Drug & supplement interaction

Beta-hydroxybutyrate (bhb) + Azithromycin

Azithromycin brand names: Zithromax, Zmax, Azasite.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 13, 2026
The bottom line No known interaction

We found no known interaction between Beta-hydroxybutyrate (bhb) and Azithromycin in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

Beta-hydroxybutyrate (bhb) and Azithromycin

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Azithromycin and Beta-hydroxybutyrate (bhb) in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

Worth understanding: our licensed dataset holds no drug-interaction record for Beta-hydroxybutyrate (bhb) at all — not against Azithromycin, and not against any other medication we track. This verdict therefore rests on the absence of any recorded data, not on research that looked at this combination and found nothing. We cannot rule an interaction out.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Beta-hydroxybutyrate (bhb) safety at a glance

Beta-hydroxybutyra... overall Use caution Generally tolerated short-term but may cause stomach upset and adds significant minerals or sodium; long-term safety is not well studied.
Pregnancy Avoid Not enough safety data; avoid during pregnancy unless your doctor advises otherwise.
Breastfeeding Avoid Not enough safety data; best to avoid while breastfeeding.

Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Azithromycin and Beta-hydroxybutyrate (bhb)? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
What to actually watch for

No Interaction Found — But Data Suggests Beta-hydroxybutyrate (bhb) and Azithromycin May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do.

  • Bloating or gas / Constipation / Stomach pain Additional detail

    Beta-hydroxybutyrate (bhb)

    “Orally, BHB may cause indigestion, diarrhea, nausea, gastrointestinal upset, and vomiting in some patients. In a small crossover study, nausea, diarrhea, and vomiting were reported in 37%, 16%, and 11% of patients, respectively, taking two 0.38 gram/kg doses of BHB salts separated by 45 minutes on a single day.”

    Beta-hydroxybutyrate (bhb) · Natural Medicines adverse-effect record, reported in constipation.

    4 sources cited
    1. 96084. Gautschi M, Weisstanner C, Slotboom J, Nava E, Zürcher T, Nuoffer JM. Highly efficient ketone body treatment in multiple acyl-CoA dehydrogenase deficiency-related leukodystrophy. Pediatr Res. 2015;77(1-1):91-8. PubMed
    2. 96096. Gross EC, Sandor P, Fischer D. Preliminary data on exogenous ketone bodies in migraine prevention. Cephalalgia 2017; 37(1S) 52-171.
    3. 102024. Evans M, Patchett E, Nally R, Kearns R, Larney M, Egan B. Effect of acute ingestion of β-hydroxybutyrate salts on the response to graded exercise in trained cyclists. Eur J Sport Sci. 2018;18(3):376-86.
    4. 96088. Clarke K, Tchabanenko K, Pawlosky R, et al. Kinetics, safety and tolerability of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate in healthy adult subjects. Regul Toxicol Pharmacol. 2012;63(3):401-8. PubMed

    Azithromycin

    Listed in the ADVERSE REACTIONS section of the FDA label for Azithromycin. Read the label on DailyMed ›

  • Stomach upset / Diarrhea / Nausea / Vomiting reported in 5.8% of FDA reports for Azithromycin Additional detail

    Beta-hydroxybutyrate (bhb)

    “Orally, BHB seems to be well-tolerated. However, a thorough evaluation of safety outcomes has not been conducted.

    Most Common Adverse Effects:

    Orally: Diarrhea, gastrointestinal upset, indigestion, mild dehydration, nausea, and vomiting.”

    Beta-hydroxybutyrate (bhb) · Natural Medicines adverse-effect record, reported in diarrhea.

    Azithromycin

    Listed in the ADVERSE REACTIONS section of the FDA label for Azithromycin, and in voluntary FDA adverse-event reports. Read the label on DailyMed ›

Reported for Beta-hydroxybutyrate (bhb) but not commonly for Azithromycin: dehydration.

Effects for Azithromycin come from the ADVERSE REACTIONS section of its FDA label; effects for Beta-hydroxybutyrate (bhb) come from the Natural Medicines adverse-effect record, quoted above. Where a percentage is shown, it is the share of 59,712 voluntary FDA FAERS reports for Azithromycin that mention that effect — a reporting proportion, not an incidence rate and not evidence the drug caused it. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

From our Q&A

Questions About Beta-hydroxybutyrate (bhb) or Azithromycin

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Beta-hydroxybutyrate (bhb) or Azithromycin, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Azithromycin

This page covers Beta-hydroxybutyrate (bhb) only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Azithromycin page lists 92 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), Arsenic (major), Cesium (major) and Ephedra (major).

By severity: 8 major · 71 moderate · 13 minor.

From our pharmacist’s overview on the Azithromycin page

“A five-day Z-Pak for a sinus or chest infection seems too brief to fuss over, but azithromycin (Zithromax, Zmax) deserves genuine caution around supplements, and the eight major-rated entries on this list are the ones to understand first. Most of those involve the heart.”

Reviewed by 2 · Jul 18, 2026

Open the Azithromycin interaction page

How much people look this up

Where Beta-hydroxybutyrate (bhb) and Azithromycin Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Beta-hydroxybutyrate (bhb)
Steady interest

#1,432 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Azithromycin
Top 5%

#60 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Beta-hydroxybutyrate (bhb) reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 13, 2026. The Beta-hydroxybutyrate (bhb) and Azithromycin records this page draws on were last updated July 10, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
Supplement

About Beta-hydroxybutyrate (bhb)

What is Beta-hydroxybutyrate (bhb)?

Beta-hydroxybutyrate (bhb)
  • Weight loss and fat burning
  • Boosting energy on a ketogenic diet
  • Athletic and exercise performance
  • Mental focus and clarity
  • Reducing 'keto flu' symptoms

Beta-hydroxybutyrate (BHB) is a ketone body your liver naturally makes when carbs are low, and it is sold as a supplement marketed for weight loss, energy, and athletic performance. Despite bold marketing claims, human evidence that BHB supplements help with weight loss or performance is limited and mixed. If you want to try it, talk with your pharmacist or doctor first, especially if you have kidney, heart, or blood pressure concerns.

Not applicable (a ketone body made by the body or produced as a synthetic salt) · Capsules, powders, drink mixes (often as BHB salts bound to sodium, calcium, magnesium, or potassium; also BHB esters)

An interaction check asks whether these two react with each other — it does not ask whether Beta-hydroxybutyrate (bhb) is a good idea for someone in your situation. Here is what our Beta-hydroxybutyrate (bhb) record says about it on its own.

Beta-hydroxybutyrate (bhb): dosing

There is no official, standardized dose of BHB. Products vary widely in how much BHB they contain and which minerals they are paired with.The best approach is to follow the directions on the product label and not exceed them. Many people start with a smaller amount to see how their stomach reacts before using more.Because mineral content matters, check how much sodium, calcium, magnesium, or potassium each serving provides.

From our Beta-hydroxybutyrate (bhb) monograph — the full record covers uses, side effects and every documented interaction.

Read the full Beta-hydroxybutyrate (bhb) monograph & all interactions
Medication

About Azithromycin

What Is Azithromycin Used For?

Brand names: Zithromax, Zmax, Azasite

  • 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.

  • 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.

Most-Reported Side Effects for Azithromycin

From FAERS, the FDA’s public side-effect reporting system (59,712 reports, all brands). Reports are voluntary and are not proof the drug caused the effect.

Dyspnea 4,651 reports
Nausea 3,461 reports
Pneumonia 3,225 reports
Cough 3,120 reports
Drug hypersensitivity 2,991 reports
See full Azithromycin drug information
Keep checking

Other Drugs & Beta-hydroxybutyrate (bhb)

Browse every other medication we’ve checked against Beta-hydroxybutyrate (bhb) — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
0Moderate
0Minor
2,829No known interaction
2,829 No interaction
No interaction 2,829 drugs checked — show the list

We also checked Beta-hydroxybutyrate (bhb) against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,829 medications checked with no known interaction — see the full Beta-hydroxybutyrate (bhb) list.

See the full Beta-hydroxybutyrate (bhb) interactions page
See every supplement checked against Azithromycin, ranked by severity
Evidence & sources

Beta-hydroxybutyrate (bhb) References

The 6 references that drive our Beta-hydroxybutyrate (bhb) monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Gautschi M, Weisstanner C, Slotboom J, Nava E, Zürcher T, Nuoffer JM. Highly efficient ketone body treatment in multiple acyl-CoA dehydrogenase deficiency-related leukodystrophy. Pediatr Res. 2015;77(1-1):91-8. PubMed
  2. Van Rijt WJ, Heiner-Fokkema MR, du Marchie Sarvaas GJ, et al. Favorable outcome after physiologic dose of sodium-D,L-3-hydroxybutyrate in severe MADD. Pediatrics. 2014;134(4):e1224-8.
  3. Clarke K, Tchabanenko K, Pawlosky R, et al. Kinetics, safety and tolerability of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate in healthy adult subjects. Regul Toxicol Pharmacol. 2012;63(3):401-8. PubMed
  4. Gross EC, Sandor P, Fischer D. Preliminary data on exogenous ketone bodies in migraine prevention. Cephalalgia 2017; 37(1S) 52-171.
  5. Evans M, Patchett E, Nally R, Kearns R, Larney M, Egan B. Effect of acute ingestion of β-hydroxybutyrate salts on the response to graded exercise in trained cyclists. Eur J Sport Sci. 2018;18(3):376-86.
  6. Malhi MS, Duerson F, Salabei JK, Okonoboh P. Starvation Ketoacidosis Induced by Ketogenic Diet and Consumption of Ketone Supplement. Cureus. 2021;13(6):e15778. Published 2021 Jun 20. PubMed

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Beta-hydroxybutyrate (bhb) and Azithromycin Together: Common Questions

Is it safe to take Beta-hydroxybutyrate (bhb) with Azithromycin?
We do not list a known interaction between Beta-hydroxybutyrate (bhb) and Azithromycin. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do Beta-hydroxybutyrate (bhb) and Azithromycin have any of the same side effects?
Yes — our sources link each of them separately to 7 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
Does Azithromycin interact with any supplements?
Yes. Azithromycin has documented interactions with 92 supplements in our database — Beta-hydroxybutyrate (bhb) is not one of them. The Azithromycin interaction page linked on this page lists every one, ranked by severity.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Where next

Keep Exploring

Beta-hydroxybutyrate (bhb) monograph Uses, safety profile, and every drug interaction in one place Azithromycin drug information The full plain-English guide to this medication Azithromycin supplement interactions Every supplement checked against Azithromycin, ranked by severity Supplement interaction checker Check any supplement or product against your medications Browse medications A–Z Every drug we’ve checked against herbs & supplements References The 6 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Azithromycin and Beta-hydroxybutyrate (bhb)?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.