Medication interaction hub

What Supplements Interact with Azithromycin?

Azithromycin brand names: Zithromax, Zmax, Azasite. Every interaction below applies to the brands too.

92 Interactions 8 Major 71 Moderate 13 Minor
Curated & coded by · Clinical Pharmacist · Updated October 5, 2026

Drug–supplement interaction data sourced from Natural Medicines Pro, the licensed clinical database from TRC Healthcare / Therapeutic Research, with additional analysis by the HelloPharmacist Pharmacist Team. Our sources · Editorial policy

What is this page for?

One answer, for one medication: what supplements and herbal products interact with Azithromycin? Every vitamin, herb, and supplement ingredient we’ve checked against it is on this page, ranked by severity, each linking to the full report for that exact pair.

This page covers supplement interactions only — to check Azithromycin against your other medications, use the drug–drug interaction checker. Educational information from our licensed clinical databases, not medical advice. Our editorial policy

HelloPharmacist Bottom Line
Our Pharmacist Explains
What is this? The interaction data in the HelloPharmacist supplement database is licensed from Natural Medicines Pro by TRC Healthcare (Therapeutic Research). HelloPharmacist pharmacists often add our own analysis and context on top of that licensed data — such as this Bottom Line summary and the notes on individual interaction pages — and any such commentary is noted as ours.

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. Azithromycin can lengthen the QT interval, the electrical pause between heartbeats, and ingredients such as ephedra or even large amounts of grapefruit can stack onto that effect and raise the risk of a dangerous rhythm. Activated charcoal is a different hazard, soaking up the antibiotic before it can do its job.

The remaining 84 entries, 71 moderate and 13 minor, are tamer but everyday. Many are probiotics the antibiotic itself kills off, which wastes the supplement rather than harming you, so space the two well apart. Twenty more can add to azithromycin's tendency to make skin burn faster in the sun. For a course this short, knowing those eight majors covers the worst of it.

— , Clinical Pharmacist · July 18, 2026

Major 8 Moderate 71 Minor 13 No known interaction 1,360

This box checks one ingredient at a time (like turmeric or magnesium). Taking a supplement product with a whole label of ingredients? Search the product instead — we check every ingredient on it ↓

Top Ingredient Interactions

Azithromycin: Top Interactions at a Glance

The most significant Azithromycin supplement & herbal interactions, colored by severity. Tap any ingredient to open the full report for that pair.

Showing the 12 highest-ranked of 92 interacting ingredients — plus 1,360 more checked with no known interaction. See the complete ranked list.

Start here

The Major Interactions to Know About

The most clinically significant Azithromycin + supplement combinations in our database, best-documented first. Open any card for the full report.

Major Likelihood Probable Activated Charcoal + Azithromycini

Activated charcoal reduces systemic exposure to many drugs, including those that undergo enterohepatic recirculation, regardless of the route of administration.

Read the full interaction Major Likelihood Probable Arsenic + Azithromycini

Arsenic trioxide can prolong the QT interval.

Read the full interaction Major Likelihood Probable Cesium + Azithromycini

Theoretically, taking cesium concomitantly with other drugs that prolong the QT interval may increase the risk of ventricular arrhythmias and death.

Read the full interaction Major Likelihood Probable Ephedra + Azithromycini

Theoretically, ephedra might have an additive effect with drugs that prolong the QT interval.

Read the full interaction Major Likelihood Probable Grapefruit + Azithromycini

Grapefruit or grapefruit juice, especially if consumed in large amounts, can cause additive QT interval prolongation when taken with QT interval-prolonging drug...

Read the full interaction Major Likelihood Probable Oleander + Azithromycini

Theoretically, macrolide antibiotics may increase the risk of oleander toxicity.

Read the full interaction
The complete list

Every Supplement Checked Against Azithromycin

All 1,452 ingredients in our database, ranked by severity — 92 with a Azithromycin interaction on file and 1,360 with none found. Filter by severity or search any ingredient; hover the for what each ingredient is.

Looking for an interaction with a specific supplement product? Search products instead ↓

Straight answers

Can You Take It With Azithromycin?

One-line answers, one card per combination — scroll through today’s 20 and tap any card for the full report. A different set rotates in daily until every combination has had its turn.

Can you take Probiotics with Azithromycin?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, taking antibiotic drugs with certain probiotics might decrease the effectiveness of probiotics.

Full Probiotics + Azithromycin answer

Can you take Black Psyllium with Azithromycin?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.

Full Black Psyllium + Azithromycin answer

Can you take Chenopodium Oil with Azithromycin?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, concomitant use of chenopodium oil with other photosensitizing drugs can increase the risk of adverse effects.

Full Chenopodium Oil + Azithromycin answer

Can you take Blond Psyllium with Azithromycin?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.

Full Blond Psyllium + Azithromycin answer

Can you take Carob with Azithromycin?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, carob might also impair the absorption of oral drugs.

Full Carob + Azithromycin answer

Can you take Celery with Azithromycin?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, celery might increase the risk of photosensitivity reactions when taken with photosensitizing drugs.

Full Celery + Azithromycin answer

Can you take Karaya Gum with Azithromycin?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Co-administration of oral drugs with bulk forming laxatives such as karaya gum may decrease, increase, or have no effect on the absorption o...

Full Karaya Gum + Azithromycin answer

Can you take Marshmallow with Azithromycin?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, mucilage in marshmallow might impair absorption of oral drugs.

Full Marshmallow + Azithromycin answer

Can you take Soy with Azithromycin?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, antibiotics may decrease the activity of soy isoflavones.

Full Soy + Azithromycin answer

Can you take Xanthan Gum with Azithromycin?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, xanthan gum can alter the absorption of oral drugs due to its fiber qualities.

Full Xanthan Gum + Azithromycin answer

Can you take Forsythia with Azithromycin?

Minor Usually — this is a minor-rated interaction, generally not clinically significant but worth mentioning to your pharmacist. Theoretically, taking forsythia with azithromycin might increase the risk of adverse effects.

Full Forsythia + Azithromycin answer

Can you take Activated Charcoal with Azithromycin?

Major Use real caution — this is a major-rated interaction, generally best avoided or used only under close supervision. Activated charcoal reduces systemic exposure to many drugs, including those that undergo enterohepatic recirculation, regardless of the rout...

Full Activated Charcoal + Azithromycin answer

Can you take Arsenic with Azithromycin?

Major Use real caution — this is a major-rated interaction, generally best avoided or used only under close supervision. Arsenic trioxide can prolong the QT interval.

Full Arsenic + Azithromycin answer

Can you take Cesium with Azithromycin?

Major Use real caution — this is a major-rated interaction, generally best avoided or used only under close supervision. Theoretically, taking cesium concomitantly with other drugs that prolong the QT interval may increase the risk of ventricular arrhythmias an...

Full Cesium + Azithromycin answer

Can you take Ephedra with Azithromycin?

Major Use real caution — this is a major-rated interaction, generally best avoided or used only under close supervision. Theoretically, ephedra might have an additive effect with drugs that prolong the QT interval.

Full Ephedra + Azithromycin answer

Can you take Grapefruit with Azithromycin?

Major Use real caution — this is a major-rated interaction, generally best avoided or used only under close supervision. Grapefruit or grapefruit juice, especially if consumed in large amounts, can cause additive QT interval prolongation when taken with QT inte...

Full Grapefruit + Azithromycin answer

Can you take Oleander with Azithromycin?

Major Use real caution — this is a major-rated interaction, generally best avoided or used only under close supervision. Theoretically, macrolide antibiotics may increase the risk of oleander toxicity.

Full Oleander + Azithromycin answer

Can you take Sida Cordifolia with Azithromycin?

Major Use real caution — this is a major-rated interaction, generally best avoided or used only under close supervision. Theoretically, Sida cordifolia might increase the risk of additive QT interval prolongation when taken with QT interval-prolonging drugs.

Full Sida Cordifolia + Azithromycin answer

Can you take American Hellebore with Azithromycin?

Major Use real caution — this is a major-rated interaction, generally best avoided or used only under close supervision. American hellebore, also known as Veratrum viride, contains alkaloids that can potentially prolong the QT interval on an electrocardiogram (...

Full American Hellebore + Azithromycin answer

Can you take Bacillus Coagulans with Azithromycin?

Moderate Possibly, but carefully — this moderate-rated combination may need monitoring, a dose adjustment, or separated timing. Theoretically, taking antibiotics with Bacillus coagulans might decrease the effectiveness of B.

Full Bacillus Coagulans + Azithromycin answer
Read the list like a pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

  • Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
  • Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
  • Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
  • No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

  • Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
  • Probable. Interaction 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.
  • Possible. 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
  • Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

  • Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
  • Each entry links to a full report with the clinical detail, likelihood, evidence level, and citations for that exact combination.
  • Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

How Does Our Interaction Checker Work?

Behind every verdict on this page is a category system. Our source database doesn’t document supplement interactions drug-by-drug — it documents them against groups of medications that behave the same way (for example, “drugs processed by the CYP3A4 liver enzyme” or “blood-thinning medications”).

So the check works in three steps: (1) Azithromycin is classified into the pharmacology categories it belongs to, (2) every supplement interaction documented against any of those categories is inherited by Azithromycin, and (3) each ingredient keeps its own severity, likelihood, and evidence grades from the underlying record. That’s why one supplement can carry several records for one drug — it may interact through more than one category.

Azithromycin sits in 7 interaction categories. Open any one to see what the group means:

Antibiotic Drugs 27 ingredients

A pharmacology grouping from our source database: medications in this group share a property that certain supplements are known to interact with, so an interaction documented for the group applies to every drug in it.

27 of the supplement ingredients on this page reach Azithromycin through this category.

Photosensitizing Drugs 20 ingredients

Medications that make skin more sun-sensitive. Supplements with the same property can compound it.

20 of the supplement ingredients on this page reach Azithromycin through this category.

Oral Drugs 17 ingredients

A pharmacology grouping from our source database: medications in this group share a property that certain supplements are known to interact with, so an interaction documented for the group applies to every drug in it.

17 of the supplement ingredients on this page reach Azithromycin through this category.

Qt Interval-Prolonging Drugs 13 ingredients

Medications that can affect the heart's electrical rhythm (the QT interval). Supplements with similar effects can add to that risk.

13 of the supplement ingredients on this page reach Azithromycin through this category.

Macrolide Antibiotics 11 ingredients

A pharmacology grouping from our source database: medications in this group share a property that certain supplements are known to interact with, so an interaction documented for the group applies to every drug in it.

11 of the supplement ingredients on this page reach Azithromycin through this category.

Topical Drugs 3 ingredients

A pharmacology grouping from our source database: medications in this group share a property that certain supplements are known to interact with, so an interaction documented for the group applies to every drug in it.

3 of the supplement ingredients on this page reach Azithromycin through this category.

Azithromycin (Zithromax) 1 ingredient

A pharmacology grouping from our source database: medications in this group share a property that certain supplements are known to interact with, so an interaction documented for the group applies to every drug in it.

1 of the supplement ingredient on this page reaches Azithromycin through this category.

About Azithromycin

Azithromycin is a macrolide antibiotic used to treat bacterial infections of the respiratory tract, skin, throat, ears, and reproductive organs.

Generic name: Azithromycin  ·  Brand names: Zithromax, Zmax, Azasite.

See the full Azithromycin drug information

Related: does Azithromycin deplete any nutrients?

Azithromycin has 21 reported nutrient associations in the research literature — see the Azithromycin nutrient depletion report.

Check a real product

Take a Supplement Product? Check the Whole Bottle Against Azithromycin

Most supplements are combination products — and the interaction may come from an ingredient you didn’t buy it for. Search any product below (or scan its label) and we’ll check every ingredient on it against Azithromycin.

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Pharmacist Counseling Corner

Azithromycin & Supplements: Common Questions

What supplements interact with Azithromycin?
Our database currently documents 92 ingredients with a known Azithromycin interaction (8 major, 71 moderate, 13 minor). The practical move: scan the major group first, then look up the exact supplements you take rather than reading all 92. The highest-ranked right now: Activated Charcoal, Arsenic, Cesium.
Which Azithromycin supplement interactions are the most serious?
The 8 major-rated combinations — led by Activated Charcoal, Arsenic, Cesium, Ephedra and Grapefruit — deserve real caution: these are the ones generally best avoided, or used only with your prescriber watching. If you take any of them today, don't panic and don't stop anything abruptly — call your pharmacist first. Jump to the ranked list.
Can I take vitamins or supplements while on Azithromycin?
Plenty of supplements coexist fine with Azithromycin; a shorter list does not. Rather than memorizing it, check the specific ingredients on your labels — the ranked list above covers every one we've checked, and multi-ingredient products can be checked label-by-label with our scanner. Try the label scanner or the interaction checker.
Do brands like Zithromax have the same supplement interactions as Azithromycin?
Yes — Zithromax, Zmax, Azasite all contain Azithromycin, so everything on this page applies to them equally. Interactions belong to the active drug, never to the brand on the box; the same is true of generics.
Where do these interaction ratings come from?
Every rating comes from the Natural Medicines database — the same evidence-graded reference pharmacists and hospitals use — and each interaction carries three separate grades: severity (how bad it can be), likelihood (how well it's documented in studies and case reports), and an evidence level. Our pharmacists review the content; we never let an AI decide an interaction. See how to read the ratings and our editorial policy.
Does Azithromycin deplete any vitamins or nutrients?
It might — Azithromycin has 21 reported nutrient-depletion associations in the research literature, which is a different question from interactions: instead of a supplement changing the drug, the drug may lower a nutrient over time. See the Azithromycin nutrient depletion report for the specifics and what to discuss with your pharmacist.
What about Azithromycin and my other medications?
This page covers Azithromycin against supplements and herbal ingredients. Checking Azithromycin against your other prescription or OTC medications is a different tool — our drug interaction checker covers that side. Head to the drug–drug interaction checker, or read the full Azithromycin drug information.

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

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Sourcing

Where This Data Comes From — and Why You Can Trust It

🧪 Licensed clinical database

Every interaction verdict on this page comes from Natural Medicines Pro (TRC Healthcare / Therapeutic Research) — the same evidence-graded reference used by pharmacists and hospitals. We license this data directly; we do not scrape it, and no AI invents an interaction.

🧑‍⚕️ Pharmacist review

This page is curated and coded by , Clinical Pharmacist, with additional analysis by the HelloPharmacist Pharmacist Team. Editorial commentary is ours; the licensed interaction records are shown as sourced.

🔄 Kept current

Our interaction database refreshes on a weekly cycle, and this page re-checks the live database every time it’s rebuilt — what you see reflects the database as of October 5, 2026.

🔍 Full transparency

How every dataset on this site is sourced, licensed, and updated is documented publicly: our data sources · editorial policy · how we use AI.

Educational information, not medical advice. An interaction being on file does not mean it will happen to you — and absence of one is not proof of safety. Never start or stop a medication or supplement without talking to your pharmacist or doctor.