Azithromycin is an effective antibiotic belonging to the macrolide class, known for its effectiveness against various bacterial infections. However, like many medications, it can interact with other drugs, potentially leading to adverse effects or altering its efficacy. Understanding these interactions is crucial for safe and effective treatment. Refer to our dedicated articles for a deeper look into its Uses and Dosages.
Overview of Azithromycin Interactions
Azithromycin interacts with numerous medications, including 369 known drugs and four disease interactions. Depending on their severity, these interactions can be categorized as major, moderate, or minor. While Azithromycin generally has a lower risk of drug interactions compared to other macrolides due to its minimal involvement with liver enzymes, it still poses risks with certain medications.
Disease Interactions
Azithromycin has four known disease interactions that require caution:
- QT Prolongation – patients with a history of QT prolongation or those taking medications that affect heart rhythm are at higher risk when using Azithromycin.
- Liver Disease – Azithromycin can exacerbate liver conditions and should be used cautiously in patients with hepatic impairment.
- Myasthenia Gravis – Azithromycin may worsen symptoms of this neuromuscular disorder.
- Colitis (Clostridium difficile) – like other antibiotics, Azithromycin can disrupt gut flora and increase the risk of C. difficile-associated diarrhea.
For more information on potential risks and who should avoid Azithromycin, visit our article on Precautions and Contraindications according to different age groups.
Common Drug Interactions
- Nelfinavir – Co-administration of nelfinavir at a steady state with Azithromycin can increase azithromycin serum concentrations. Although no dose adjustment is recommended, close monitoring for known adverse reactions, such as liver enzyme abnormalities and hearing impairment, is advised.
- Warfarin – Postmarketing reports suggest that Azithromycin may enhance the effects of oral anticoagulants like warfarin despite no changes in prothrombin time observed in drug interaction studies. Therefore, prothrombin times should be closely monitored when using Azithromycin and oral anticoagulants.
- Macrolide Interactions – Although clinical trials with Azithromycin have not reported interactions with digoxin, colchicine, or phenytoin, such interactions have been observed with other macrolides. Until further data is available, patients taking these medications alongside Azithromycin should be carefully monitored.
- Antacids – Azithromycin should be taken at least an hour before or two hours after antacids to avoid reduced absorption.
- Ergotamine or Dihydroergotamine – These medications, used for migraines, should be avoided with Azithromycin due to the potential increased risk of ergot toxicity.
- Ciclosporin or Tacrolimus – These immunosuppressants may interact with Azithromycin, potentially affecting its efficacy or increasing the risk of side effects.
- Colchicine – This interaction can increase the risk of colchicine toxicity, leading to muscle weakness and nausea.
- Digoxin – Azithromycin may increase digoxin levels, enhancing the risk of toxicity and heart rhythm issues.
- Rifabutin – Co-administration with another antibiotic may require monitoring due to potential interactions.
- Statins – While not extensively studied, caution is advised when using Azithromycin with statins like simvastatin or atorvastatin due to the potential increased risk of muscle damage.
- Heart Rhythm Medications – Azithromycin can interact with antiarrhythmic drugs such as amiodarone or sotalol, increasing the risk of QT prolongation and heart rhythm disorders. Other medications affecting heart rhythm, including antidepressants like citalopram, antipsychotics, and certain anti-nausea drugs like domperidone, should also be used cautiously.
Comparing with Other Antibiotics
Understanding how Azithromycin compares to other antibiotics in terms of efficacy and safety can help you choose the best treatment option. Our article “Comparing Azithromycin with Other Antibiotics” provides more information on this topic.
Azithromycin and Herbal Remedies and Supplements
While limited information exists on the safety of combining Azithromycin with herbal remedies or supplements, caution is advised. These products are not tested to the same standards as prescription or pharmacy medicines, and their interactions with other drugs remain largely unknown.
By being informed about potential interactions and taking necessary precautions, you can ensure safe and effective treatment with Azithromycin. Always inform your doctor or pharmacist about any supplements, vitamins, or herbal products you use.
OTC Medications
Common over-the-counter drugs like aspirin (low dose), acetaminophen (paracetamol), loratadine (Claritin), and cetirizine (Zyrtec) are generally safe to use with Azithromycin. However, they should still be discussed with a healthcare provider to avoid unexpected interactions.
Azithromycin and Food
There are no known significant interactions between Azithromycin and food. However, the absorption of Azithromycin is not significantly affected by food intake, except for specific formulations like Zmax, which should be taken on an empty stomach. For optimal absorption, taking Azithromycin one hour before or two hours after a meal is generally recommended. Taking Azithromycin with food may help reduce gastrointestinal side effects but does not affect its efficacy. To learn more about possible Side Effects, check our detailed guide.
Azithromycin and Drinks
Limited information exists on the interaction between Azithromycin and specific drinks, including caffeine. Moderate amounts of caffeine are generally considered safe while taking Azithromycin, but some evidence suggests that caffeine may enhance the antibacterial effects of antibiotics like Azithromycin.
Azithromycin and Alcohol
The interaction between Azithromycin and alcohol is not well-documented. However, there is no specific warning against consuming alcohol while taking Azithromycin, although it is generally advisable to limit alcohol intake when on antibiotics to avoid potential interactions or exacerbation of side effects.
Precautions and Additional Considerations
When taking Azithromycin, you must inform your doctor about any other medications you’re using, especially those that affect heart rhythm or are known to interact with Azithromycin. For more detailed information on Precautions, explore our article.
Azithromycin can influence heart rhythm, so avoid combining it with other medications that have similar effects. Notify your doctor if you are using drugs that may affect your heartbeat, including:
- Medications for irregular heart rhythms (e.g., amiodarone, sotalol).
- Antidepressants like citalopram.
- Antipsychotics for mental health conditions.
- Certain anti-nausea drugs, such as domperidone.
- Some antibiotics, like moxifloxacin.
Also, keep in mind that magnesium and aluminum-containing products can interfere with azithromycin absorption. It is recommended to take Azithromycin at least two hours before or after any aluminum—or magnesium-containing antacids.
Azithromycin can interact with certain vaccines, such as the cholera vaccine (Vaxchora). After finishing Azithromycin, it is advised to wait at least two weeks before receiving this vaccine.
For those interested in purchasing Azithromycin online, check out our guide on Buying Azithromycin online.
If you still have questions, visit our FAQ article, where we have gathered all the most frequently asked questions about Azithromycin.