Drug & supplement interaction

Rue + Azithromycin

Azithromycin brand names: Zithromax, Zmax, Azasite.

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

Rue has a moderate interaction with Azithromycin. Theoretically, rue might increase the risk for phototoxicity when used with photosensitizing drugs.

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

Rue and Azithromycin

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

Moderate

PHOTOSENSITIZING DRUGS

Why this applies to Azithromycin

Azithromycin falls under PHOTOSENSITIZING DRUGS — the group Rue interacts with.

Theoretically, rue might increase the risk for phototoxicity when used with photosensitizing drugs.
Rue contains photosensitizing furanocoumarins and psoralens and has been associated with multiple reports of phototoxic reactions. There is also one case report of an increased phototoxic response to psoralen and ultraviolet A (PUVA) therapy associated with ingestion of rue.
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's the thing to know about pairing rue with azithromycin: it's not about how your body breaks the antibiotic down. Instead, both can independently make your skin more sensitive to sunlight. Rue contains natural compounds (furanocoumarins and psoralens) that have been linked to phototoxic skin reactions, and azithromycin itself can occasionally cause sun sensitivity. Stack them together and you may sunburn faster or get a stronger reaction than usual.

I'll be honest, the evidence here is thin. It's mostly theoretical and based on a few case reports, not solid studies. Still, while you're on your antibiotic, it's smart to use sunscreen, cover up, and limit strong sun. If you take rue regularly, mention it to your pharmacist or doctor so they can weigh in.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Puig L. Pharmacodynamic interaction with phototoxic plants during PUVA therapy. Br J Dermatol 1997;136:973-4. PubMed
  2. Radotra I, Gardiner S, Barnes D. A phytophototoxic injury at a burns unit: the ungraceful after-effects of the "common rue" plant. J Burn Care Res. 2018;39(6):1064-6. PubMed
  3. Avallone G, Mastorino L, Agostini A, et al. Ruta graveolens phytophotodermatitis. Dermatol Online J 2021;27(7). PubMed

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

Rue Also Interacts With Other Medications

Rue has 334 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.

Moderate 334 No known interaction 2,496 (incl. Azithromycin)
Taking anything else?

Check Another of Your Medications Against Rue

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

From our Q&A

Questions About Rue 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 Rue 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 Rue 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 Rue as Part of a Dietary Supplement Product? Check It for Interactions

We hold 47 real supplement products containing Rue, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Rue. Your product may carry other ingredients that interact with Azithromycin too, on top of Rue — 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 Rue 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 Rue
Steady interest

#738 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.

Supplement

About Rue

What is Rue?

Rue
  • Menstrual cramps
  • Digestive upset
  • Muscle spasms and pain
  • Headache
  • Insect repellent (topical)
  • Traditional folk remedy

Rue is a strong-smelling herb from southern Europe with a long history in folk medicine, but there is very little reliable human research to support its health uses. It can be toxic in larger amounts and is considered unsafe during pregnancy, so most people should avoid it or use it only under professional guidance.

Read the full Rue 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.

See full Azithromycin drug information
Keep checking

Other Drugs & Rue

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

0Major
334Moderate
0Minor
2,495No known interaction
334 Moderate 2,495 No interaction
Moderate

334 interactions

Showing 60 of 334 moderate interactions — see all 334 on the Rue page.

No interaction 2,495 drugs checked — show the list

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

Showing the 60 most looked-up of 2,495 medications checked with no known interaction — see the full Rue list.

See the full Rue 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
Rue 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 Rue and Azithromycin Together: Common Questions

Can you take Rue 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 Rue 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 Rue?

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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.