Is Amoxicillin Safe for People with Peanut or Tree Nut Allergy?

Most amoxicillin products do not contain peanut or tree nut–derived ingredients, and they are generally considered safe for people with food allergies to nuts. However, as with any medication, it’s wise to check the exact product’s inactive ingredients and be aware of rare allergy risks related to the drug itself and its excipients (inactive additives). The core safety issue with amoxicillin is not nut cross‑reactivity, but potential hypersensitivity to penicillins and related antibiotics. Labels advise careful screening for past reactions to penicillins, cephalosporins, or other allergens and prompt discontinuation if an allergic reaction occurs. ^{[1] [2] [3] [4] [5] [6]}

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Key Point: No Known Nut-Derived Excipients in Standard Amoxicillin Labels

FDA drug labels for common amoxicillin tablets, capsules, chewables, and oral suspensions list inactive ingredients such as microcrystalline cellulose, hypromellose, magnesium stearate, crospovidone, colloidal silicon dioxide, polyethylene glycol, lactose, mannitol, sucrose, sodium citrate, talc, and titanium dioxide. None of these are peanut or tree nut derivatives. ^{[7] [8] [9] [10] [11] [12] [13] [14] [15]}

• Example tablet labels include colloidal silicon dioxide, crospovidone, hypromellose, magnesium stearate, microcrystalline cellulose, and polyethylene glycol. ^{[7] [8]}
• Some chewable or suspension forms include sugars (sucrose), lactose, mannitol, and sodium citrate. ^{[14] [15]}
• An oral suspension label lists cellulose, sodium starch glycolate, talc, triethyl citrate, titanium dioxide; sodium content per 5 mL is also specified. ^[10]

These ingredient lists are consistent across multiple manufacturers’ FDA listings and do not indicate peanut or tree nut content. ^{[7] [8] [9] [14] [15]}

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Important Distinction: Drug Allergy vs. Food Allergy

Amoxicillin allergy is unrelated to peanut or tree nut allergy. Penicillin-class antibiotics (including amoxicillin) can cause immediate (IgE-mediated) or delayed (T-cell–mediated) hypersensitivity in some people, independent of food allergies. People with true penicillin allergy may react to amoxicillin, and there is known, variable cross-reactivity within beta‑lactams (penicillins and some cephalosporins), often driven by shared side chains. ^{[16] [17] [18] [19]}

• Clinical guidance notes that cross-reactivity with third-generation cephalosporins is low, and penicillin skin testing or graded oral challenge may be used in evaluation of suspected penicillin allergy. ^{[20] [21] [22]}
• Labels advise assessing history of hypersensitivity to penicillins, cephalosporins, or other allergens before starting amoxicillin, and stopping the drug if reactions occur. ^{[1] [2] [3] [4] [5] [6]}

This means a nut allergy does not automatically increase the risk of an amoxicillin reaction; the key is whether you have a history of penicillin or cephalosporin allergy.

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Excipients and Rare Reactions

While active drug components cause most adverse reactions, inactive ingredients (excipients) can occasionally trigger issues typically in sensitive individuals (for example, reactions to lactose, dyes, sweeteners, or preservatives). Pediatric reports have described delayed hypersensitivity with amoxicillin solutions where the excipient rather than amoxicillin might have contributed, emphasizing the importance of checking specific product formulations. ^{[23] [24]}

Routine amoxicillin labels do not list peanut or tree nut excipients. Common excipients like lactose, sucrose, mannitol, microcrystalline cellulose, hypromellose, crospovidone, and silicon dioxide are not nut-derived. ^{[7] [8] [14] [15]}

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Practical Guidance for Nut-Allergic Individuals

• Review the exact product’s inactive ingredient list (on the box or FDA label) to confirm there are no unexpected allergens; manufacturers sometimes vary excipients slightly between dosage forms and strengths. ^{[7] [8] [9]}
• If you have a known penicillin allergy (e.g., immediate hives, wheezing, anaphylaxis) or severe delayed reactions (e.g., Stevens‑Johnson syndrome), you should avoid amoxicillin and consult a clinician about evaluation or alternatives. ^{[21] [25]}
• If you have a nut allergy but no penicillin allergy history, amoxicillin is generally considered safe because routine formulations do not contain nut-derived ingredients. ^{[7] [8] [14] [15]}
• For children or those sensitive to certain excipients (such as lactose or dyes), consider verifying the specific suspension or chewable formulation, as excipient profiles can differ. ^{[14] [15] [23] [24]}

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Common Inactive Ingredients Seen in Amoxicillin Labels

Below is a summary of typical excipients found in FDA-listed amoxicillin products; none are peanut or tree nut derivatives.

• Microcrystalline cellulose; hypromellose; crospovidone; colloidal silicon dioxide; polyethylene glycol. ^{[7] [8] [9]}
• Lactose (anhydrous) and mannitol (sugar alcohol) in some tablets/chewables. ^{[14] [15]}
• Sucrose and sodium citrate in certain suspensions. ^{[14] [15]}
• Talc, titanium dioxide, triethyl citrate, sodium starch glycolate in some suspensions. ^[10]

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Safety Summary

• Amoxicillin ingredients listed on FDA labels do not include peanut or tree nut excipients. For individuals with peanut or tree nut allergy, amoxicillin is typically safe from a nut-content standpoint. ^{[7] [8] [14] [15] [10]}
• The primary allergy risk is to the drug class itself (penicillins), not to nuts; labels stress screening for prior penicillin or cephalosporin hypersensitivity and stopping the drug if an allergic reaction occurs. If you have a history of penicillin allergy, discuss evaluation and alternatives with your clinician. ^{[1] [2] [3] [4] [5] [6] [20] [21] [22]}

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Quick Comparison Table: Amoxicillin Forms and Typical Excipients

Form	Typical inactive ingredients (examples)	Nut-derived content noted in FDA labels
Film-coated tablets	Colloidal silicon dioxide, crospovidone, hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol	None reported [7] [8] [9]
Chewable tablets	Lactose (anhydrous), mannitol, sucrose, microcrystalline cellulose, sodium citrate, magnesium stearate	None reported [14] [15]
Capsules	Microcrystalline cellulose, hypromellose variants, magnesium stearate, silicon dioxide	None reported [11] [12] [13]
Oral suspension powders	Cellulose, sodium starch glycolate, talc, triethyl citrate, titanium dioxide; sucrose may be present in some products	None reported [10] [14] [15]

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Bottom Line

For people with peanut or tree nut allergy, standard amoxicillin formulations do not list nut-derived ingredients and are generally safe from a nut-content perspective. The bigger concern is whether you have a penicillin-class drug allergy; if so, seek medical guidance before taking amoxicillin, and stop the medication if any allergic symptoms develop. ^{[7] [8] [14] [15] [10] [1] [2] [3] [4] [5] [6]}