Azithral (Azithromycin)
Also sold as: Azithral, Azax, Azee, Zithrox, Zady
Pregnancy
Cat B
Lactation
Safe
Schedule
H
Forms
Tablet 250/500mg +2
Indications
- Atypical pneumonia (Mycoplasma, Chlamydia, Legionella)
- Pharyngitis (penicillin allergy)
- Acute exacerbation of COPD
- Genital chlamydia
- Typhoid (uncomplicated)
- Traveler's diarrhea
Adult Dosing
Most infections
500 mg PO once daily
3-5 days
Genital chlamydia
1 g PO single dose
Typhoid (uncomplicated)
1 g PO daily
5-7 days
Pediatric Dosing
For AOM: 30 mg/kg single dose OR 10 mg/kg/day × 3 days
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 10 mL/min | No adjustment |
| CrCl < 10 mL/min | Use with caution — limited data |
Hepatic Adjustment
Use cautiously in hepatic impairment. Discontinue if hepatitis or jaundice occurs.
Pregnancy & Lactation
Pregnancy: Category B
Considered safe; preferred macrolide in pregnancy.
Lactation: Safe
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Warfarin | Increased INR | Moderate |
| QT-prolonging drugs (ondansetron, citalopram, haloperidol, fluconazole) | Additive QT prolongation — Torsades risk | Major |
| Digoxin | Increased digoxin levels | Moderate |
| Statins (simvastatin) | Increased statin levels — myopathy risk | Moderate |
| Antacids (Mg/Al) | Reduced absorption — separate by 2 hours | Minor |
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Side Effects
Common
- Diarrhea
- Nausea
- Abdominal pain
- Headache
- Taste disturbance
Serious / Discontinue If
- QT prolongation, Torsades de Pointes
- Cholestatic hepatitis
- Hearing loss (high-dose, prolonged use)
- Pyloric stenosis in infants <6 weeks
Contraindications
- Macrolide hypersensitivity
- Prior azithromycin-induced cholestatic jaundice
- History of QT prolongation
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Azithral 500 | Alembic | 5 tab ₹95 |
| Azax 500 | Lupin | 3 tab ₹78 |
| Azee 500 | Cipla | 5 tab ₹105 |
| Zithrox 500 | Wockhardt | 3 tab ₹65 |
Monitoring Required
- ECG (QT) in patients with risk factors
- LFT if prolonged use
Patient Counseling Points
- Can be taken with or without food (with food reduces nausea)
- Avoid antacids within 2 hours
- Complete the full course
- Report palpitations or fainting
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EasyClinic auto-flags Azithral interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
References
- BNF — Azithromycin
- IAP Recommendations on Macrolides
- CredibleMeds.org QT-prolonging drug list
- Pfizer Zithromax PI