Drug & supplement interaction

Coconut Water + 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 Coconut Water 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

Coconut Water 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 Coconut Water 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.

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.

Coconut Water safety at a glance

Coconut Water overall Generally safe Generally safe as a beverage for most healthy adults in normal amounts.
Pregnancy Use caution Likely fine as a food/drink in moderation, but discuss regular use with your provider.
Breastfeeding Use caution Likely fine as a drink in moderation; limited formal safety data exists.

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

Still wondering about combining Azithromycin and Coconut Water? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Azithromycin

Interactions in our licensed database are recorded against drug classes, not just single drug names. Azithromycin is filed under 7 classifications — including macrolide antibiotics, qt interval-prolonging drugs, antibiotic drugs. Coconut Water has documented interactions with 3 drug classes — the most serious being antihypertensive drugs (moderate), quinolone antibiotics (moderate) and antidiabetes drugs (minor) — and none of Azithromycin’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Coconut Water Does Interact With Other Medications

Coconut Water has 193 moderate, 86 minor known drug interactions in our database — Azithromycin isn’t one of them. If you take anything else, check it against the full list below.

Moderate 193 Minor 86 No known interaction 2,551 (incl. Azithromycin)
Taking anything else?

Check Another of Your Medications Against Coconut Water

Covers the 2,830 medications we’ve checked against Coconut Water. Pick one to open its full report.

What to actually watch for

No Interaction Found — But Data Suggests Coconut Water 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. One of them is worth acting on rather than waiting out — marked below.

  • Seizures Worth acting on Additional detail

    Coconut Water

    “In one case report, a 35-year-old female consumed 3 liters of coconut water at the onset of labor. After delivery, the full-term neonate experienced seizures, and severe hyponatremia (113 mEq/L) was identified. The infant required treatment with infusions of 3% hypertonic sodium chloride along with 10% dextrose in normal saline.”

    Coconut Water · Natural Medicines adverse-effect record, reported in epilepsy.

    1 source cited
    1. 115939. Soriano LP, Rollins MD, Barreto Chang OL. Case Report of Hyponatremic Seizures in a Term Neonate Attributed to Excessive Maternal Coconut Water Ingestion During Labor. A A Pract 2024;18(7):e01815. PubMed

    Azithromycin

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

  • Sweating / Nausea / Vomiting reported in 5.8% of FDA reports for Azithromycin Additional detail

    Coconut Water

    “In one case report, a 69-year-old male died within approximately 30 hours of consuming a small amount of coconut water that was found to contain 3-nitropropionic acid due to spoilage with Arthrinium saccharicola. About 3 hours after consumption, the patient developed sweating, nausea, and vomiting, and was in a state of reduced consciousness when presenting to the hospital about 1.5 hours later.”

    Coconut Water · Natural Medicines adverse-effect record, reported in nausea and vomiting.

    1 source cited
    1. 107670. Birkelund T, Johansen RF, Illum DG, et al. Fatal 3-nitropropionic acid poisoning after consuming coconut water. Emerg Infect Dis 2021;27(1):278-280. PubMed

    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 Coconut Water but not commonly for Azithromycin: low sodium and confusion.

Effects for Azithromycin come from the ADVERSE REACTIONS section of its FDA label; effects for Coconut Water 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 Coconut Water 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 Coconut Water 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 Coconut Water 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

One more smart check

Taking Coconut Water as Part of a Dietary Supplement Product? Check It for Interactions

We hold 67 real supplement products containing Coconut Water, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Coconut Water. Even though Coconut Water itself has no known interaction with Azithromycin, another ingredient on your label might. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Coconut Water 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 Coconut Water
Top half

#394 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 Coconut Water reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 13, 2026. The Coconut Water and Azithromycin records this page draws on were last updated July 11, 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 Coconut Water

What is Coconut Water?

Coconut Water
  • Hydration
  • Rehydration after exercise
  • Electrolyte replacement
  • General wellness drink
  • Blood pressure support

Coconut water is a natural drink rich in potassium and other electrolytes that many people use for hydration, especially around exercise. For most healthy people it is a safe, tasty beverage, but it is not a proven medicine and should not replace medical electrolyte solutions for serious dehydration. People with kidney disease or those on potassium-affecting medicines should check with their pharmacist or doctor first.

Cocos nucifera · Arecaceae · Liquid (water) from young green coconuts · Fresh from young coconuts, bottled or canned drinks, powders

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

Coconut Water: dosing

There is no official or standardized medical dose for coconut water—it is a food and beverage, not a regulated medicine. Most people simply drink one serving (about 8 to 12 ounces) as they would any other drink.If you are using a packaged product, follow the serving size on the label and check the sodium, sugar, and potassium content.

From our Coconut Water monograph — the full record covers uses, side effects and every documented interaction.

Read the full Coconut Water 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 & Coconut Water

Browse every other medication we’ve checked against Coconut Water — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
193Moderate
86Minor
2,550No known interaction
193 Moderate 86 Minor 2,550 No interaction
Moderate

193 interactions

Showing 60 of 193 moderate interactions — see all 193 on the Coconut Water page.

Minor

86 interactions

Showing 60 of 86 minor interactions — see all 86 on the Coconut Water page.

No interaction 2,550 drugs checked — show the list

We also checked Coconut Water against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,550 medications checked with no known interaction — see the full Coconut Water list.

See the full Coconut Water interactions page
See every supplement checked against Azithromycin, ranked by severity
Evidence & sources

Coconut Water References

The 5 references that drive our Coconut Water 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. Alleyne T, Roache S, Thomas C, Shirley A. The control of hypertension by use of coconut water and mauby: two tropical food drinks. West Indian Med J 2005;54:3-8. PubMed
  2. Birkelund T, Johansen RF, Illum DG, et al. Fatal 3-nitropropionic acid poisoning after consuming coconut water. Emerg Infect Dis 2021;27(1):278-280. PubMed
  3. Alatawi KA, Alshubaily FA. Coconut products alleviate hyperglycaemic, hyperlipidimic and nephropathy indices in streptozotocin-induced diabetic wistar rats. Saudi J Biol Sci. 2021;28(8):4224-4231. PubMed
  4. Dai Y, Peng L, Zhang X, et al. Effects of coconut water on blood sugar and retina of rats with diabetes. PeerJ. 2021;9:e10667. PubMed
  5. Soriano LP, Rollins MD, Barreto Chang OL. Case Report of Hyponatremic Seizures in a Term Neonate Attributed to Excessive Maternal Coconut Water Ingestion During Labor. A A Pract 2024;18(7):e01815. 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 Coconut Water and Azithromycin Together: Common Questions

Is it safe to take Coconut Water with Azithromycin?
We do not list a known interaction between Coconut Water 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 Coconut Water and Azithromycin have any of the same side effects?
Yes — our sources link each of them separately to 4 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.
How was the Coconut Water and Azithromycin combination checked?
Interactions in our licensed database are recorded against drug classes. Azithromycin is filed under 7 classifications, and Coconut Water has documented interactions with 3 drug classes — none of Azithromycin's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Coconut Water interact with any other medications?
Yes. Coconut Water has 279 documented drug interactions in our database — Azithromycin is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Azithromycin interact with any supplements?
Yes. Azithromycin has documented interactions with 92 supplements in our database — Coconut Water 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

Coconut Water 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 5 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Azithromycin and Coconut Water?

Our pharmacists answer your medication & supplement questions — free.

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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.