Based on FDA | Does azithromycin contain any nut-derived ingredients, and is it safe to take if I have a peanut or tree nut allergy?

Short Answer

Azithromycin itself does not contain peanut or tree‑nut ingredients, and commonly marketed azithromycin tablets and oral suspensions list excipients such as starches, cellulose, magnesium stearate, hypromellose, titanium dioxide, flavors, and colorants not nut derivatives. ^{[1] [2] [3] [4] [5] [6]} Based on official ingredient listings, azithromycin is generally considered safe for people with peanut or tree‑nut allergies, though it’s wise to verify the specific product label or consult your pharmacist if you have severe allergies. ^{[2] [3]}

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What Azithromycin Is

Azithromycin is a macrolide antibiotic used to treat many bacterial infections, including respiratory, skin, and some sexually transmitted infections. ^[7] Allergic reactions to macrolide antibiotics are uncommon and usually relate to the drug molecule itself rather than food‑derived excipients. ^[7]

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Ingredient Check: Tablets

Official product monographs for azithromycin tablets list the active ingredient as azithromycin (dihydrate or monohydrate), with typical inactive ingredients such as:

• Croscarmellose sodium
• Dibasic calcium phosphate anhydrous
• Hypromellose
• Magnesium stearate
• Polyethylene glycol
• Microcrystalline cellulose
• Sodium lauryl sulfate
• Titanium dioxide
• Talc
• FDA colorants (e.g., FD&C Blue #2, Red #40, Yellow #6), depending on strength and manufacturer. ^{[1] [2] [3] [8] [9] [10]}

None of these excipients are peanut or tree‑nut derived according to the referenced labels. ^{[1] [2] [3]}

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Ingredient Check: Oral Suspension (Liquid)

Azithromycin powder for oral suspension typically contains excipients such as:

• Sucrose
• Flavors (banana, cherry, vanilla)
• Hydroxypropyl cellulose
• Colloidal silicon dioxide
• Xanthan gum
• Tribasic sodium phosphate
• Colorants (e.g., FD&C Red No. 40). ^{[6] [11] [12]}

These listed components are not peanut or tree‑nut derivatives per the official labeling. ^[6]

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A Note on “Lecithin” and Color Lakes

Some tablet formulations reference “lecithin” alongside color lakes (e.g., FD&C Blue #1 aluminum lake and lecithin). ^{[13] [14]} Lecithin is most commonly derived from soy; it is not a peanut/tree‑nut ingredient, and refined lecithin is typically nonallergenic for most individuals, though soy‑allergic patients may choose to confirm the source with the manufacturer. ^{[13] [14]} The presence of color lakes and flavorings does not indicate nut origin in the cited azithromycin products. ^[13]

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Safety for Peanut/Tree‑Nut Allergy

• Peanut and tree‑nut allergy is common and can be severe, but risk primarily involves foods and certain oils/proteins, not standard azithromycin excipients listed above. ^{[15] [16]}
• There is no established cross‑reactivity between peanut/tree‑nut allergens and macrolide antibiotics like azithromycin. ^[7]
• Therefore, azithromycin products, as labeled, would generally be considered suitable for individuals with peanut or tree‑nut allergies, provided you review the exact product’s inactive ingredients. ^{[2] [3]}

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Practical Tips

• Check the specific product label and the pharmacy’s stock for the exact manufacturer and formulation, as excipients can vary slightly by brand and strength. ^[8]
• If you have a history of severe anaphylaxis, consider asking your pharmacist to confirm the excipient list and any allergen statements from the manufacturer for the exact lot you will receive. ^[8]
• If you are also soy‑allergic and see “lecithin” listed, you may wish to discuss alternative manufacturers or formulations that do not use lecithin, though lecithin is often well tolerated. ^{[13] [14]}
• Report any symptoms such as hives, swelling, wheezing, or difficulty breathing immediately if they occur after dosing, as these can signal a drug hypersensitivity reaction unrelated to nut allergy. ^[7]

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Bottom Line

Based on official ingredient listings across multiple azithromycin tablet and suspension products, no peanut or tree‑nut derivatives are included, and azithromycin is generally safe for individuals with nut allergies, with routine diligence to verify excipients in the specific product you receive. ^{[1] [2] [3] [4] [5] [6] [8]}