Zithromax Side Effects:  Zithromax, available as generic azithromycin, is available in 250 mg., 500 mg., 600 mg. tablets and as a 200 mg/ 5 ml syrup and as a single dose 2 gram liquid. Zithromax is a member of the same family of antibiotics as erythromycin and clarithromycin called the macrolide antibiotics. This class of antibiotics is noted for gastrointestinal side effects, but the incidence of GI Zithormax side effects is far less than with erythromycin, and likely less common than with clarithromycin. The typical dosing of Zithromax for bacterial infections is to take a 500 mg dose on day 1, and a 250 mg dose on days 2 through 5, for a total of a 5 day course of Zithromax which is marketed as a Z-pac. For treatment of Chlamydia infections a single 1 gram dose of Zithromax is indicated. Zithromax also has indications for bacterial endocarditis prevention in patients who cannot take amoxicillin, for chancroid therapy, for acute salmonellosis, for adjunctive treatment of typhoid fever, for mild to moderate babesiosis, and for adjuvant therapy of mycobacterium avium complex tuberculosis.

Common Zithromax Side Effects:  Many of the common Zithromax side effects are related to the gastrointestinal tract irritation common to most of the macrolide antibiotics. These include nausea, vomiting, diarrhea, abdominal pain, dyspepsia, and loss of appetite. Other common Zithromax side effects include yeast vaginitis, a side effect of essentially all antibiotics, as well as pruritus, rash and dizziness.

Serious Zithromax Side Effects: Many of the potential serious Zithromax side effects are related to drug interactions listed below in the next section. Severe allergic reactions can occur including anaphylaxis and angioedema, Steven’s Johnson Syndrome, and toxic epidermal necrolysis. Hepatotoxicity as a Zithromax side effect can manifest as cholestatic jaundice or hepatotoxicity, and pancreatitis is an uncommon but serious Zithromax side effect. Torsades d’pointes, a potentially life threatening cardiac arrhythmia can be a Zithromax side effect, as well as QT prolongation. Zithromax has been noted to exacerbate Myasthenia gravis, and as with nearly all antibiotics clostridium difficiele colitis can be a serious Zithromax side effect.

Cautions and Drug Interactions:  Contraindications to Zithromax use include a history of serious problems from Zithromax including a history of Zithromax induced cholestatic jaundice, Zithromax associated hepatic impairment, or hypersensitivity to the drug itself or the drug class of macrolide antibiotics. Caution is required in patients with severe liver or kidney impairment. Prolongation of the QT segment is a known Zithromax side effect, so it is best avoided in patients with known QT prolongation or with risk of QT prolongation, and in patients with myasthenia gravis. Zithromax is contraindicated with several uncommonly used medications including live BCG intravessical, cisapride (not available in the U.S.), dronedarone, phenothiazines, and primodone. Zithromax is best avoided in conjunction with class Ia and class III antiarhthmcs, with chloroquine, with other erythromycins or macrolides, with methadone, quinine, and with live typhoid vaccine. Drug interactions with warfarin, digoxin, venlafaxine, multiple other drugs is important to take into consideration. For complete lists of cautions and drug interactions see the manufacturer’s prescribing information or discuss potential issues with your pharmacist.

Pregnancy and Lactation:  Zithromax is pregnancy category B and its safety for use during lactation is currently unknown.

Unusual Zithromax Side Effects: The potential for exacerbation of myasthenia gravis is an unusual but noteworthy Zithromax side effect. Myasthenia gravis is an uncommon disease in which patients develop muscle weakness that worsens with repeated muscle use.

Zithromax specific issues:  Some experts believe that the widespread use of Zithromax has led to a marked increase in the incidence or macrolide antibiotic bacterial resistance. This is felt to be due to the very long serum half life of Zithromax, averaging 68 hours, which leads to prolonged subtheraputic serum levels of the drug, potentially allowing for the selection of bacteria with resistance to the drug at low levels and development of high level drug resistance. Communities with high use of Zithromax tend to have higher resistance of bacteria to the macrolides.

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