From the Guidelines
Azithromycin can cause nausea and vomiting as side effects, with rates of 3% and <1%, respectively, as reported in the study by 1. These gastrointestinal symptoms are among the most common adverse reactions experienced by patients taking this antibiotic. The study by 1 notes that incident or worsening nausea or vomiting are exacerbated by the primary gastrointestinal infection, and are more common than in the treatment of non-gastrointestinal infections. To minimize these effects, it's recommended to take azithromycin with food (unless specifically instructed otherwise by your healthcare provider). Staying well-hydrated and taking the medication at the same time each day may also help reduce gastrointestinal discomfort. If nausea and vomiting become severe, persistent, or are accompanied by signs of an allergic reaction such as rash, itching, or difficulty breathing, you should contact your healthcare provider immediately. Another study by 1 also reports gastrointestinal side effects, including nausea and vomiting, in patients taking azithromycin, although the rates are not specified. However, the study by 1 provides more specific information on the rates of nausea and vomiting, and is therefore considered the most relevant evidence for this question. Some key points to consider when taking azithromycin include:
- Taking the medication with food to minimize gastrointestinal discomfort
- Staying well-hydrated to reduce the risk of nausea and vomiting
- Contacting your healthcare provider if nausea and vomiting become severe or persistent
- Being aware of the potential for allergic reactions, such as rash, itching, or difficulty breathing, and seeking medical attention immediately if these symptoms occur.
From the FDA Drug Label
Most of the side effects leading to discontinuation were related to the gastrointestinal tract, e.g., nausea, vomiting, diarrhea, or abdominal pain. Side effects that occurred with a frequency of 1% or less included the following: ... Gastrointestinal: ... vomiting, The most common side effects were diarrhea/loose stools (4 to 5%), nausea (3%) and abdominal pain (2 to 3%) being the most frequently reported Side effects that occurred in patients on the single one-gram dosing regimen of azithromycin with a frequency of 1% or greater included diarrhea/loose stools (7%), nausea (5%), abdominal pain (5%), vomiting (2%) The most common side effects were diarrhea/loose stools (5.9% azithromycin vs. 14.6% control), vomiting (2.1% azithromycin vs. 1.1% control) The most common side effects were diarrhea (6.4% with azithromycin vs. 12. 7% with the comparator), vomiting (4% with each agent) The most common side effects were vomiting (5.6%), diarrhea (3.2%), and abdominal pain (1. 6%). The most common side effects were diarrhea/loose stools (6% azithromycin vs. 2% penicillin), vomiting (6% azithromycin vs. 4% penicillin), and abdominal pain (3% azithromycin vs 1% penicillin).
Azithromycin can cause nausea and vomiting.
- The frequency of nausea is around 3% in adult patients receiving multiple-dose regimens and 5% in patients receiving a single 1-gram dose regimen.
- The frequency of vomiting is around 2% in patients receiving a single 1-gram dose regimen and 2.1% in pediatric patients.
- These side effects are most commonly related to the gastrointestinal system. 2 2
From the Research
Azithromycin and Gastrointestinal Side Effects
- Azithromycin is a macrolide antibiotic that can cause various side effects, including gastrointestinal symptoms 3
- However, the provided studies do not directly address the specific question of whether azithromycin can cause nausea and vomiting
- A study on the comparison of azithromycin and metronidazole in a quadruple-therapy regimen for Helicobacter pylori eradication in dyspepsia does not mention nausea and vomiting as side effects 4
- Another study on the effects of azithromycin on gut metagenomics within a household also does not mention nausea and vomiting as side effects 5
- A study on drug-drug interactions in pharmacologic management of gastroparesis mentions antiemetic agents such as promethazine and ondansetron, which are used to reduce nausea and vomiting, but does not specifically discuss azithromycin 6
Potential for Gastrointestinal Side Effects
- Azithromycin has a good record of safety, but rare cases of cardiac torsades des pointes have been reported in patients at risk 3
- The alteration of gut microbiome by azithromycin may potentially lead to gastrointestinal side effects, but this is not directly addressed in the provided studies 5
- Further research is needed to determine the specific side effects of azithromycin, including nausea and vomiting, and their potential relationship to the alteration of gut microbiome 5