Drug & supplement interaction

Lily-of-the-valley + Azithromycin

Azithromycin brand names: Zithromax, Zmax, Azasite.

Moderate Interaction
Medically reviewed by · Updated October 2026
The bottom line Moderate

Lily-of-the-valley has a moderate interaction with Azithromycin. Theoretically, using lily-of-the-valley with macrolide antibiotics can increase the risk of cardiac glycoside toxicity.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Lily-of-the-valley and Azithromycin

Here is the interaction we found between these two, with the evidence behind it.

Moderate

MACROLIDE ANTIBIOTICS

Why this applies to Azithromycin

Azithromycin falls under MACROLIDE ANTIBIOTICS — the group Lily-of-the-valley interacts with.

Theoretically, using lily-of-the-valley with macrolide antibiotics can increase the risk of cardiac glycoside toxicity.
Macrolide antibiotics appear to increase the gastrointestinal absorption of oral digoxin. Theoretically, concomitant use of macrolide antibiotics might increase the absorption of the cardiac glycosides found in lily-of-the-valley.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here is the short version: lily-of-the-valley is a poisonous plant packed with heart-affecting compounds (cardiac glycosides) that act a lot like digoxin. The concern is not that azithromycin (Zithromax) breaks it down differently. Instead, macrolide antibiotics like azithromycin seem to nudge up how much of these glycosides your gut absorbs. So more of the plant's heart chemicals could get into your bloodstream.

If that happens, you could see signs of glycoside toxicity, things like nausea, a slow or irregular heartbeat, dizziness, or vision changes. Keep in mind this warning is theoretical and based on how the drugs work, not on real cases. Honestly, lily-of-the-valley is dangerous on its own and isn't recommended for self-treatment. Please run any herbal use past your pharmacist or doctor before combining it with antibiotics.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Ellenhorn MJ, et al. Ellenhorn's Medical Toxicology: Diagnoses and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams & Wilkins, 1997.

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Lily-of-the-valley Also Interacts With Other Medications

Lily-of-the-valley has 26 major, 130 moderate known drug interactions in our database — the Azithromycin one above is one of them. If you take anything else, check it against the full list below.

Major 26 Moderate 130 No known interaction 2,674 (incl. Azithromycin)
Taking anything else?

Check Another of Your Medications Against Lily-of-the-valley

Covers the 2,830 medications we’ve checked against Lily-of-the-valley. Pick one to open its full report.

From our Q&A

Questions About Lily-of-the-valley 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 Lily-of-the-valley 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 Lily-of-the-valley 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 Lily-of-the-valley as Part of a Dietary Supplement Product? Check It for Interactions

We hold 10 real supplement products containing Lily-of-the-valley, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Lily-of-the-valley. Your product may carry other ingredients that interact with Azithromycin too, on top of Lily-of-the-valley — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Lily-of-the-valley 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 Lily-of-the-valley
Steady interest

#1,192 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Azithromycin
Top 5%

#44 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.

Supplement

About Lily-of-the-valley

What is Lily-of-the-valley?

Lily-of-the-valley
  • Heart failure (historical)
  • Irregular heartbeat (historical)
  • Fluid retention/edema
  • General heart tonic (traditional)

Lily-of-the-valley is a poisonous plant that contains powerful heart-affecting compounds called cardiac glycosides, similar to the drug digoxin. While it was used historically for heart conditions, it is dangerous and is not recommended for self-treatment. All parts of the plant are toxic, and accidental poisoning can be life-threatening.

Read the full Lily-of-the-valley monograph & all interactions
Medication

About Azithromycin

What Is Azithromycin Used For?

Brand names: Zithromax, Zmax, Azasite

Azithromycin treats mild to moderate infections caused by susceptible bacteria. Oral tablets and oral suspension are used for several infection types in adults and, for some, children.

Oral uses include acute bacterial flare-ups of chronic bronchitis, acute bacterial sinusitis, uncomplicated skin infections, urethritis and cervicitis, genital ulcer disease in men, ear infections (acute otitis media) in children, community-acquired pneumonia, and pharyngitis/tonsillitis. The injection (Zithromax and azithromycin for injection) is used for community-acquired pneumonia in adults and pelvic inflammatory disease. AzaSite eye drops are used only for bacterial conjunctivitis (pink eye).

See full Azithromycin drug information
Keep checking

Other Drugs & Lily-of-the-valley

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

26Major
130Moderate
0Minor
2,673No known interaction
26 Major 130 Moderate 2,673 No interaction
Major

26 interactions

Moderate

130 interactions

Showing 60 of 130 moderate interactions — see all 130 on the Lily-of-the-valley page.

No interaction 2,673 drugs checked — show the list

We also checked Lily-of-the-valley against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,673 medications checked with no known interaction — see the full Lily-of-the-valley list.

See the full Lily-of-the-valley interactions page
See every supplement checked against Azithromycin, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

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

Keep exploring
Lily-of-the-valley monograph › Uses, safety, and every drug interaction in one place Azithromycin supplement interactions › Every supplement checked against Azithromycin, ranked by severity Azithromycin drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Lily-of-the-valley and Azithromycin Together: Common Questions

Can you take Lily-of-the-valley with Azithromycin?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Lily-of-the-valley and Azithromycin interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

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

Still Have a Question About Azithromycin and Lily-of-the-valley?

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.