Based on FDA | Is it safe to eat tofu while taking azithromycin, or can soy products affect the antibiotic's absorption or effectiveness?

You can safely eat tofu and other soy products while taking azithromycin. Azithromycin can generally be taken with or without food, and there is no evidence that soy foods (like tofu, soy milk, edamame, or tempeh) reduce its absorption or effectiveness. ^[1] Azithromycin’s official patient instructions emphasize avoiding simultaneous use with aluminum- or magnesium-containing antacids, not with specific foods such as soy. ^[1]

How azithromycin interacts with food

Azithromycin tablets and oral suspension are designed to be taken with or without meals, and eating does not reduce the overall exposure (AUC) to the drug. ^[2] In studies, food can increase the peak level (Cmax) of azithromycin without changing the total amount absorbed, which means the antibiotic still works as expected. ^[3] For the oral suspension, food increased Cmax but did not change AUC, again indicating maintained effectiveness. ^[4]

Notable exception: antacids

What does matter is timing with certain antacids. Aluminum- and magnesium-containing antacids can lower the peak concentration of azithromycin if taken at the same time, so they should be separated by a few hours. ^[5] The overall exposure (AUC) isn’t changed, but the peak can drop, so spacing them apart is advised to avoid potential impact on effectiveness. ^[6] This caution applies to antacids, not to tofu or other soy foods. ^[7]

Dosage form details

• Tablets: Can be taken with or without food; food may modestly raise peak levels without affecting overall absorption. ^[8]
• Oral suspension: Similar profile food can increase peak levels but not total absorption. ^[9]
• Capsules (less commonly used): When taken with food, peak levels can decrease due to dosage-form issues; this effect is specific to capsules and not to soy foods. ^[10]

Practical guidance

• It’s reasonable to take azithromycin with meals if it helps your stomach feel better, and soy foods are fine. ^[11]
• Avoid taking azithromycin at the exact same time as aluminum/magnesium antacids; give a few hours in between. ^[12]
• If you experience any signs of an allergic reaction (such as rash, swelling, or trouble breathing), stop the medication and seek medical care. ^[13]

Bottom line

There is no known interaction between soy products and azithromycin, and eating tofu should not reduce the antibiotic’s absorption or effectiveness. ^[14] Azithromycin may be taken with or without food, with the key caution being to avoid simultaneous use with aluminum/magnesium antacids. ^[15]