Apple Cider Vinegar - Zithromax (Azithromycin) Interaction
Herbal: Apple Cider Vinegar
Also Known As: ACV, Cider Vinegar, Vinagre de Manzana, Vinagre de Sidra de Manzana, Vinaigre de Cidre
Drug: Azithromycin
Brand names:
Zithromax, Zmax, Azasite
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
May 18, 2025
Interaction Details
There were no interactions found between Azithromycin and Apple Cider Vinegar. This does not mean the potential for an interaction does not exist, however. There is often a lack of studies and data surrounding traditional medicine, especially concerning drug interactions, so it is important to always consult your provider before making any changes to your medication regimen.
Pharmacist Analysis
The use of apple cider vinegar or the amounts of ACV in supplements is unlikely to cause clinically significant drug interactions at recommended dosages.
However, it is important to be aware of potential interactions, especially with medications that lower blood glucose levels, as these interactions have been theoretically proposed, but as I've written in my analysis on individual interaction detail pages, even this interaction is unlikely to be clinically significant for most.
In terms of side effects, it is uncommon for individuals to experience any adverse effects from taking ACV, but some mild side effects, such as nausea and indigestion, have been reported. It is important to consider that these side effects could be additive if taken with other medications that cause similar symptoms.
As always, it is important to consult with a healthcare provider before starting any new supplement, including ACV, to ensure its safe and appropriate use for your specific medical situation.
What About Antibiotics Like Azithromycin?
Apple cider vinegar is not known to interact with azithromycin. It isn't thought to affect the metabolism, absorption, or how the antibiotic works.
They are considered safe to take together.
Azithromycin can be taken with or without food, so the fact that apple cider vinegar is acidic should not have any effects on how cephalexin is absorbed.
Apple Cider Vinegar Overview
Apple cider vinegar, or ACV, is the fermented juice from crushed apples. ACV is typically made by crushing apples and adding yeast and bacteria to the mixture, which ferments the sugars in the apples and turns them into alcohol. This alcohol is then converted into vinegar through a second fermentation process. ACV contains pectin, vitamins, minerals, and acid in the form of acetic acid or citric acid. While it is most popularly used in salad dressings and cooking, apple cider vinegar has been used medicinally as it is thought to have antioxidant, anti-inflammatory, and antimicrobial properties, and may help to boost the immune system.
Azithromycin Overview
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Azithromycin is used to treat certain bacterial infections, such as bronchitis; pneumonia; sexually transmitted diseases (STD); and infections of the ears, lungs, sinuses, skin, throat, and reproductive organs. Azithromycin also is used to treat or prevent disseminated Mycobacterium avium complex (MAC) infection [a type of lung infection that often affects people with human immunodeficiency virus (HIV)]. Azithromycin is in a class of medications called macrolide antibiotics. It works by stopping the growth of bacteria.
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Antibiotics such as azithromycin will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.
Apple Cider Vinegar - More Interactions
Apple Cider Vinegar interacts with 160 drugs
Interaction Rating Key
These severity listings are for informational use only. Never start, stop or otherwise change your therapy before speaking with your provider.
| Major | The combined use of these agents is strongly discouraged as serious side effects or other negative outcomes could occur. |
| Moderate | Use cautiously under the care of a healthcare professional or avoid this combination. A significant interaction or negative outcome could occur. |
| Minor | Be aware that there is a chance of an interaction. Watch for warning signs of a potential interaction. |
| Unknown | No interactions have been reported or no interaction data is currently available. |
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Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC
Drug descriptions are provided by MedlinePlus.
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Dr. Brian Staiger, PharmD
In addition to being a clinical pharmacist specializing in pharmacotherapy, Dr. Brian Staiger is a registered herbalist through the American Herbalist Guild. He has combined his passion for pharmacy practice with the study of medical ethnobotany to improve patient care. Feel free to reach out about any of your herbal or medication questions!
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