Can You Take Prednisone With Azithromycin?

Answer

Thanks so much for reaching out to us and I hope that you are feeling better!

All the drugs you listed in your question (azithromycin, prednisone, famotidine, and fexofenadine) are considered safe to take together as there is no reported interaction between them.

You specifically mentioned azithromycin and prednisone, so I do want to focus on that part.

Azithromycin With Prednisone

I certainly understand your concern here with taking prednisone. Prednisone is the most commonly prescribed corticosteroid, and corticosteroids, as a class of drugs, are associated with immunosuppression, which is why you've probably heard not to take them with antibiotics (since you are treating an infection with those).

Additionally, several studies have noted that individuals taking corticosteroids consistently, at high doses to treat certain inflammatory conditions (such as rheumatoid arthritis, Crohn's, and ulcerative colitis) are more at risk for certain infections due to the immunosuppression prednisone causes, namely:

• Common viral infections (e.g. herpes viruses)
• Common bacterial infections(e.g. Staphylococcus aureus) 
• Common fungal infections (Candida species)

Having said all this, the dose of prednisone you are taking and how long you are taking it is highly relevant.

Although taking prednisone at any dose and duration can increase the risk of infection, generally, those who take high doses, consistently, are most at risk (what a 'high dose' of prednisone is varies by source, but is generally around 40mg or more per day).

Combining an antibiotic with prednisone for short-term treatment of a condition is really a question of if the positives outweigh the risks. Azithromycin and prednisone are very commonly prescribed together for the short-term treatment of conditions like sinusitis and bronchitis since the benefit of therapy generally outweighs the risk of complications from the combination.

In fact, one of the most commonly prescribed combinations of medications used for the short-term treatment of sinus infections is a Medrol Dose Pack (which contains methylprednisolone, a similar steroid to prednisone) and a Z-Pak (azithromycin). Several studies have published results showing preliminary positive benefits with short-term use of the combination:

Current evidence suggests that oral corticosteroids as an adjunctive therapy to oral antibiotics are effective for short-term relief of symptoms in acute sinusitis

The point here is that, yes, there are concerns with taking a corticosteroid and how it can suppress the immune system, which increases the risk of infection. However, for many individuals, a short-term course, at a relatively low dose of a steroid, is considered safe, with the benefits outweighing the risk.

It is more commonly those that are taking steroids on a daily basis, or at high doses (or both) that we are more concerned about.

So, overall, there is no specific interaction between azithromycin and prednisone, and the drugs don't interfere with one another. It's the conflict between immune suppression and treating an active infection that is the concern. As everyone's medical situation is different, I recommend talking to your doctor about what makes the most sense for you.

Final Words

Thanks for your question and please feel free to reach back out in the future!