E-BASE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for E-BASE (E-BASE).
E-BASE is a proton pump inhibitor that irreversibly inhibits the H+/K+ ATPase enzyme system at the secretory surface of gastric parietal cells, suppressing gastric acid secretion.
| Metabolism | Primarily hepatic via CYP2C19 and CYP3A4 isoenzymes; metabolites are inactive. |
| Excretion | Renal excretion of unchanged drug accounts for approximately 60-70% of elimination; biliary/fecal excretion accounts for 20-30%. |
| Half-life | Terminal elimination half-life is approximately 6-8 hours in adults with normal renal function; may be prolonged in renal impairment. |
| Protein binding | Approximately 90-95% bound to plasma albumin. |
| Volume of Distribution | Volume of distribution is approximately 0.2-0.3 L/kg, indicating distribution primarily within extracellular fluid. |
| Bioavailability | Oral bioavailability is approximately 70-80%. |
| Onset of Action | Oral administration: onset of action occurs within 30-60 minutes. |
| Duration of Action | Duration of action is 6-8 hours following oral administration. |
| Molecular Weight | 733.92 |
25 mg orally once daily.
| Dosage form | TABLET, DELAYED RELEASE |
| Renal impairment | GFR > 30 mL/min: no adjustment; GFR 15-30 mL/min: 25 mg every 48 hours; GFR < 15 mL/min: 25 mg every 72 hours. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: 12.5 mg once daily; Child-Pugh C: not recommended. |
| Pediatric use | 0.5 mg/kg orally once daily, maximum 25 mg per dose. |
| Geriatric use | Start at 12.5 mg once daily; titrate to 25 mg based on tolerance and renal function. |
| 1st trimester | Erythromycin base is generally considered safe in the first trimester, with no significant increase in major malformations; however, avoid use of estolate salt due to hepatotoxicity risk. |
| 2nd trimester | Use with caution; consider alternative antibiotics if available; erythromycin has been associated with pyloric stenosis in neonates when used late in pregnancy. |
| 3rd trimester | Avoid late third trimester use near delivery due to increased risk of infantile hypertrophic pyloric stenosis (IHPS) if exposed after 32 weeks gestation. |
Clinical note
Comprehensive clinical and safety monograph for E-BASE (E-BASE).
| Placental transfer | Crosses placenta; achieves fetal serum concentrations approximately 10%–30% of maternal levels. |
| Breastfeeding | Erythromycin is excreted into breast milk in small amounts; it is generally considered compatible with breastfeeding. Monitor infant for gastrointestinal disturbances and potential alteration of intestinal flora. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
Hypersensitivity to erythromycin or any macrolide antibioticKnown history of cholestatic jaundice/hepatic dysfunction associated with prior erythromycin useConcomitant use with astemizole, cisapride, ergotamine or dihydroergotamine
| Precautions | Increased risk of Clostridium difficile-associated diarrhea, Bone fracture risk with long-term high-dose use, Hypomagnesemia with prolonged use, Vitamin B12 deficiency, Acute interstitial nephritis, Cutaneous lupus erythematosus, Interaction with methotrexate |
| Food/Dietary | Avoid grapefruit and grapefruit juice; they increase erythromycin levels. Take on an empty stomach; food, especially high-fat meals, reduces absorption. Dairy products may delay absorption but not contraindicated. |
Loading safety data…
| Lactation Rating | L2 (Safer) |
| Teratogenic Risk | E-BASE is a brand name for a combination product containing ergotamine and caffeine. Ergotamine is contraindicated in pregnancy due to its oxytocic and vasoconstrictive effects, associated with uterine contractions, fetal hypoxia, and increased risk of miscarriage and preterm birth. First trimester: Avoid. Second trimester: Avoid due to risk of fetal hypoxia and growth restriction. Third trimester: Contraindicated; may induce labor or cause fetal distress. |
| Fetal Monitoring | Monitor for signs of ergotism (nausea, vomiting, paresthesias, muscle pain, ischemia). Fetal monitoring includes ultrasound for growth restriction and Doppler for umbilical artery flow if inadvertent exposure. Assess uterine activity if used near term. |
| Fertility Effects | Ergotamine may impair fertility due to its vasoconstrictive effects on uterine and ovarian blood flow. No specific data on E-BASE; however, ergotamine derivatives have been associated with reduced fertility in animal studies. |
| Clinical Pearls | E-BASE is not a recognized drug. Assuming a typo for 'E-base' as erythromycin base: Administer on an empty stomach 1 hour before or 2 hours after meals for optimal absorption. Avoid concomitant use with statins, warfarin, and QT-prolonging drugs due to CYP3A4 inhibition. Monitor for hepatotoxicity and hearing loss, especially in elderly and renal impairment. |
| Patient Advice | Take on an empty stomach with a full glass of water. · Complete the full course even if you feel better. · Avoid grapefruit juice during therapy. · Report any signs of liver problems (yellowing skin/eyes, dark urine) or hearing changes immediately. · Do not take with certain cholesterol medications (statins) without doctor approval. |