Astemizole (Hismanal)
Chloroquine (Aralen)
Chlorpromazine (Thorazine)
Citalopram (Celexa)
Dronedarone (Multaq)
Flecainide (Tambocor)
Haloperidol (Haldol)
Moxifloxacin (Avelox)
Probucol (Lorelco)
Procainamide (Pronestyl)
Quinidine (Cardioquin)
Sotalol (Betapace)
Thioridazine (Mellaril)

Of course, no one should EVER stop taking any medication without a doctor's supervision. Some of these drugs are so essential to health that stopping them would pose a far greater risk than any potential arrhythmia. Nevertheless, patients should always be warned about the possibility of drug-induced arrhythmias and told what symptoms to be alert for.

We fear that many physicians may fail to mention possible arrhythmias when they prescribe medications. We consider that a major oversight. To protect yourself and those you love, we suggest reading Top Screwups Doctors Make and How to Avoid Them. It provides questions, tips and checklists to help you prevent unanticipated but deadly drug reactions. You'll find a list of questions to ask any time you are handed a prescription.

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This is useful information as few patients read the exhaustive documentation included with most medications. Of particular note, I find most patients consider OTC NSAIDs as benign.

I think it would be worthwhile to point out, however, that a number of studies have indicated that Naproxen has minimal if any significant cardiac risk compared to other NSAIDs such as Diclofenac, however it does have significant other risk factors such as liver and renal which are worse than average.


Dear Dr. RKM,

Thanks for your thoughtful message above. You are quite right that when it comes to heart attacks and strokes naproxen seems (we emphasize seems because it is not yet guaranteed) safer than most other NSAIDs like ibuprofen or diclofenac. But when it comes to arrhythmias such as A-fib or flutter, however, we have not seen any evidence that naproxen is less likely to cause problems. If you have, please point us in the direction of some references.

Thanks again for taking time to share your thoughts on this critical issue.

I would like to hear more about this subject.

I am an unemployed nurse pratitioner and I am unemployed by choice. I graduated from the top rated nursing school in the US but, at the same time, had just enough knowledge gained while studying for my pHd from Clayton College, my studies as a Nutritional Therapist, my readings from Dr. Mercola, etc. to question what I was learning. I was in some of the same classes taught to MDs. One sports medicine lecturer, speaking before a class of 50, stated that a certain medication does not work but to prescribe it anyway because patients expect to leave the office with an Rx. No one was to question the use of vaccines in children, end of discussion. We were to accept that "days of nonstop crying" after an infant DTaP vaccine is normal and expected.

I did work as a functional medicine nurse practitioner and saw many patients damaged by medications. One in particular was in a wheelchair and had been for quite sometime and she will be for the remainder of her life. She had been on long term fluoroquinolones and her tendons had ruptured. I saw firsthand the damage caused by statins. I saw the damage caused by oral hypoglycemics.

As a student, I witnessed foster parents parading in 4,5,6 children into the clinic and lining them up for their psychotropics. These kids were zombies and had no free will. I recall one woman telling the physician she felt suicidal after starting on an SSRI. He made a joke about it and walked away. The so called "black box warnings" that come with psychotropics and other meds are often not getting to the patients and are often not mentioned in doctor/patient discussions.

Working in a functional medicine clinic was interesting but I saw how it has evolved into pushing supplements, hence corporate profits. I now am seeing it in animal medicine. Huge new veterinary clinics are springing up everywhere in my rural community, thanks to the push to medicate our pets with meds to control their behavior.

Until we return to our roots, reconnect to the earth, relearn plant medicine and respect for all living things, we will continue on this path that has already wreaked havoc on our health and the health of our planet. We must say no to the toxins that are destroying our food, our air and our water and we must say no to toxic drugs promoted in the name of profit.

I was listening this morning to your Saturday morning broadcast. Three years ago I had a hip replacement. Now, each time I see my dental hygienist, they demand that I take 2000 MG of Amoxicillin one hour before the appointment. Reluctantly I comply, however, this time it did not go well. I felt sick for three days afterwards and pushed myself to actually get up and get around. I felt weak and lethargic. It took awhile for me to make a connection to the drug.

I am very sensitive to medications and have been on 200 mg of Celebrex daily since the surgery and so far have had no reaction. So now I wonder if it is the combination of the two drugs that made me sick or was I overdosing myself with the antibiotic? Celebrex is the only prescription drug that I take on a regular basis. I think 2000 MG of an antibiotic is too much for me at one time. I am seventy four years old and in excellent health.

I just told my doctor this week that I wanted to stop taking Celebrex. Her reply was to just wait until after my hip replacement. I think I will go ahead and stop taking it now. I took it for several years and it didn't seem to help much, so I stopped it for about a year, then resumed taking it about six months ago.

I just do not want to live with the risk of the potential dangers of nsaids.

I have recovered from a heart attack. The doctor felt it necessary to give me an injection to prevent pneumonia. I have no idea as to the ingredients of a pneumonia shot. Are any of the medicines listed in the above article contained in a pneumonia shot? What should I tell my doctor if they are?

PEOPLE'S PHARMACY RESPONSE: If, as is likely, the "shot" was a vaccination against pneumonia, it is not an antibiotic at all. Since you have had a heart attack, you are in a high-risk category that calls for extra protection from pneumonia (and flu) through immunization.

Thank you for covering this topic. I took Z-Pak for a severe sinusitis in December; the first time I've taken an antibiotic in nearly a decade. No problem... whew. I haven't taken any OTC NSAIDs for more than two years--until this week. I also had several SVT (supraventricular tachycardia) episodes this week, and your timely alert has me considering a link between the two.

I'd be interested in your comments on this information as it relates to a guest you had on your radio show some months ago, a doctor from Madison, WI, who was promoting giving teenagers with teen-years-onset asthma, azithromycin for very long periods of time (I believe over a year, in many cases). Don't remember hearing about this side effect during this program, and I didn't see anything in the follow-up reading I did.

Like several of your correspondents, I listened in disbelief to item about Azithromycin and cardiac problems. Last October (2011), I had a deep bronchial cough/infection (probably pneumonia as pediatrician diagnosed nephew with "walking pneumonia within a week of being in his home) for which Azith-- was prescribed -- 6 capsules.

The medication worked as far as lung infection is concerned, but connected with this miserable period, specifically, I thought, to deep coughs, I began to have severe chest constrictions, relieved with deep belches. While the coughs and pneumonia subsided, the chest constrictions, SOB, depleted energy did not.

In Dec, a cardio-lite stress test revealed blockage (and I had the worst constriction by, then, labeled "angina" ever during that test.) Before any more tests, nitrostat and plavix were prescribed. In Jan, catheterization revealed blockage in left descending artery and on 1-26, I got a stent. That night, when I first toddled to the bathroom, attached to the monitors, my Pulse rate zoomed -- 3 nurses came rushing in, but I was OK.

In the following weeks of cardio-rehab (at 1st Health in Pinehurst), my pulse rate would elevate beyond the limits, corresponding to amount of exertion.
Staff and cardiologist started talking EPT and even, pacemaker, but I insisted that it wasn't a flutter, that the rate immediately returned to normal with cessation of exercise, that I did not have any "known" cardiac history --except for impact of the pneumonia cough.

Of course my systems have been building up plaque for years (I am 74), and probably the Azith -- was a catalyst for problem identification before an actual heart attack occurred. (All sorts of folks nod and tell me I have not had one.)

And so, now, I shall add the Azithromycin to the coughing. Finally, my gut instinct correlates to a known problem. I want to go into the statistical count for this, and am notifying the cardiologist, my internist and the cardio-rehab staff.

In 1974 my mother died and after the autopsy it was noted that myacin drugs might have been to blame. We were told she had an aneurism. There were seven children and we were told to make sure we we never took any myacin drugs. After all these years I am wondering how many people have died due to myacin drugs.

In my experiences, I have unfortunately discovered that doctors generally do not understand medication as well as they should. Thus, I now always contact pharmacists with medication issues.

I took biaxin for 2 days and azithromycin for 2 days. After 2 day
Of azithromycin I had severe back and arm pain. For a few hours after that I had extreme nausea. My blood pressure went up but slowly came back down. I laid in bed all day and was in pain and felt completely helpless and ill. I slowly started feeling better but 24 hrs after that last dose I took I getting all the feelings all over again. Pounding heart, nervousness, extreme hunger and nausea so I can't eat, dry mouth and throat. I have been trying to drink extra fluids. After reading all the bad news about azithromycin it makes me feel even worse. I just want this antibiotic out of my system. Apparently I will be this way for a while.

Another problem I'm having is going to sleep. Every time I drift off I get a surge and wake up. It's horrible! I hope these side effects start Wearing off soon. Can't take much more before I head to the ER.

My Daughter and I both contracted a severe Bronchitis type bug which was more like a pneumonia, After two courses of erethramyacin didn't work we were given clarithromycin and experienced dreadful effects, I have thigh muscle damage from crestor from a previous adverse drug effect and the pain in my leg was made so much worse than ever by this antibiotic, the wheezing and coughing was so much worse whilst taking this drug, we thought our condition had severely worsened, until comparing notes and realizing the drug was the cause.

We returned to the Doctor to report the adverse effects was told to cease taking it. Doctor indicated she had not heard of tendon pain as a side effect of this drug, BUT I could hardly walk after taking six days of these tablets at two per day, such was the pain of the tendons in my groin and under my feet that I experienced great problems just even getting into and out of bed, it was almost as if the tendons in my legs had been shrunk and upon standing they pulled and caused severe pain.
Severe nausea, ringing in ears, palpation's and headache, were also severe I was not taking any other medications. I am 69 years of age. My daughter who also was not taking other meds experienced severe palpitations and leg pains headache and ringing in the ears nausea with severe agitation and feeling of confusion.. never again will either of us take this drug CLARITHROMYCIN.

I finished taking this drug in November and am still here? No one was aware of an Abscessed tooth until the bridge fell out eating a Tootsie Roll (Ha) When the back tooth fell off I had to have it x-rayed to see what was going on. Two weeks later it was removed and I no longer recover from a lung infection (COPD) and have another infection 10 days after using two other antibiotics. I haven't felt this good for over a year.

With being a 75 year old senior who has hypothyroidism I sometimes wonder why I am still heer. My M.D. missed it for 3 years. He said he was sorry. I lost my wife 4 years ago due to 5 doctors??? not diagnosing a leaking organ, appendix (sepsis), and stage 4+ lung cancer after being under their care for 5 years!!! She did the dumb thing and endured chemo and radiation for 5 weeks until she could not talk. 7 days later in the hospital she expired. What are M.D.'s for? She is in a much better place on the shelf now. Mt M.D. had to retire due to Diabetes??? Hooray, but he diagnosed Sepsis on her first visit!!! I guess that evens thing up??

It's amazing that the medical and pharmacological fields don't adapt to the inevitable conclusions you just posted almost a year ago, that I just saw... I spent the summer in Africa working with the Maderere University in Uganda and the University of Botswana regarding the local farmers growing local native medicinal plants instead of their maze and other crops dependent on RAIN, in an already arid climate made worse by this GLOBAL warming trend...

The drug companies are just as guilty as the oil industry in hastening our demise. I'm a Botanist and it all ties in to us as a civilization being controlled. No wonder most of the new movies and TV shows are catering to ZOMBIES !!!

I am now wondering about the impact of the Z pack for pneumonia. My 80 yeard old mother was in the hospital to initialize dialysis. She had no prior history of heart disease or any disease other than kidney issues.

In the hospital,she began to encounter complications caused by the hospital. ( bedsores, accidents and two bouts of pneumonia) After getting her acclimated to dialysis, she was supposed to leave the hospital. But instead, the doctor told us that she had mild pneumonia. He administerd the Z pack. All of sudden, she had heart arrhythmia. Then we were told that she had suddencardiac arrest and they refused to resusitate even though they didn't have those instructions from the family. We couldn't get any explanation from the doctors. They seemed as baffled as we were. We know that her dialysis didn't do it because she went into cardiac arrest many hours later.

Could the drug have caused the cardiac arrest? This has agnonized me for years not knowing what happened.

Hi, Glenda. I turned 73 last week and had total hip replacement in October, 2012. I, too, used to take Celebrex, but stopped a couple of years ago because of known reactions and damage it could cause. I now take Sular. You may want to ask your doctor about it. I was taking Sular in the a.m. and Atenolol at night, but Atenolol lowered my heart rate so much that I was exhausted all the time. I finally asked my doctor about taking Sular twice a day and stop Atenolol. She agreed.

It is sad that we have to depend on ourselves often to get the right care.

When I went into the hospital for the hip replacement, I took a sign reading "NO BLOOD THINNERS", and kept it with me until they were ready to take me to the O.R. because I knew blood thinners were routinely administered after the surgery and I have had three brain bleeds in the past. So, instead, a screen was put in place to prevent any blood clots from entering the wrong place. If I had not had the sign, I believe they would not have looked into my record not to give blood thinners, and I might not be here today!!!

I'm sorry....I just remembered, you probably take the Celebrex as an anti-inflammatory agent or for pain, rather than high blood pressure.

Good luck to you, Glenda.

Got prescribed the Z pack by a family doctor after an upper respiratory infection would not go away for 2 months! The night I started the Zpack, strong abdominal pains woke me up in the middle of the night and felt that my intestines were tearing up for the following hours! I was hesitant to keep on taking it but kept going for 2 more doses. Developed an insomnia effect and irregular hearth beats that lead to a heavy pounding chest feeling, with cold sweats, I became extremely anxious as well as fatigued at times.

After reading plenty of reviews I took the hard decision of keeping my upper respiratory infection instead of continuing having these harsh effects. In the 3 days that I took the Z pack I did become better as far as my infection, but my hearth issues became more severe for the next 3-4 weeks and almost landing me in ER a couple of times!
I was surprised to find out that everyone around me had been prescribed this med at least once over the last few years and that most of them had mild side effects compared to mine.

I have been to a cardiologist recently and found that I'm in perfect hearth condition, but some how I feel different as if more vulnerable when it comes to my hearth and developed a phobia for prescribed meds. Now I read reviews and side effects before taking anything and I have added the Z pack as my only medical allergy.
I did get the upper respiratory infection back after a few days, only this time Amoxicilin did its job together with a couple of days rest.

Need to be more conscious about the medications some doctors prescribe. Read into them and find out if it's right for you. I do ask my doctor for a different prescription if customer reviews come back being close to 50% on the negative side!

You're a smart cookie! I am an R.N.-- graduated #1 in my class -- was valedictorian--I wouldn't work in a Hospital for a million dollars. I am a School Nurse in a small private school -- I enjoy the teenagers -- I know I am making a difference to them and I am not owned by big money-Pharma!
Good luck honey.

I had double pneumonia at Christmas, and then in February, I got bronchitis and tonsilitis. Each time I was treated with heavy doses of antibiotics and steroids. Over the years, I have gotten a torn rotator cuff in my shoulder, a torn Achilles tendon, and two knees with meniscus tears. I don't recall either my Mom or Dad, in their sixties, ever telling me that they had these problems. I think the medications are doing damage to our tendons, etc.

Also, I was put on Lipitor and it was damaging my liver, so I was taken off of it immediately. All these medications that are being thrust at people is just a money making scam. I think if people watch their diet, and exercise, they can control their cholesterol. Also, our bodies manufacture cholesterol. I am not a fan of medications.

My wife of 37 years had an upper respiratory infection and went to an ER alternative and was prescribed the z pack. That was on April 16 2013 and to make a long story short she became very ill after starting the z pack. She couldn't eat anything without it running straight through her. She went to the emergency room on 4/29/13 and they diagnosed her as being dehydrated, low potassium and diarrhea, but they did not admit her. They should have simply because she was dehydrated and had low potassium.

Then on May 11th I took her again to the E R and this time they admitted her. Unfortunately it was too late, on May 13th 2 days later my wife was Dead!!!

I never knew that antibiotics (z pack) could kill you. They should be broadcasting nightly on the news until it gets thru to everybody. I miss my wife dearly 24/7 and don't know if I will ever get over this loss that was such a shock and tore my world and my daughter and grandaughter's world apart.

I'm on a ZPak right now; 2 days ago I began having my heart "flutter" and I could feel it in my throat. Will this go away when the medicine is finished??? today was my last pill. Interestingly enough, I felt pretty good until I took the pill; within 45 minutes I started having the heart flutter and fatigue again. Any answers???

Remember the days when the FDA actually regulated pharmaceuticals, and where they came from?

There was a time that no physician would think of prescribing a drug that could actually harm a person, much less kill them.

Drugs that could produce fatalities alone, or in combination with other drugs, simply were not allowed to be used, or received FDA approval. My how times have changed.

In fact, both FDA, and EPA were serious about their role in government, and physician licensing, coroners, and EMTs took their role in human safety seriously, as did local and federal police.

Those were the days of the American Dream before it became the American nightmare for most of us. In fact, the duty extended to Congress, to all of government and local regulators, to investigator reporters, and law enforcement, including attorneys. Now, attorneys make fortunes from such wrongful deaths, and produce hazards. Even they have become opportunistic and entrepreneurial, just like the Enrons, and the Madoff's of the nation, not to mention the world.

It wasn't that long ago when life was precious, and much of society was devoted to protecting it. America needs a revival of that spirit, and to stop profiting from failures, and pretentious immunity always sought and granted in these cases due to our corporate highjacking of government. Perhaps we need a voluntary Congress, not a paid Congress once again?

In Oct 2007 I developed a deep hacking cough which lasted weeks; since I don't believe doctors know what to do for cough, I went to a local organic grocery store and asked a clerk in the supplements dept if she could recommend something. She laughed, and handed me NAC [N Acetyl L Cysteine], said it was an antioxidant that our bodies produce naturally, but that it had this weird side effect [side benefit?]. It stops coughing.

I took two, coughed a bit for 10 minutes and then quieted right down for hours! Took two more before bed. It took weeks for the cough to subside if I skipped a dose, but as there were no side effects, and the cough was diminishing, I kept plodding along. The cough is long gone, but I still take it every day [1x]. Have needed to up the dosage only once in all these years, when I caught a cold.

I am taking azithromax for bronchitis. I began the antibiotics 2 days ago. Last night and the night before I have had irregular heartbeats / flutters. I researched online because I'm on a lot of other meds and the zpak is what caught my eye online. Others say it is linked to ihb. I now know for sure that's causing mine. I'm only 32 yo. And should not be having heart irregularities.

My beloved 27 yo husband passed away in October 2013 by a sudden heart attack lasted for minutes, i.e. more than a year after that study.

He had a sore throat and took some antibiotic from the pharmacy by himself. No doctor gave me a reason for his sudden death!!!!! But now I know why.
Shouldn't any organization prevent those medicines from all over the world?

I am grateful for the info on these meds. In the past, I have been prescribed some of them, but never again! Thank you for your newsletters and all the information you provide.

I have Supraventricular Tachycardia. Almost 2 years ago, I was prescribed Z Pak for bronchitis. On my 4th day of the treatment, I had a major SVT event that led to crackles in my respiration & shortness of breathe... I basically went into congestive heart failure because fluid started building up in my lungs since my heart was racing so fast!

This has never happened to me before with an SVT event nor has it happened since. It was very scary! Afterwards, I called a family member that is a doctor and he said he just about a month before had a notice come across his desk that warned not to prescribe Z Pak to someone with SVT.

If I hadn't called him about it, I would have never known! This is dangerous if you have an arrhythmia and you should be aware of this! I am an otherwise healthy, trim woman that doesn't smoke or drink with a healthy heart except for this electrical problem! I have had this put in my medical records so that this will never be prescribed to me again.

Did the irregular heart beat/flutter stop after you stopped taking it? I took azithromycin and had 4 heart flutters/irregular beats a week afterwards.

I was prescribed 4 pills (1000mg) to be taken all at once, in case anyone is wondering.

Am 77 years of age -- will NEVER AGAIN take a prescribed/legal drug. Went to Dr. for bronchitis, was given prescription for azithromycin. Took me six days after completion of the 5-day dosage to realize an irregular heart rhythm had developed. The tiredness, and chest constrictions were not easing up. Began immediately to take a natural herbal supplement from an alternative source. Am unable to have an appointment with an alternative doctor before April 21st, trusting he will be able to bring me back to my formerly healthy status where no meds were involved -- only herbal supplements. Also, I would never again return to any of these medical doctors regarding the side effects of the drug, as they will just give you another drug, or another equally menacing treatment. Right now, I will pray God to care for me while I continue to take this supplement until April 21st. Then I pray God to guide that practitioner with the wisdom needed to put me back on the right course.

About 3 weeks ago was sick thought I had taken bad food and brought up just fluid that was the color of Pepsi or coke I do drink a lot of Pepsi...

Last night had the same problem and again just fluid the color of Pepsi and have been weak the last week and don't eat a lot of food..

People's Pharmacy response: If you haven't yet seen your doctor, do so right away.

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