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Amoxicillin and Z-pak (Zithromax, Zithromycin, Azithromycin) -- Antibiotics Used to Treat Infections -- Questions and Drug Interactions

CAUTION: Be sure to take amoxicillin or the Z-pak (Zithromax, zithromycin, azithromycin) until the prescription is finished, unless directed otherwise by your physician. They may be taken with or without food. Make sure all your health care providers have a complete list of your medications, including over-the-counter medications, herbals and vitamins.

Amoxicillin questions are first, followed by Z-pak questions.

Can I take amoxicillin with:

Aleve? Yes. Take Aleve (naproxyn sodium) with food or milk.
Allegra D (Fexofenadine with Pseudoephedrine)? Yes. They may be taken together. Take the amoxicillin until finished.  If you have high blood pressure or heart disease, talk to your doctor before taking Allegra D.
Atarax and Mucinex? Yes. They all may be taken together. Take Atarax and Mucinex as needed, and drink plenty of fluids. Atarax can cause drowsiness.
Azithromycin? Yes. There are no direct drug interactions between these two antibiotics. Normally you would take azithromycin (Z-pak) daily in the morning for 5 days and amoxicillin 2 or 3 times daily for 10 days. They may be taken with or without food. Take them at the same times each day.
Benadryl (Diphenhydramine)? Yes. Benadryl can cause drowsiness. Take as needed. You may take both with food, and drink plenty of water.
Benylin Cold and Flu Capsules? Yes. Take the cold medication only as needed. Drink plenty of water. Take Tylenol (acetaminophen) for fever.
Carbatrol (carbamazepine)? Yes.
Cetirizine (Zyrtec)? Yes. They may be taken together. Take amoxicillin as instructed until gone.
Chemotherapy? Talk with your oncologist. All your physicians -- including your pharmacy --  should know about your chemotherapy.
Clarithromycin (Biaxin) and Zithromax (Azithromycin)? Although an interaction is possible, these drugs may be used together safely. Macrolides (such as Zithromax and clarithromycin) may interfere with the killing action of penicillins (amoxicillin). These medications may be given together to treat certain infections. Have all these been prescribed by the same physician?  If not, tell all your health care providers what you are taking or have been prescribed.  If these drugs must be given together, take the amoxicillin first. 
Clonazepam? Yes.
Clonazepam and Zoloft? Yes.
Dairy Products? Yes. Amoxicillin may be taken with food, milk and other dairy products.
DayQuil? Yes. They may be taken together. Take the DayQuil as needed. Drink plenty of water while taking the DayQuil.
Keflex? No. I see no reason to take these drugs at the same time. Amoxicillin is a synthetic penicillin derivative. Keflex (cephalexin) is a first-generation cephalosporin, a synthetic compound based on the penicillin molecule. Verify with your doctor why you need both. They have similar indications and activity.
Levaquin (Levofloxacin) Yes. Take both until finished. The main side effect of antibiotics is GI symptoms. If you notice diarrhea, try eating yogurt or taking a probiotic product.
Levoxyl? Yes. Take Levoxyl 30 minutes before breakfast.
Lisinopril (Prinivil, Zestril)? Yes. They may be taken together. Take lisinopril every day as prescribed and amoxicillin until finished.
Loratadine (Claritin)? Yes. Normally you would only take one loratadine daily -- in the morning with plenty of water. Amoxicillin is safe to take with any antihistamine.
Lorazepam (Ativan) and Prilosec (Omeprazole)? Yes. Lorazepam can cause drowsiness and is normally taken only as needed. If you take Prilosec for GERD (esophageal reflux), take this every day. If this is for ulcers, this is normally taken for two to four weeks.
Metformin (Glucophage)? Yes. Take metformin on an empty stomach.
Methotrexate There can be drug interactions between methotrexate and any type of penicillin including Amoxil (amoxicillin).  Amoxil has a fairly short half life so taking these four days apart should not be a problem. If you get fever, chills, unusual bleeding or bruising, severe stomach pain, mouth sores or other side effects of methotrexate, notify your health care provider immediately.
Methotrexate for a Urinary Tract Infection? No. There is a major interaction between methotrexate and amoxicillin. Taken together there is a greater chance of methotrexate toxicity. Several days is enough in between to take these different drugs, but amoxicillin is not normally prescribed for urinary tract infections. There are other drugs that are indicated for UTIs. Call your physician. Until your doctor sees you or sends you medications, drink cranberry juice and if you have pains, get phenazopyridine at the pharmacy. This is a dye to coat the urinary tract, and it eliminates the pain.
Midol? Yes. There should not be a problem with plain Midol and any antibiotic. Take Midol as needed.
Mucinex? Yes. You may take Mucinex (guaifenesin) with any antibiotic.
Mucinex and Ibuprofen? Yes. Drink plenty of water with the Mucinex, and take ibuprofen with food.
Naproxen? Yes. Amoxicillin may be taken with NSAIDs. Any NSAIDs should be taken with food or milk. Take naproxen as needed.
Naproxen and NyQuil? Yes. There are no direct drug interactions between amoxicillin, naproxen (Naprosyn/Aleve) and Vicks NyQuil (acetaminophen, dextromethorphan, doxylamine, pseudoephedrine). They may be taken together. Take the amoxicillin until finished, naproxen with food or milk and NyQuil as needed.
NyQuil? Yes. They may be taken together. Take the amoxicillin until complete. NyQuil can cause drowsiness. Some NyQuil formulations also have a decongestant, which can elevate blood pressure. If you have high blood pressure or heart disease, talk to your doctor before taking NyQuil. 
Paroxetine and Ativan? Yes. They may be taken together, but watch for drowsiness. Take paroxetine at the same time each day. Do not stop or change doses unless instructed by your doctor. Take Ativan as needed. Avoid alcohol.
Phenazopyridine (Pyridium, Azo Standard)? Yes. Take azithromycin until finished. Drink plenty of water with the phenazopyridine (which will change the color of the urine, so don't be alarmed).
Phentermine? Yes. They may be taken together. Phentermine is normally taken once daily in the morning. If you have high blood pressure, heart disease or take an SSRI, talk to your doctor before taking this drug.
Prednisolone? Yes. Prednisolone is a steroid that may be taken with amoxicillin. Always take prednisolone with food or milk. Take both until completed, unless instructed otherwise by the prescribing physician.
Rondec DM (Chlorpheniramine, Dextromethorphan and Phenylephrine)? Yes. They may be taken together if needed. Take amoxicillin until finished and Rondec only as needed. Rondec can cause drowsiness. Be careful if you must be alert.
Soma (Carisoprodol)? Yes. Soma can cause drowsiness. Take as needed.
Sudafed (Pseudoephedrine)? Yes. If you have heart problems or high blood pressure, talk to your doctor before taking Sudafed. It can constrict blood vessels and increase blood pressure.
Tramadol (Ultram)? Yes. Take tramadol as needed. It can cause drowsiness.
Tylenol? Yes. Do not take more than 3000mg of Tylenol (acetaminophen) per day.
Tylenol Cold/Flu? Yes. If you have high blood pressure or heart disease, speak to your doctor before taking any oral decongestant.
Vitamins? Yes. Generally speaking, amoxicillin may be taken with vitamins and vitamin/mineral combinations without any problem.
Wine? Yes. Amoxicillin is not affected by food or minimal amounts of alcohol.
Xanax (Alprazolam)? Yes. Take Xanax as needed. Xanax can cause drowsiness.
Zicam (Zinc Gluconate)? Yes. These may be taken together, with or without food, and with dairy products.
Zoloft (Sertraline)? Yes. They may be taken together if needed. Take amoxicillin as directed until finished. Take Zoloft at the same time each day.
Zoloft (Sertraline) and Robitussin (Guaifenesin)? Yes. They may be taken together if needed. Take the amoxicillin until finished.  Take Robitussin only when needed, with plenty of water.
Zyrtec and Mucinex? Yes. If the dose timing works out, you could take them at the same time. Take Zyrtec and Mucinex as needed with plenty of water.
Zyrtec D? Yes. They may be taken together. If you have high blood pressure or heart problems, talk to your doctor before taking Zyrtec D. The D part can increase blood pressure. Take Zyrtec as needed.

Can I take lisinopril, hydrochloriazine and Augmentin?
The only possible drug interaction between lisinopril (Zestril), hydrochlorothiazine (HCTZ) and Augmentin (amoxicillin, clavulanic acid) does not
involve the antibiotic. The blood pressure and diuretic tablets can have a slight interaction. Although an interaction is possible, these drugs may be used together. To limit this interaction, do not stand or sit up too quickly. Contact your prescriber if you have dizziness which does not go away.
Take the antibiotic until finished. You may take this with food to reduce the chance of stomach upset or diarrhea.

Can you take amoxicillin clavulanic acid and levofloxacin?
Yes. Take each of these until finished. You may want to take the amoxicillin product with food or milk to prevent GI problems.

Is it safe to take 1/2 of a 37.5 phentermine while taking a Z-pak and prednisone and albuterol inhaler?
I would suggest avoiding the phentermine (Adipex) and albuterol (ProAir, Ventolin, Proventil). Taking the phentermine with albuterol can increase the risk of a fast heart rate, nervousness, palpitations, problems with sleep, or other side effects. Do not take Z-pak and albuterol together without approval from your prescriber. Although rare, taking these drugs together can increase the risk of a dangerous change in heartbeat or heart rhythm. Contact your doctor immediately if you experience chest pain, dizziness, fainting or fainting spells, palpitations, shortness of breath, or a change in your usual heart beat (such as fast or irregular heart beat). The side effects from albuterol may get worse if you take steroids like prednisone. Although an interaction is possible, these drugs are often used together.

I have to take amoxicillin 3 times a day. Can I take it every 6 hours?
Normally if you are to take something three times daily, I suggest to make it every 8 hours or as close as practical. Since amoxicillin is not affected by food, this works well. If your sleep pattern is longer than 8 hours, taking this every 6 hours while awake is fine. Take a dose when you get up, just before bedtime and one somewhere in the middle of your day. Take the amoxicillin until it is finished.

Can I take amoxicillin/clavulanate potassium with calcium together?
Yes. You should take the amoxicillin/clavulanate (Augmentin) with food. If you take other antibiotics, this may not be the same. Many antibiotics do interact with calcium and other mineral ions. Take the antibiotic until gone.

 

Z-Pak (Zithromax or Azithromycin)

What drugs interact with azithromycin?
The possible drug interactions with azithromycin (Zithromax) are not often seen, but can be a problem. Possible severe interactions: amiodarone, antacids, cephalosporins. Antacids are included, because they can defeat the effectiveness of the antibiotic.

The rest are more rare and less problematic. Dihydroergotamine (probable), Ergoloid Mesylates (probable), Ergonovine (probable), Ergotamine (probable), Methylergonovine (probable), Methysergide (probable), Disopyramide (probable), Digoxin (probable), Fentanyl (probable), Nelfinavir (probable), Rifabutin (probable), Theophylline (probable), Warfarin (probable), Pimozide (theoretical), Acecainide (theoretical), Azimilide (theoretical), Bretylium (theoretical), Dofetilide (theoretical), Ibutilide (theoretical), Propafenone (theoretical), Sematilide (theoretical), Sotalol (theoretical), Tedisamil (theoretical).

Whenever receiving a new prescription, ask the doctor and pharmacist about drug interactions with your current medications.

If you ever notice something out of the ordinary after beginning a new drug, notify your pharmacist and doctor as soon as you can.

Can I take a Z-pak (Zithromax or azithromycin), a long-acting erythromycin (macrolide) type of antibiotic, with:

Acyclovir (Zovirax)? Yes. They may be taken together. Take the Z-pak antibiotic (usually in the early morning) until finished. Acyclovir antiviral should be taken as prescribed by the physician.
Adderall? Yes. Take the Adderall (amphetamine salts) as prescribed and the Z-pak each day. If you run a fever, take Tylenol (acetaminophen) as needed.
Adipex (Phentermine), Mucinex DM (Guaifenesin with Dextromethorphan) and Topamax (Topiramate)? Yes. Take the azithromycin until finished. Take Mucinex DM as needed with plenty of water.
Advil? Yes. Z-pak may be taken with any NSAID like Advil (ibuprofen).
Alcohol?
I'd avoid alcohol with any medication, but that's not realistic. Z-pak, which may be taken with food, is an erythromycin derivative, with the main side effects involving the gastrointestinal tract: abdominal pain, diarrhea, nausea and vomiting. Alcohol irritates the stomach, so you may experience an increase in GI problems. Most people take the Z-pak dose in the morning. Assuming your alcohol consumption will be later in the day, there should not be a problem. If you do have stomach distress, do NOT take any antacid like Mylanta/Maalox/Tums with the Z-pak.
Aleve (Naproxen) and Flagyl (Metronidazole)? Yes. Take Zithromax early each morning until gone. Take Flagyl with meals until finished. Take Aleve with food or milk as needed.
Allegra D? Yes. There are no direct drug interactions between Allegra D (fexofenadine with pseudoephedrine) and azithromycin. You may take these together. If you have heart problems or high blood pressure, talk to your physician before taking this medication. Take azithromycin early in the day. Take Allegra as needed.
Allergy Capsules (Antihistamine and Diphenhydramine)? Yes. They may be taken together. Take the antibiotic early each morning until finished. It can cause drowsiness. Some long-acting antihistamines (Allegra, Zyrtec, Claritin) can interact with azithromycin -- the antibiotic blocks the breakdown of the antihistamine. This causes higher levels of the drug in your body, which can lead to increased chance of side effects.
Ativan? Yes. Ativan can cause drowsiness.
Avelox? Yes. There are no direct drug interactions with these antibiotics. Avelox (moxifloxacin) is a quinolone type, and the Z-pak an erythromycin type macrolide antibiotic. These are more specific for strep infections. Take the Z-pak each morning, and take the Avelox as prescribed.
Benadryl? Yes. Benadryl can cause drowsiness.
Ceftin? Yes. There are no direct drug interactions with these antibiotics. You may take them together; I would suggest early in the day with breakfast. Both can upset your stomach. Take them until complete. You may also want to take them with yogurt, as diarrhea is a common side effect.
Celebrex? Yes. Take Celebrex with a meal.
Cheratussin? Yes. There are no direct drug interactions between Zithromax and Cheratussin (guaifenesin with codeine). 
Claritin 24 Hours and Benadryl at Bedtime? Azithromycin is normally given early every day until finished. Taking Claritin and Benadryl is duplication of antihistamines. Claritin (loratadine) is less likely to cause drowsiness and has a much longer duration of action. Benadryl (diphenhydramine) is a short-acting antihistamine with a high incidence of drowsiness. That is why they use this drug to help people sleep. Do not take both unless advised by your physician. It makes more sense to take a 12-hour Claritin in the morning and Benadryl at bedtime. Always increase the fluid (water) intake while taking antihistamines.
Claritin D (Loratadine with Pseudoephedrine)? Yes. They may be taken together if needed. Take the azithromycin each morning until finished. Talk to your physician before taking any oral decongestant, if you have high blood pressure or heart problems.
Cough Syrup and an Inhaler? Not knowing what inhaler you mean, I can only answer for the azithromycin (Zithromax) and cough syrups in general. Azithromycin is fine with any plain dextromethorphan, with or without guaifenesin. It is usually fine with most cold medications also, but talk with your pharmacist. Take azithromycin to completion, and take the cough medication as needed.
Diphenhydramine (Benadryl)? Yes. Take the Z-pak early in the day. Take generic Benadryl as needed. It can cause drowsiness.
Flexeril? Yes. Take the antibiotic daily in the morning, until finished. Flexeril is a muscle relaxant that can cause drowsiness.
Guaifenesin with Codeine (Robitussin AC)? Yes. Take Zithromax until finished and guaifenesin with codeine as needed.  Drink plenty of water while taking these medications.
Halls Cough Drops? Yes. Gargle with warm salt water several times daily for a sore throat.
Hydrochlorothiazide (HCTZ)? Yes. You may take them together. Finish the antibiotic, normally taken once daily in the morning for 5 days. Hydrochlorothiazide is a potassium depleting diuretic. If you don't take a potassium supplement or eat potassium-containing foods, talk to your physician about  a blood test. Potassium is in most fruits and vegetables. The #1 food is bananas. Cantaloupe, potatoes, tomatoes, nuts, seeds, raisins, oranges, eggplant and spinach all contain high amounts of potassium.
Hydroxyzine (Atarax)? Yes. Zithromax should be given daily in the morning until finished. Hydroxyzine is a very strong antihistamine product that causes drowsiness. Take only as needed.
Ibuprofen? Yes.
Indocin? Yes. Take azithromycin early each morning. Take Indocin after meals or with a glass of milk to avoid stomach upset. Take as needed for gout. If your physician has not given you a diet to follow to assist in the prevention of gout, ask for one.
Lexapro (Escitalopram)? Yes. They may be taken together. Take azithromycin until finished.
Librax and Ofloxacin? Yes. Neither of these antibiotics, or others in the same class of antibiotics, will interact with Librax.
Lipitor?
Yes. Take the Z-pak in the morning. Take Lipitor every day at the same time. Make sure you have an annual blood test for the Lipitor.
Loratadine (Claritin, Alavert), Fluticasone (Flonase), Lisinopril (Zestril) and Lipitor (Atorvastatin)?

Yes. Take azithromycin until finished, take lisinopril and Lipitor as prescribed, and use loratadine and fluticasone when needed as prescribed. These may all be taken together or throughout the day. Follow the directions of your doctor.
Maximum Strength Mucinex DM (1200mg guaifenesin & 60mg dextromethorphan) tablets?   Yes. They may be taken together if needed. Take azithromycin daily until gone and Mucinex DM as needed with plenty of water.
Methotrexate, Lorazepam and anti-inflammatories (plus antacids every now and then)?
Yes. Follow the dosing instructions.
Milk? Yes. Milk will not keep the medication from working. Zithromax's main side effect is GI upset, so take it with food or milk to avoid stomach upset.
Motrin or Tylenol? Yes, as long as there are no other reasons to avoid Motrin or Tylenol. Zithromax is normally given for a five-day course of therapy. Motrin (ibuprofen) is a NSAID for pain, fever or inflammation. Tylenol (acetaminophen) is for pain and fever. If Zithromax upsets your stomach, Motrin could aggravate the problem. Take with food or milk.
Mucinex DM? Yes. They may be taken together. Drink plenty of water with the Mucinex, and take the Z-pak until completion.
Mucinex DM and Zyrtec?
Yes. Take the Z-pak each morning. Drink plenty of fluids with the Mucinex DM (guaifenesin with dextromethorphan) and Zyrtec (cetirizine), and take these as needed.
Paxil CR and Plaquenil? Yes. Take the Z-pak early in the day. Take Paxil at the same time each day, and do not stop taking this drug without consulting your physician. Take Plaquenil with food.
Phenazopyridine (Pyridium, Azo Standard)? Yes. Take azithromycin until finished, and drink plenty of water with the phenazopyridine. It will change the color of the urine, so don't be alarmed.
Phenergan (Promethazine)? Yes. You may take these together. Take the antibiotic until finished. Take Phenergan as needed. It can cause drowsiness.
Phentermine? Yes. They may be taken at the same time. Take the Z-pak in the morning.
Phenylephrine (Sudafed)? Yes. Take azithromycin early in the morning. If you have high blood pressure or heart problems, talk with you doctor before taking decongestants like phenylephrine or pseudoephedrine. They can constrict vessels and cause increased blood pressure.
Prednisone? Yes. Take each as prescribed. If you take prednisone (a steroid) once a day, take it in the morning with food.
Promethazine? Yes. Azithromycin should be taken early each morning until finished. Promethazine, which can cause drowsiness, should be taken as needed.
Promethazine with Codeine Cough Syrup? Yes. There are no direct drug interactions between promethazine with codeine (Phenergan with codeine) and azithromycin (Zithromax). They may be taken together. Take azithromycin until it is finished. Take promethazine with codeine as needed. It can cause drowsiness.
Protonix? Yes.
Robitussin?
Yes. Take the Z-pak every morning and Robitussin as needed. Drink plenty of water with the Robitussin to help it work more efficiently.
Septra DS? Yes. Septra DS (sulfamethoxazole with trimethoprim) is a sulfa antibiotic that must be taken with plenty of water.
Sudafed (pseudoephedrine)? Yes. Take Sudafed until the symptoms go away. If you have high blood pressure or heart problems, talk to your physician before taking Sudafed.
Tums? Yes. Take azithromycin each morning until finished. Make sure you let all your health care providers know that you take Tums, as the calcium does interact with many other medications.
Tylenol Sinus? Yes. Take Tylenol as needed with plenty of fluids.
Valacyclovir? Yes. They may be taken together.
Vitamin D after a Thyroid Ablation?
 
Yes. There are no direct drug interactions between the Z-pak, thyroid hormone and vitamin D (ergocalciferol). Take the Z-pak and thyroid medicine before breakfast. Take vitamin D any time during the day.
Wine? Yes. As long as you are only taking azithromycin (no other medications), are over 21, are not planning to drive after drinking, have no other problems or reasons not to ingest alcohol, and mean a typical 5-ounce serving.
Xanax? Yes. Take the Z-pak early each day. Xanax can cause drowsiness.
Zantac (Ranitidine), Delsym (dextromethorphan) and Acyclovir (Zovirax)? Yes. They may actually be taken together if needed.  Take the Zithromax until finished, the Zantac and acyclovir as prescribed and the Delsym as needed.
Zinc Capsules for a Blister on my Lip? Yes. Take azithromycin in the morning each day and the zinc until the sore clears. If this is a recurring problem, talk to your physician about an antiviral cream.
Zoloft? Yes.
Zyrtec? Yes. Take the antibiotic early in the day and until completely finished.

I recently heard about the Z-Pack causing fatal irregular heart beats. Can I take this with my Amlodipine5MG, Bystolic 2.5MG and Zoloft 100MG?
There are no direct drug interactions between Z-Pak (azithromycin) and any of the other three medications. This drug is normally prescribed for a five-day therapy. Cardiovascular adverse reactions associated with azithromycin therapy that have been reported in less than 1 percent of patients.

Can I take echinacea and goldenseal with amoxicillin?
Yes.

If I am allergic to Zithromax, will I be allergic to Zyrtec?
There is no cross sensitivity between an allergy to Zithromax and Zyrtec (cetirizine). You would be safe to take Zyrtec if needed.

If I took a one course dose of azithromycin 4 days ago, is it ok to drink alcohol?
Are you under 21? Are there any reasons, other than the azithromycin that you should not have alcohol? If you answer "no" to both, it should be OK to have a drink of alcohol. Do not drink and drive, fly an airplane or pilot a boat.

Does the Z-pak raise blood pressure?
There are no contraindications for Z-pak with hypertension or high blood pressure. There can be issues if the patient has risks of cardiac arrhythmia or cardiac repolarization with prolonged QT intervals. This is an "electrical" conduction problem some people have and another reason to make sure all of your health care providers have an up-to-date list of your medications and chronic conditions.

 
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