Taking NyQuil WIth Azithromycin (Z-Pak)

In our latest question and answer, the pharmacist discusses whether or not it is safe to take NyQuil and azithromycin (Z-Pak) together.

Jun 07, 2018

TJS asked

I started with my first dose of Azithromycin today, two 250mg around 6hours ago. Can I take Nyquil tonight before bed.


NyQuil PourThere are no drug interactions between azithromycin (Z-pak) and Nyquil (acetaminophen, dextromethorphan, and doxylamine). They can be safely taken together. Below, we will discuss more about the two medications.


Information About The Z-Pak

A Z-pak consists of six tablets of azithromycin 250 mg. Usually two tablets are prescribed on the first day of therapy, followed by one tablet for the following four days.

Azithromycin is a macrolide antibiotic that can treat a variety of infections including bronchitis, sinus infections, ear infections, skin infections, sexually transmitted infections, and more. Azithromycin can cover several types of bacteria, but is not effective in treating the flu, the common cold, or other viral infections.

Like most antibiotics, azithromycin may cause diarrhea, nausea, vomiting, and abdominal pain. Macrolides are more likely to cause these types of side effects, but azithromycin is one of the more tolerable drugs in the class. Another concern with azithromycin is that it can cause QT prolongation in patients with a past medical history related to the heart. Drug interactions can also be a concern so always check each new medication prior to starting a new therapy.


Information About Nyquil

Nyquil comes in a variety of formulations and contains several different ingredients. Nyquil Cold & Flu contains the following:

  • Acetaminophen (pain relief, fever reducer)
  • Dextromethorphan (cough suppressant)
  • Doxylamine (antihistamine)

Acetaminophen is an analgesic that can be taken for a wide variety of acute and chronic pain ailments. Acetaminophen has a half-life of 2-3 hours. Acetaminophen gets absorbed at 85-98% and reaches peak concentrations within 30-60 minutes. Typically, acetaminophen can start working within 15 minutes. Acetaminophen can have negative impacts on the liver, especially at higher doses for an extended period of time.

Dextromethorphan (commonly referred to as DM on many over-the-counter products) is a cough suppressant that reduces the urge to cough. It is best to prevent bothersome dry cough or a cough that doesn’t involve mucus from the lower respiratory system.

Doxylamine is a first-generation antihistamine that is more likely to cause sedation and drowsiness as compared to second-generation antihistamines (i.e. loratadine, cetirizine). Other first-generation antihistamines include Benadryl (diphenhydramine), Dramamine (dimenhydrinate), Chlor-Trimeton (chlorpheniramine), Tavist (clemastine), and Phenergan (promethazine), among others. 


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