Editing Telithromycin (section)

== Adverse effects ==
Most common side-effects are gastrointestinal, including diarrhea, nausea, abdominal pain and vomiting. Headache and disturbances in taste also occur. Less common side-effects include palpitations, blurred vision, and rashes.  Prolonged [[QTc]] intervals may also be caused by telithromycin.<ref>Bertram G. Katzung, Susan B. Masters, Anthony J. Trevor ''Basic & Clinical Pharmacology, 11e'' McGraw-Hill 2009 via "accessmedicine.com"</ref>

Rare but severe side-effects were initially reported in March 2006, involving damage to the liver.<ref name="Clay KD 2006">{{cite journal | vauthors = Clay KD, Hanson JS, Pope SD, Rissmiller RW, Purdum PP, Banks PM | title = Brief communication: severe hepatotoxicity of telithromycin: three case reports and literature review | journal = Annals of Internal Medicine | volume = 144 | issue = 6 | pages = 415–420 | date = March 2006 | pmid = 16481451 | doi = 10.7326/0003-4819-144-6-200503210-00121 | doi-access = free }}</ref> Three different incidents were reported: one case of temporary drug-induced [[hepatitis]], one ending in a [[liver transplant]], and one ending in death.

In the United States, the FDA's Office of Epidemiology and Surveillance identified 12 cases of acute liver failure, resulting in four deaths, and an additional 23 cases of acute, serious liver injury, among 5.2 million patients taking telithromycin through April 2006.<ref>{{Cite web |url=https://www.fda.gov/ohrms/dockets/AC/06/slides/2006-4266s1-01-07-FDA-Brinker.ppt | vauthors = Brinker A | date = December 2006 |title=Telithromycin-Associated Hepatotoxicity | work = U.S. [[Food and Drug Administration]] |access-date=2019-12-16 |archive-date=2017-05-17 |archive-url=https://web.archive.org/web/20170517005728/https://www.fda.gov/ohrms/dockets/ac/06/slides/2006-4266s1-01-07-FDA-Brinker.ppt |url-status=dead }}</ref><ref>{{cite news |url=https://online.wsj.com/articles/SB114644463095840108 |title=Fraud, Errors Taint Key Study Of Widely Used Sanofi Drug - WSJ |newspaper=Wall Street Journal |date=May 2006 | vauthors = Mathews AW }}</ref>

In 2010, a published report described the likely mechanism of action underlying not only the cases of liver failure but also cases of visual disturbances and exacerbations of myasthenia gravis.  The study showed that a pyridine moiety that is part of the telithromycin molecule acts as an antagonist on cholinergic receptors located in the neuromuscular junction, the ciliary ganglion of the eye and the vagus nerve innervating the liver.  Other macrolides, such as azithromycin and clarithromycin and the fluoroketolide, [[solithromycin]], do not contain the pyridine  moiety and do not antagonize these cholinergic receptors significantly.<ref>{{cite journal | vauthors = Bertrand D, Bertrand S, Neveu E, Fernandes P | title = Molecular characterization of off-target activities of telithromycin: a potential role for nicotinic acetylcholine receptors | journal = Antimicrobial Agents and Chemotherapy | volume = 54 | issue = 12 | pages = 5399–5402 | date = December 2010 | pmid = 20855733 | pmc = 2981250 | doi = 10.1128/aac.00840-10 }}</ref>