(2R,3S,4R,5R,8R,10R,11R,13S,14R)-11-[(2S,3R,4S,6R)-4-(dimethylamino)-3-hydroxy-6-methyloxan-2-yl]oxy-2-ethyl-3,4,10-trihydroxy-13-[(2R,4R,5S,6S)-5-hydroxy-4-methoxy-4,6-dimethyloxan-2-yl]oxy-3,5,6,8,10,12,14-heptamethyl-1-oxa-6-azacyclopentadecan-15-one | 83905-01-5

• 物质功能分类: 原料药 - 抗生素类药物 - 大环内酯类药
• 分子结构分类: 有机化合物 - 有机氧化合物
• 英文名称: (2R,3S,4R,5R,8R,10R,11R,13S,14R)-11-[(2S,3R,4S,6R)-4-(dimethylamino)-3-hydroxy-6-methyloxan-2-yl]oxy-2-ethyl-3,4,10-trihydroxy-13-[(2R,4R,5S,6S)-5-hydroxy-4-methoxy-4,6-dimethyloxan-2-yl]oxy-3,5,6,8,10,12,14-heptamethyl-1-oxa-6-azacyclopentadecan-15-one
• CAS: 83905-01-5
• 化学式: C₃₈H₇₂N₂O₁₂
• 分子量: 749.0
• InChiKey: MQTOSJVFKKJCRP-OHJWJPDZSA-N

物化性质

• 熔点：
  113-115°C
• 比旋光度：
  D20 -37° (c = 1 in CHCl3)
• 沸点：
  822.1±65.0 °C(Predicted)
• 密度：
  1.18±0.1 g/cm3(Predicted)
• 溶解度：
  几乎不溶于水，易溶于无水乙醇和二氯甲烷。
• 颜色/状态：
  Amorphous solid
• 蒸汽压力：
  2.65X10-24 mm Hg at 25 °C (est)
• 旋光度：
  Specific optical rotation: -37 °C at 20 °C/D (c = 1 on CHCl3)
• 解离常数：
  pKa = 8.74

计算性质

• 辛醇/水分配系数(LogP)：
  4
• 重原子数：
  52
• 可旋转键数：
  7
• 环数：
  3.0
• sp3杂化的碳原子比例：
  0.97
• 拓扑面积：
  180
• 氢给体数：
  5
• 氢受体数：
  14

ADMET

代谢

生物转化的主要途径涉及去氧糖或大环内酯环9a位置上的N-脱甲基化。其他代谢途径包括克拉定糖和去氧糖部分以及大环内酯环的O-脱甲基化和水解和/或羟基化。已经鉴定出阿奇霉素的最多10种代谢物，所有这些代谢物在微生物学上均不活跃。尽管短期给予阿奇霉素会导致药物在肝脏中积累并增加阿奇霉素脱甲基酶活性，但目前证据表明，通过细胞色素-代谢物复合物形成导致肝脏细胞色素p450诱导失活的情况并不发生。与红霉素不同，阿奇霉素不会通过此途径抑制其自身的代谢。

The principal route of biotransformation involves N-demethylation of the desosamine sugar or at the 9a position on the macrolide ring. Other metabolic pathways include O-demethylation and hydrolysis and/or hydroxylation of the cladinose and desosamine sugar moieties and the macrolide ring. Up to 10 metabolites of azithromycin have been identified, and all are microbiologically inactive. While short-term administration of azithromycin produces hepatic accumulation of the drug and increases azithromycin demethylase activity, current evidence indicates that hepatic cytochrome p450 induction of inactivation via cytochrome-metabolite complex formation does not occur. In contrast to erythromycin, azithromycin does not inhibit its own metabolism via this pathway.

来源:Hazardous Substances Data Bank (HSDB)

毒理性

• 在妊娠和哺乳期间的影响

哺乳期使用总结：由于阿奇霉素在母乳中的含量较低，且在婴儿中以较高剂量使用，预计不会对哺乳婴儿造成不良影响。监测婴儿可能对胃肠道菌群的影响，如呕吐、腹泻、念珠菌病（鹅口疮、尿布疹）。未经证实的流行病学证据表明，在哺乳的前两周内，母亲使用大环内酯类抗生素可能会增加婴儿肥厚性幽门狭窄的风险，但也有人对此关系表示质疑。在一项研究中，给予分娩期间女性单次剂量的阿奇霉素（这些女性是致病性葡萄球菌和链球菌的鼻腔携带者）降低了母乳中这些细菌的数量，但增加了母乳中阿奇霉素耐药的大肠杆菌和肺炎克雷伯菌的流行率。 对哺乳婴儿的影响：一项对诊断为婴儿肥厚性幽门狭窄的婴儿进行的队列研究发现，受影响的婴儿在分娩后90天内服用大环内酯类抗生素的母亲的可能性是正常婴儿的2.3至3倍。对婴儿进行分层后发现，女性婴儿的比值比为10，男性婴儿为2。所有受影响婴儿的母亲都哺乳了她们的婴儿。大多数大环内酯类抗生素的处方是红霉素，但只有7%是阿奇霉素。然而，作者没有说明受影响婴儿的母亲服用了哪种大环内酯类抗生素。 丹麦的一项回顾性数据库研究15年的数据显示，在分娩后前13天内服用大环内酯类药物的母亲所生的婴儿患婴儿肥厚性幽门狭窄的风险增加了3.5倍，但在后期暴露时没有增加风险。这些婴儿中有多少被哺乳的情况未知，但可能比例很高。服用每种大环内酯类药物的妇女的比例也没有报告。 一项比较服用阿莫西林的母亲哺乳的婴儿和服用大环内酯类抗生素的母亲哺乳的婴儿的研究发现，没有肥厚性幽门狭窄的实例。然而，大多数在母乳中接触到大环内酯类的婴儿接触的是罗西拉霉素。在接触大环内酯类的55名婴儿中，只有10名接触了阿奇霉素。接触大环内酯类的婴儿中有12.7%出现了不良反应，这与接触阿莫西林的婴儿的不良反应率相似。反应包括皮疹、腹泻、食欲不振和嗜睡。 8名在剖宫产手术前15、30或60分钟静脉注射500毫克阿奇霉素的妇女哺乳了她们的新生儿。他们的婴儿没有出现不良反应。 两项荟萃分析未能证明哺乳期间母亲使用大环内酯类药物与婴儿肥厚性幽门狭窄之间存在关系。 对哺乳和母乳的影响：在冈比亚进行的一项双盲对照研究中，对鼻腔携带金黄色葡萄球菌、肺炎链球菌或B型链球菌的妇女在分娩期间给予了单次2克剂量的阿奇霉素。接受阿奇霉素的妇女的乳汁样本中携带这些病原体的比例为9.6%，而接受安慰剂的妇女为21.9%。母亲和婴儿在分娩后第6天的鼻腔携带率也有所降低。然而，后来的分析发现，口服产间阿奇霉素并没有减少大肠杆菌和肺炎克雷伯菌的携带，并且与母乳中阿奇霉素耐药的大肠杆菌和肺炎克雷伯菌分离株的增加有关。

◉ Summary of Use during Lactation:Because of the low levels of azithromycin in breastmilk and use in infants in higher doses, it would not be expected to cause adverse effects in breastfed infants. Monitor the infant for possible effects on the gastrointestinal flora, such as vomiting, diarrhea, candidiasis (thrush, diaper rash). Unconfirmed epidemiologic evidence indicates that the risk of infantile hypertrophic pyloric stenosis might be increased by maternal use of macrolide antibiotics during the first two weeks of breastfeeding, but others have questioned this relationship. In one study, a single dose of azithromycin given during labor to women who were nasal carriers of pathogenic Staphylococcus and Streptococcus reduced the counts of these bacteria in breastmilk, but increased the prevalence of azithromycin-resistant E. coli and K. pneumoniae in breastmilk. ◉ Effects in Breastfed Infants:A cohort study of infants diagnosed with infantile hypertrophic pyloric stenosis found that affected infants were 2.3 to 3 times more likely to have a mother taking a macrolide antibiotic during the 90 days after delivery. Stratification of the infants found the odds ratio to be 10 for female infants and 2 for male infants. All of the mothers of affected infants nursed their infants. Most of the macrolide prescriptions were for erythromycin, but only 7% were for azithromycin. However, the authors did not state which macrolide was taken by the mothers of the affected infants. A retrospective database study in Denmark of 15 years of data found a 3.5-fold increased risk of infantile hypertrophic pyloric stenosis in the infants of mothers who took a macrolide during the first 13 days postpartum, but not with later exposure. The proportion of infants who were breastfed was not known, but probably high. The proportion of women who took each macrolide was also not reported. A study comparing the breastfed infants of mothers taking amoxicillin to those taking a macrolide antibiotic found no instances of pyloric stenosis. However, most of the infants exposed to a macrolide in breastmilk were exposed to roxithromycin. Only 10 of the 55 infants exposed to a macrolide were exposed to azithromycin. Adverse reactions occurred in 12.7% of the infants exposed to macrolides which was similar to the rate in amoxicillin-exposed infants. Reactions included rash, diarrhea, loss of appetite, and somnolence. Eight women who were given azithromycin 500 mg intravenously 15, 30 or 60 minutes prior to incision for cesarean section breastfed their newborn infants. No adverse events were noted in their infants. Two meta-analyses failed to demonstrate a relationship between maternal macrolide use during breastfeeding and infantile hypertrophic pyloric stenosis. ◉ Effects on Lactation and Breastmilk:In a double-blind, controlled study in Gambia, women who were nasopharyngeal carriers of Staphylococcus aureus, Streptococcus pneumoniae or group B streptococcus were given a single 2 gram dose of azithromycin during labor. Milk samples from women who received azithromycin had 9.6% prevalence of carriage of the organisms compared to 21.9% in women who received placebo. Nasopharyngeal carriage in mothers and infants was also reduced on day 6 postpartum. However, a later analysis found oral intrapartum azithromycin did not reduce carriage of Escherichia coli and Klebsiella pneumoniae and was associated with an increase in the prevalence of azithromycin-resistant E. coli and K. pneumoniae isolates in breastmilk.

来源:Drugs and Lactation Database (LactMed)

毒理性

• 相互作用

因为同时使用匹莫齐特和其他大环内酯类抗生素（例如，克拉霉素）会增加匹莫齐特的血药浓度，并且与QT间期延长和严重心血管反应的风险相关，所以匹莫齐特的生产商指出，匹莫齐特与大环内酯类抗生素（包括阿奇霉素）的联合使用是禁忌的。

Because concomitant use of pimozide and other macrolides (e.g., clarithromycin) has increased pimozide concentrations and is associated with a risk of prolonged QT interval and serious cardiovascular effects, the manufacturer of pimozide states that concomitant use of pimozide and macrolides (including azithromycin) is contraindicated.

来源:Hazardous Substances Data Bank (HSDB)

毒理性

• 相互作用

尽管尚未进行阿奇霉素与特定药物的相互作用研究，但与其他大环内酯类药物同时使用已导致苯妥英钠浓度升高。因此，如果阿奇霉素和苯妥英钠同时使用，应密切监测患者。

Although specific drug interaction studies have not been performed with azithromycin, concomitant use with other macrolides has resulted in increased phenytoin concentrations. Therefore, the patient should be carefully monitored if azithromycin and phenytoin are used concomitantly.

来源:Hazardous Substances Data Bank (HSDB)

毒理性

• 相互作用

尽管阿奇霉素的单剂量缓释口服悬浮液可以不考虑含有氢氧化镁和/或氢氧化铝的抗酸剂，但传统的口服阿奇霉素制剂（片剂或口服悬浮液）不应与含铝或镁的抗酸剂同时服用。一项使用阿奇霉素胶囊（目前已不再商业销售）的研究表明，与含铝和氢氧化镁的抗酸剂同时服用口服阿奇霉素500毫克会降低阿奇霉素的吸收速率，表现为峰值血清阿奇霉素浓度降低了24%；然而，阿奇霉素的吸收程度（AUC）不受影响。

Although the single-dose extended-release oral suspension of azithromycin may be taken without regard to antacids containing magnesium hydroxide and/or aluminum hydroxide, conventional oral azithromycin preparations (tablets or oral suspension) should not be administered simultaneously with aluminum- or magnesium-containing antacids. A study using azithromycin capsules (no longer commercially available) indicate that administration of oral azithromycin 500 mg with an aluminum- and magnesium hydroxide-containing antacid resulted in a decreased rate of absorption of azithromycin as evidenced by 24% reduction in peak serum azithromycin concentrations; however, the extent of azithromycin absorption (AUC) was unaffected.

来源:Hazardous Substances Data Bank (HSDB)

毒理性

• 相互作用

尽管尚未进行阿奇霉素与特定药物的相互作用研究，但与其他大环内酯类药物同时使用已导致麦角生物碱（麦角胺、双氢麦角胺）浓度升高。因此，如果阿奇霉素与麦角生物碱同时使用，应密切监测患者。

Although specific drug interaction studies have not been performed with azithromycin, concomitant use with other macrolides has resulted in increased concentrations of ergot alkaloids (ergotamine, dihydroergotamine). Therefore, the patient should be carefully monitored if azithromycin and ergot alkaloids are used concomitantly.

来源:Hazardous Substances Data