What happens if you take Azithromycin twice?

In this brief article, we will discuss the potential dangers of taking Azithromycin, an antibiotic, twice. We will also discuss the mild and serious side effects of overdosing on the antibiotic and the best ways to ensure safe and effective use. 

What happens if you take Azithromycin twice?

Taking Azithromycin twice, often known as ‘double dosing’, can increase the risk of antibiotic-induced side effects. However, it is not considered life-threatening in most cases. 

Azithromycin is an antibiotic commonly prescribed to treat bacterial infections like respiratory tract infections, skin infections, and sexually transmitted diseases (1). When taken correctly as prescribed by your healthcare provider, Azithromycin is effective in fighting infections and promoting recovery.

Double dosing can increase the concentration of the drug in your system, leading to higher levels of the medication than intended. This heightened level may not necessarily improve the effectiveness of the treatment but instead, increase the risk of experiencing adverse reactions and side effects (1).

Common side effects of Azithromycin may include: (2)

  • Nausea
  • Diarrhoea
  • Stomach pain or discomfort
  • Vomiting
  • Headache
  • Dizziness
  • Fatigue or weakness
  • Mouth sores
  • Changes in taste or loss of taste
  • Upset stomach
  • Palpitations (more common in women)

These side effects can vary from person to person. Some people may not experience these side effects on standard therapeutic doses, but taking the medication twice can significantly increase the risk of these side effects. 

The important concern with taking Azithromycin twice is temporary gastrointestinal damage. Azithromycin and other antibiotics can disrupt the balance of beneficial bacteria in your body.

This is because antibiotics not only target harmful bacteria causing infections but can also affect the beneficial bacteria that contribute to a healthy gut and immune system (3). This disruption may lead to digestive issues, such as diarrhoea and upset stomach (3).

The higher the dose, the higher will the effects on your gut health. Although it’s temporary, it can be quite disturbing. This is why it’s best to stick to the recommended doses and take Azithromycin as properly as you can. 

Long-term organ damage associated with recurrent overdosing on Azithromycin

Overdosing on Azithromycin or taking it more frequently than prescribed can potentially lead to long-term organ damage and serious health consequences. Although taking a double dose once is not considered life-threatening, frequent double dosing can cause fatal consequences. 

Frequent Azithromycin overdosing can affect the following organs/organ systems:

  • The liver and kidneys
  • Gastrointestinal system
  • Cardiovascular system

The liver and kidneys

The liver and kidneys are vital organs which are primarily involved in the metabolism and excretion of medications, including Azithromycin. 

The liver plays a crucial role in metabolizing drugs, including Azithromycin. Taking excessive amounts of the medication over an extended period can strain the liver, leading to liver damage or impairment (4,5). 

This can result in symptoms such as jaundice (yellowing of the skin or eyes), dark urine, persistent nausea, and abdominal pain.

The kidneys, on the other hand, are responsible for filtering and eliminating drugs from the body. Prolonged Azithromycin overdosing can put extra stress on the kidneys, potentially leading to kidney damage or kidney function decline.

Gastrointestinal system

Azithromycin overdose can also cause severe gastrointestinal problems. It may irritate the lining of the stomach and intestines, leading to gastritis, ulcers, or bleeding (3,6). Persistent gastrointestinal issues can result in malabsorption of nutrients and contribute to weight loss and nutritional deficiencies.

Cardiovascular system

Azithromycin has been associated with a rare but serious side effect known as ventricular arrhythmia (7). This means that the medication can interfere with the electrical signals that control the heart’s rhythm, leading to abnormal and potentially dangerous heartbeats.

Overdosing on Azithromycin or taking more than the recommended dose can increase the risk of experiencing this serious side effect. Arrhythmias can cause palpitations, dizziness, and fainting, and in severe cases, it can be life-threatening (8).

What to do if you have accidentally taken Azithromycin twice?

If you have accidentally taken Azithromycin twice and you feel unusual, please seek medical attention immediately. While taking an extra dose once is generally not considered life-threatening, people are different and can respond differently to such conditions.

Most people experience gastrointestinal (GI) side effects, which can be managed by proper care and medications. Your doctor may prescribe you antidiarrheal medications to manage loose stools and vomiting. 

There are plenty of dietary options that can also help you manage GI side effects, like the use of Probiotics, a soft diet including gastroprotective foods, and staying hydrated.

These GI symptoms may take some time to resolve, but they eventually do with proper care. However, some people may show other symptoms which should be properly evaluated by a doctor. This is why it’s best to seek medical attention after taking an extra dose of Azithromycin.

How to ensure the proper use of Azithromycin?

To ensure the proper use of Azithromycin, the following points are important (1):

  • Take Azithromycin exactly as prescribed by your healthcare provider, and do not adjust the dose without their approval.
  • Preferably take Azithromycin one hour before or two hours after meals for better absorption.
  • Finish the entire prescribed course of the antibiotic, even if you feel better, to ensure effective treatment. 
  • Do not consume alcohol while on Azithromycin, as it may increase the risk of side effects.
  • Keep Azithromycin in its original container at room temperature, away from moisture and sunlight. Always check the expiration date on the medication packaging, and do not use it if it has expired.
  • Avoid taking Azithromycin with certain medications, herbal supplements, or antacids without consulting your doctor.
  • Report any unusual or severe side effects to your healthcare provider promptly.


In this brief article, we have discussed the potential side effects of taking Azithromycin twice. We have also discussed the long-term organ damage associated with repeated Azithromycin overdosing and some ways to manage the side effects. 

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