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Does Azithromycin Have Side Effects?
Updated on January 31, 2024
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At Home Health
Does Azithromycin Have Side Effects?

Azithromycin (uh-zi-throw-mai’-sn) is a macrolide antibiotic used in the treatment of certain bacterial infections. Doctors often prescribe it for:

  • Respiratory infections (e.g., pneumonia)
  • Ear, nose, and throat infections (e.g., sinusitis)
  • Some sexually transmitted diseases (e.g., gonorrhea)

Azithromycin can also treat Lyme disease, traveler’s diarrhea, whooping cough (pertussis), salmonella infections, and some infections of the pelvis, heart valve, and digestive tract.

When taken as prescribed, azithromycin can treat an infection in three to ten days. But like any medication, it can cause side effects in some people. These can vary from person to person.

Most of azithromycin’s side effects aren’t serious and can be managed with other drugs and lifestyle changes.

Understanding Azithromycin Side Effects

People who take azithromycin may experience side effects or adverse reactions. Side effects are unwanted but often expected drug reactions. Adverse drug reactions are unwanted or harmful reactions to medications; these usually arise from over-ingestion.

What Are the Most Common Side Effects of Azithromycin?

More than 1 in 100 people who take azithromycin may experience mild side effects. Some of the most commonly reported side effects are:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Headaches
  • Dizziness
  • Feeling tired
  • Changes in taste
  • Stomach upset
  • Mild diarrhea
  • Abdominal pain

What Are the Serious Side Effects of Azithromycin?

Azithromycin rarely leads to serious side effects. But it can happen to less than 1 in 1,000 people who take this antibiotic treatment. The most serious side effects are those from an allergic reaction—usually as angioedema and difficulty breathing. These side effects include:

Signs of Liver or Gallbladder Problems(from overdosage of the medication)Other Serious Side Effects
- Nausea or vomiting that doesn’t go away
- Yellowish eyes or skin
- Severe abdominal pain
- Loss of appetite
- Unusual tiredness
- Pale-colored stools
- Dark urine
- Pancreatitis (inflammation of the pancreas that may cause severe stomach pain or back pain)
- Changes in hearing (reduced hearing, temporary hearing loss)
- Vertigo (the feeling that your surrounding is moving or spinning, and finding it difficult to maintain your balance)
- Tinnitus (ringing in the ears)
- Increased skin sensitivity to sunlight 
- Faster or irregular heartbeat
- Difficulty speaking or swallowing
- Muscle weakness or cramps
- Severe dizziness
- Blurry vision
- Drooping eyelids
- Fainting

Babies who experience side effects to azithromycin may become more irritable. This condition is called Hypertrophic Pyloric Stenosis. Older adults are more prone to experiencing faster and irregular heartbeats.

What Are Some Long-Term Effects of Azithromycin Treatment?

Some people may develop a Clostridium difficile infection. It can happen while taking the drug or up to several weeks or months following treatment.

This infection is triggered by the gut imbalance caused by azithromycin, which wipes out both harmful and beneficial bacteria in your digestive tract.

Symptoms of C. difficile infection include abdominal cramps, severe diarrhea that doesn’t stop, and passing stool with blood or mucus.

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Allergic Reactions to Azithromycin

Azithromycin can cause allergies in people who are allergic to the drug and similar drugs, such as clarithromycin, erythromycin, and telithromycin.

An allergic reaction usually shows up as soon as you start taking the drug. However, there can also be delayed reactions to the drug. Here are the signs you’re allergic to azithromycin:

  • Fever
  • Skin rash
  • Bruising
  • Muscle aches
  • Hives or blisters
  • Red or purple skin discoloration
  • Swollen glands (lymph nodes)
  • Pain in the skin and/or eyes
  • Swollen face, mouth, lips, or throat
  • Trouble breathing or swallowing
  • Sore throat (pharyngitis)
  • Hoarse voice

Keep in mind that allergies and side effects are not the same. A side effect is an undesirable drug reaction and is usually predictable. 

Drug allergies are triggered by your immune system. They can be unpredictable if you have unknown allergies to azithromycin or other macrolides.

How Long Do Azithromycin Side Effects Last?

Most azithromycin side effects go away once your body adjusts to the drug. But for other people, they may not disappear until after they’ve finished treatment.

Your symptoms can linger for several days, weeks, or longer after you’ve stopped taking the prescription drug. It depends on how your body tolerates it.

How to Manage Azithromycin Side Effects

While azithromycin side effects resolve on their own, there are some things you can do to lessen the discomfort and ease your symptoms.

You should talk to a healthcare professional before taking other medications to relieve your symptoms. This may cause unwanted drug interactions.

A doctor or pharmacist can recommend over-the-counter drugs that may help you safely reduce azithromycin side effects.

Here are some common azithromycin side effects and how to deal with them:

Nausea and Vomiting

Azithromycin is best taken on an empty stomach. However, when you develop nausea or feel like vomiting, you can eat simple and light meals with bland-tasting ingredients. Avoid heavy meals and foods that are greasy, fried, sweet, and spicy.

Stay away from strong flavors and scents, including perfumes. They can make you nauseous if you’re sensitive to their smell.

Drink small sips of water throughout the day to prevent heavy vomiting. Your doctor may suggest over-the-counter (OTC) medications for nausea relief.

Diarrhea and Stomach Upset

You can follow the same dietary restrictions as someone with nausea and vomiting to relieve your symptoms. In addition, you should:

  • Avoid high-fiber foods like whole grains, which can worsen symptoms
  • Drink plenty of water so you can prevent dehydration

Probiotic supplements and certain OTC drugs (like loperamide) may also help you manage your diarrhea.

“Diarrhea, which is associated with antibiotic use, resolves upon stopping the drug. If it persists, you need to consult your doctor as this may be a symptom of Clostridium difficile infection,” says our in-house expert and medical practitioner, Dr. Rizza Mira.

Loss of Appetite

Continue to eat during expected meal times, even if you’re not hungry. You can also try to eat smaller but frequent meals and snacks as often as you can.

Remember to eat nutritious foods so you can get as many nutrients as you can.

Feeling Tired or Dizzy

If you feel dizzy or tired when attempting to stand up, get up slowly or stay in your seat until you feel well enough to stand up.

If you feel dizzy or tired while in a standing position, lie down for a few minutes to prevent fainting and sit up as soon as you feel better.

Avoid lying down for prolonged periods because this can make the feeling worse.


Bright lights can worsen your headache. So you should dim the lights in your room, decrease the brightness of your screens, and limit your screen time.

Cover your windows with blackout curtains while indoors. If you need to go out during the daytime, wear sunglasses to protect your eyes. 

Get plenty of rest and water, and ask your doctor to recommend a painkiller.

Increased Sensitivity to Sunlight

Wear clothes that cover up your skin when heading outdoors. Apply sunscreen with at least SPF 30 or higher, especially on areas exposed to sunlight.

You should avoid tanning beds so your skin doesn’t burn.

What Should I Do Before Taking Azithromycin?

Before taking azithromycin, let your doctor know if you’re allergic to other macrolide antibiotics such as clarithromycin, erythromycin, and telithromycin.

Your doctor may suggest alternatives if you’re potentially allergic to azithromycin. 

Inform them if you’re taking other drugs that can interact with azithromycin, or if you have a medical history or currently have the following conditions:

Some Drugs That Interact with Azithromycin

  • Amiodarone
  • Atorvastatin
  • Chloroquine
  • Coumadin
  • Digoxin
  • Disopyramide
  • Dofetilide
  • Hydroxychloroquine
  • Ibutilide
  • Lovastatin
  • Nelfinavird
  • Procainamide
  • Quinidine
  • Rifabutin
  • Sotalol
  • Theophylline
  • Warfarin

Contraindications for Azithromycin

  • Abnormal liver function
  • Cystic fibrosis
  • Diarrhea
  • Kidney or liver disease
  • Heart disease (e.g., congestive heart failure)
  • Heart rhythm disorders (e.g., long QT syndrome, slow heartbeat)
  • Low magnesium levels (hypomagnesemia)
  • Low potassium levels (hypokalemia)
  • Severe muscle weakness (e.g., myasthenia gravis)
  • Weakened immune system
  • You’re currently pregnant or breastfeeding

These drugs and medical conditions puts you at an increased risk for serious side effects, and it may not be safe for you to take azithromycin.

Your doctor can decide if you can take azithromycin, what dosage they should give you, and which precautions you need to take.

This is to ensure your safety and reduce your risk for adverse effects.

What to Use Instead of Azithromycin

If your doctor determines that azithromycin isn’t safe for your health, they can suggest other antibiotics to treat your condition.

Some possible alternatives to azithromycin include:

  • Amoxicillin
  • Amoxicillin-clavunate
  • Doxycycline
  • Levofloxacin

What Should I Do When Taking Azithromycin?

Follow your doctor’s prescription. Do not take azithromycin any more or less than the prescribed dose, and not for longer periods than what your doctor advised.

Take azithromycin at the same time each day and at evenly spaced times. This may help minimize your risk for side effects.

Even if you start to feel better, you shouldn’t stop taking azithromycin earlier than expected. Continue your treatment as prescribed by your physician.

Stopping your medication too early may cause bacteria to continue growing, which can lead to reinfection.

Here are more tips depending on the form you’re taking:

  • Azithromycin tablets and capsules should be taken whole with water
  • Capsules must be taken one hour before food or two hours after
  • Azithromycin tablets or liquids can be taken with or without food
  • When taking it in liquid form, use the syringe or spoon that comes with your medication so you can measure the right amount

Azithromycin liquids can leave a bitter aftertaste on your child’s mouth. You can give your child sweet juice afterward to lessen its effects.

What to Do If You Miss a Dose of Azithromycin

Take the missed dose of oral azithromycin as soon you remember, unless it’s almost time for your next dose. In this case, you should leave out the missed dose and take the next dose as scheduled.

Never take two doses of azithromycin simultaneously to make up for the missed dose. Call your doctor if you miss two or more doses consecutively.

What Not to Take with Azithromycin

Do not take antacids containing aluminum or magnesium with azithromycin. Some examples are Acid Gone,  Milk of Magnesia, and Pepcid Complete.

You should also avoid taking the drug with alcohol. Taking antacids and drinking alcohol at the same time as azithromycin can make it less effective. 

If you need to take antacids, take azithromycin two hours before or after. Other medications you should not take with this antibiotic drug are:

  • Bepridil
  • Cisapride
  • Dihydroergotamine
  • Dronedarone
  • Ergoloid Mesylates
  • Ergonovine
  • Ergotamine
  • Levoketoconazole
  • Methylergonovine
  • Methysergide
  • Pimozide
  • Piperaquine
  • Saquinavir
  • Sparfloxacin
  • Terfenadine
  • Thioridazine
  • Ziprasidone

When to See a Doctor About Azithromycin Side Effects

Serious allergic reactions and life-threatening side effects require immediate medical attention. Call your doctor and seek emergency medical help if:

  • You have a faster heart rate (tachycardia) or an irregular heart rhythm (arrhythmia) accompanied by chest pain or tightness of the chest
  • You have serious skin reactions that affect many parts of your body
  • Your mouth, face, lips, tongue, or throat become swollen
  • You find it difficult to breathe or talk
  • Your throat is tightening up

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Updated on January 31, 2024
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1 sources cited
Updated on January 31, 2024
  1. Types of Adverse Drug Reactions.” MSD Manual Consumer Version. 

Dr. Rizza Mira
Dr. Rizza Mira
Medical Reviewer
Dr. Rizza Mira is a medical doctor and a general practitioner who specializes in pediatrics, nutrition, dietetics, and public health.

As a pediatrician, she is dedicated to the general health and well-being of children and expecting parents. She believes that good nutrition, a healthy lifestyle, and prevention of illness are key to ensuring the health of children and their families.

When she’s not in the hospital, Rizza advocates and mobilizes causes like breastfeeding, vaccination drives, and initiatives to prevent illness in the community.
Ada Sandoval
Ada Sandoval
Content Contributor
Ada Sandoval is a B.S. in Nursing graduate and a registered nurse with a heart for abandoned animals. She works as a content writer who specializes in medical-related articles and pet health.
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