When should you take the second Z-Pak dose?
By
Dr Milena Locci de Oliveira (PhD)
Author bio
Dr Milena Locci de Oliveira is a Pharmacist and Doctor of Philosophy in Sciences from the University of São Paulo (USP). She has experience in microbiology, analytical toxicology, and clinical pharmacokinetics. She writes and reviews content on these topics.
Dr Milena’s Highlights:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration in the areas of Pharmacometrics and Population Pharmacokinetics, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
“Science can be translated, and it is essential that everyone has access to quality information to make informed decisions” – Dr Milena Oliveira, PhD.
Professional Experience:
With a decade-long career as a researcher, Dr Milena has amassed extensive experience in conducting research projects in microbiology, analytical toxicology, and clinical pharmacokinetics.
Her expertise also extends to the preparation of technical and scientific reports, literature reviews, data analysis, and scientific communication, both oral and written.
Dr Milena has served as a Clinical Pharmacist, providing expert supervision and guidance to teams during the challenging times of the COVID-19 pandemic, particularly in the ICUs of two reference hospitals for patient hospitalization.
In her most recent role, Dr Milena worked on the implementation of the deliberatives of the São Paulo State Government Pharmaceutical Assistance Coordination. These decisions were aimed at ensuring medication access within the Unified Health System.
A widely multidisciplinary background enabled Dr Milena to become a professional capable of integrating scientific knowledge into private initiatives, education, and healthcare, delivering consistent services in patient safety and population health.
Professional Memberships & Affiliations:
Dr Milena Oliveira is a member of the Regional Council of Pharmacy of the State of São Paulo, Brazil.
Education:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
Relevant Published Work & Citations:
Oliveira ML de, Rocha A, Nardotto GHB, Pippa LF, Simões BP, Lanchote VL. Analysis of daunorubicin and its metabolite daunorubicinol in plasma and urine with application in the evaluation of total, renal and metabolic formation clearances in patients with acute myeloid leukemia. Journal of Pharmaceutical and Biomedical Analysis. Nov 2020. 191:113-124.
Abstracts. CPT: Pharmacometrics & Systems Pharmacology. 2020 Nov; 9 (S1).
Pippa LF, Oliveira ML de, Rocha A, de Andrade JM, Lanchote VL. Total, renal and hepatic clearances of doxorubicin and formation clearance of doxorubicinol in patients with breast cancer: Estimation of doxorubicin hepatic extraction ratio. Journal of Pharmaceutical and Biomedical Analysis. 2020 Jun 5; 185:113-231.
Godoy ALPC, De Jesus C, De Oliveira ML, Rocha A, Pereira MPM, Larangeira DF, Lanchote VL, Barrouin-Melo SM. Determination of Allopurinol and Oxypurinol in Dogs Plasma by High-Performance Liquid Chromatography with an Ultraviolet Detector: Application for Pharmacokinetic Studies. J Chromatogr Sep Tech. 2017; 8 (4).
Clímaco EC, Oliveira ML de, Pitondo-Silva A, Oliveira MG, Medeiros M, Lincopan N, et al. Clonal complexes 104, 109 and 113 playing a major role in the dissemination of OXA-carbapenemase-producing Acinetobacter baumannii in Southeast Brazil. Infection, Genetics and Evolution. 2013 Oct;19:127–33.
Conference Papers:
Oliveira, M. L.; NARDOTTO, G. H. B.; PIPPA, L. F.; ROCHA, A.; SIMOES, B. P.; LANCHOTE, V. L. . Daunorubicin metabolism and urinary excretion in patients with acute myeloid leukemia. In: 84th Annual Meeting of the German Society for Experimental and Clinical Pharmacology and Toxicology (DGPT) and the 20th Annual Meeting of the Association of the Clinical Pharmacology Germany (VKliPha), 2018, Göttingen. Naunyn-Schmiedeberg’s Arch Pharmacol, 2018. v. 391. p. S76-S76.
Oliveira, M. L.; NARDOTTO, G. H. B. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . The low contribution of urinary excretion in the elimination of daunorubicin and its metabolite daunorubicinol in patients with acute myeloid leukemia. In: 49th Brazilian Congress of Pharmacology and Experimental Therapeutics., 2017, Ribeirão Preto. Livro de Resumos, 2017. p. 64-64.
Oliveira, M. L.; PIPPA, L. F. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . Quantification of daunorubicin and its metabolite daunorubicinol in human plasma by LC-MS/MS. In: I International Meeting of Environmental Health and Toxicology (IMEHTOX), 2016, Ribeirão Preto. Livro de Resumos, 2016.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. . PFGE typing of Carbapenem-Resistant Acinetobacter baumannii isolated from different University Hospitals. In: V International Postgraduate and Research Symposium, 2012.
Clímaco, E.C. ; SILVA, A. P. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. Relação clonal entre linhagens de Acinetobacter baumannii produtoras de carbapenemases da família OXA em quatro hospitais no Brasil. In: XXI Latin American Congress of Microbiology, 2012, Santos. XXI Latin American Congress of Microbiology, 2012.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Darini A.L.C. . Dissemintion of OXA carbapenemases genes in carbapenem-resistant Acinetobacter baumannii in University Hospital of Juiz de Fora, MG. In: 8th CIFARP – International Congress of Pharmaceutical Sciences, 2011, Ribeirão Preto.
Clímaco, E.C. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Darini A.L.C. . Avaliação do sequenciamento parcial do gene rpoB e de seus flanqueadores para identificação de espécies de Acinetobacter na rotina laroratorial. In: 2° International Symposium on Clinical Microbiology, 2010, Florianópolis.
You can view some of Dr Milena’s work below and links to her professional profile.
Linkedin: https://www.linkedin.com/in/dra-milena-locci-de-oliveira-28986042/?locale=en_US
ResearchGate: https://www.researchgate.net/profile/Milena-Oliveira-6
Escavador: https://www.escavador.com/sobre/5394254/milena-locci-de-oliveira
Lattes: https://buscatextual.cnpq.br/buscatextual/busca.do
Scopus: https://www.scopus.com/authid/detail.uri?authorId=57199779361
Scholar: https://scholar.google.com/citations?view_op=list_works&hl=pt-BR&user=1YUBDIQAAAAJ
When should you take the second Z-Pak dose?
You should take your second Z-Pak dose 24 hours after the first one. Z-Pak (Azithromycin) contains 6 tablets, which are intended to be taken within 5 days, which is the usual duration of treatment with this antibiotic (1).
On the first day, you are supposed to take two 250 mg tablets, which makes 500 mg. This is considered a loading dose of Azithromycin to kickstart the bacterial-killing effect (1,2).
For the next four days, you will have to take 250 mg tablet daily at an interval of 24 hours. All of your doses should have a gap of an entire day. Make sure you take two tablets on the first day as it’s important for the maximum antibacterial effects (1,2).
You can try setting the alarm for the next four days to remind you to take Z-Pak. If you find this antibiotic heavy on your stomach, you can take it will meals. Talk to your healthcare provider if you’re concerned about any other side effects.
Importance of completing the full Z-Pak course
Completing the full Z-Pak course is crucial for effective treatment of bacterial infections. When you start taking Z-Pak, it begins to attack the harmful bacteria causing the infection. However, some bacteria might survive the initial doses and continue to multiply.
By completing the full course of Z-Pak as prescribed by your healthcare provider, you ensure that all the bacteria are eliminated from your body.
This helps prevent the recurrence of the infection, as Azithromycin is a long-acting antibiotic and keeps working as long as the last dose remains in your body (2). It can also prevent developing antibiotic resistance (3,4).
Antibiotic resistance occurs when bacteria become resistant to the medication, making it less effective in future treatments (3,4). Stopping the Z-Pak course prematurely, even if you start feeling better, may lead to incomplete eradication of the bacteria. (3,4)
The remaining bacteria can become stronger and more resistant, making it difficult to treat the infection later on. Therefore, it is essential to follow your healthcare provider’s instructions and complete the full Z-Pak course to achieve the best possible outcome and ensure your health and well-being.
How to manage missed Z-Pak doses?
If you miss a dose of Z-Pak, there are some important steps that you can take. These include: (1,2)
Take the missed dose as soon as you remember
If you realize you missed a dose and it’s not close to the time for the next scheduled dose, take it right away. If it’s almost time for the next dose, skip the missed one and continue with your regular schedule.
Don’t double up
Never take two doses together to make up for the missed one. Taking extra medication can lead to unwanted side effects. Always stay on track with your dosing schedule to ensure the medication works effectively. Set reminders or alarms on your phone to help you remember.
Inform your healthcare provider
If you miss multiple doses or are unsure about what to do, talk to your doctor or pharmacist for guidance. They can provide personalized advice based on your situation.
Complete the course
Continue taking the remaining doses of Z-Pak as prescribed, even if you missed one. Finishing the full course is essential for the medication to effectively treat the infection.
How to ensure the safe and effective use of Z-Pak?
To ensure the safe and effective use of Z-Pak, there are a few essential things to keep in mind. First and foremost, always take the medication exactly as prescribed by your healthcare provider.
Follow the recommended dosage and duration without skipping or doubling up on doses. It’s crucial to complete the full course, even if you start feeling better before finishing it.
Inform your doctor about any other medications you may be taking or any medical conditions you have, as this can help prevent potential drug interactions or adverse effects.
If you experience any unusual or severe side effects while on Z-Pak, contact your healthcare provider promptly. By being responsible and informed about your medication, you can maximize its benefits and support a successful recovery.
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References
1.-
LABEL: AZITHROMYCIN tablet, film-coated. DailyMed [Internet]. Available from: https://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=5dca5a11-3c02-4a51-a35d-f91f37b8e00c&type=pdf
2.-
Sandman Z, Iqbal OA. Azithromycin. 2023 Jan 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32491698. https://www.ncbi.nlm.nih.gov/books/NBK557766
3.-
Habboush Y, Guzman N. Antibiotic Resistance. 2023 Mar 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30020649. https://www.ncbi.nlm.nih.gov/books/NBK513277
4.-
Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015 Apr;40(4):277-83. PMID: 25859123; PMCID: PMC4378521. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/
