Augmentin side effects and how to avoid them

Headache, diarrhea, and heartburn are common Augmentin side effects but they often go away within a few days of treatment

By Georgia C. Yalanis, MD | Jun. 21, 2021 Medically reviewed by Josephine Bawab, Pharm.D.

Augmentin is the brand name for amoxicillin-clavulanate, which is a combination of amoxicillin and clavulanic acid or amoxicillin and clavulanate potassium (clavulanic acid as potassium salt). It’s a powerful penicillin antibiotic used to treat a variety of serious bacterial infections such as sinusitis, pneumonia, respiratory tract infections, otitis media resistant to amoxicillin alone, sore throats of bacterial origin, bronchitis, tonsillitis, skin infections, certain eye infections, and urinary tract infections. Antibiotics like Augmentin do not treat fungal or viral infections.

Augmentin preparations are prescription-only and not available over-the-counter. Augmentin is available as a chewable tablet, an extended-release tablet called Augmentin XR, and an oral suspension intended for pediatric use. The Food and Drug Administration (FDA) has approved Augmentin for use in adults and children as young as neonates (babies younger than 4 weeks of age).

Common side effects of Augmentin

If any of the common side effects of Augmentin listed below become bothersome, notify your healthcare provider.

Gastrointestinal symptoms including nausea, vomiting, stomach pain, and diarrhea
Skin issues such as urticaria (hives), rash, and pruritus or itchy skin
Inflammation of the tongue, mouth, and lips
Black hairy tongue
Oral or vulvovaginal yeast infection
Liver problems including elevated liver enzymes
General feelings of malaise such as headache and fatigue
Teeth discoloration with oral preparations

Headache

Headaches are a very common side effect of antibiotic use. They are so common that their incidence and prevalence are not recorded in the literature. Notably, antibiotics, including penicillin antibiotics, have been associated with drug-induced aseptic meningitis (DIAM). Aseptic meningitis can present with headaches. If you experience a headache that does not go away, you should seek medical advice right away.

Diarrhea

Abdominal issues including diarrhea are very commonly associated with antibiotic use. Amoxicillin is one of the six most common antibiotics associated with a serious type of diarrhea caused by the bacterium Clostridium difficile. This bacterium can cause severe damage to the colon and should be treated by medical professionals right away.

Heartburn

It is possible that antibiotics, including Augmentin, can disrupt the bacterial microbiome in thestomach and intestines by killing the good bacteria. This disruption to the intestinal microbiome can actually lead to acid reflux, more commonly known as heartburn. Therefore, it is not the antibiotic itself that directly causes heartburn, but the alterations to the GI tract that are caused by the antibiotic.

Fatigue

Fatigue is a word that encompasses a broad range of feelings of tiredness and exhaustion. Often, when the body is mounting an immune response, it is normal to feel tired, achy, weak, or generally unwell during that process. This is not a side effect of the antibiotic, but instead a consequence of the body fighting an infection.

Serious side effects of Augmentin

Augmentin use is associated with severe adverse reactions. If you experience any of these reactions, you should seek medical attention right away.

Hypersensitivity allergic reactions including anaphylaxis and a serum sickness-like reaction
Severe and potentially life-threatening skin conditions such as erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis
Superinfection with other bacteria
C. difficile-associated diarrhea
Blood cell problems including hemolytic anemia, leukopenia, thrombocytopenia, and agranulocytosis
Interstitial nephritis
Serious liver disease including hepatitis
Cholestatic jaundice resulting in dark urine and yellowing of the skin and eyes
Aseptic meningitis
Seizures

Rash

Penicillin-containing antibiotics, including Augmentin, are associated with very severe and potentially life-threatening skin rashes. The exact incidence of these events is difficult to calculate with multiple medications being possible offenders and multiple types of rashes as outcomes.

In general, if you are taking a penicillin-containing antibiotic and experience a painful, red rash that peels, has blisters, spreads quickly, or causes extreme discomfort, you should seek medical care right away. You should also seek medical care if you experience a minor rash with any associated signs and symptoms of anaphylaxis, including trouble breathing, rapid heart rate, swelling or edema, severe itchiness, clammy skin, confusion, or loss of consciousness.

How long do Augmentin side effects last?

Most common side effects associated with Augmentin use, such as abdominal pain, will resolve on their own within several days after starting the medication or within a few days after discontinuing it. Some severe side effects such as skin rashes, blood dyscrasias, liver problems, or jaundice could take several weeks to months to resolve. Anaphylaxis is potentially fatal and should be treated right away.

Augmentin contraindications and warnings

Penicillin allergy

Augmentin is absolutely contraindicated for use for individuals with a penicillin

allergy. Penicillin allergy is extremely common and other antibiotics with similar bacterial coverage should be used. While there can sometimes be a concern for cross-reactivity and some have experienced severe reactions, cephalosporins are generally the most commonly used alternative for safe and reliable treatment. Before initiating treatment with Augmentin, it is important to notify your healthcare provider about any previous hypersensitivity reactions to penicillins or cephalosporins.

Pregnancy and breastfeeding

Augmentin may be used during pregnancy, however, there is conflicting human data on the risk of possible harm to the developing fetus. Informed decision-making should be used when determining the risks of taking Augmentin over the need for it to treat a specific disease.

There is no known risk of fetal harm with Augmentin use in breastfeeding patients. There is a possible risk of infant diarrhea, rash, hives, thrush, or sleepiness.

Kidney and liver disease

Individuals with kidney disease or on hemodialysis should have a dosing adjustment in the amount and frequency of medication administered.

Augmentin is contraindicated for use in individuals with a history of hepatic impairment.

Overdose

Augmentin dosages vary based on the condition it is being used to treat. The absolute maximum dose is 4,000 mg per day. However, it is recommended to follow the usual dosing when targeting a high dose (80 to 90 mg/kg/day). While there are no strict criteria for overdose, if you believe you have taken too much medication, contact the Poison Control Centers at 1-800-222-1222.

Augmentin interactions

While there are no medications with absolute contraindications for use with Augmentin, there are several medications that should be used with caution due to drug interactions. It is important to notify your healthcare provider about all medical conditions and prescription drugs you are using before starting treatment with Augmentin.

Allopurinol

Allopurinol, a gout medication, has been associated with severe hypersensitivity syndromes. Taking Augmentin with allopurinol could increase the risk of developing a serious skin rash.

Probenecid

Probenecid , another gout medication, delays amoxicillin excretion through the kidneys but not the excretion of clavulanic acid. Overall, this could keep the antibiotic in the blood longer than desired. However, this is a desirable side effect when treating sexually transmitted infections such as gonorrhea or syphilis.

Oral contraceptives

Rifampin is the only antibiotic with published data demonstrating associated contraceptive failure when taking oral birth control pills. There is no definitive data to suggest that taking penicillin-containing antibiotics like Augmentin decreases the efficacy of oral contraceptives. However, if you are taking birth control pills to prevent pregnancy, speak with your healthcare provider about the potential need for an additional method of contraception to be used when taking Augmentin.

Warfarin

Penicillin-containing antibiotic medications are associated with an increased risk of bleeding when used with the blood thinner warfarin. Caution should be used when administering Augmentin while taking warfarin, especially when administering warfarin in older individuals.

Mononucleosis

There is evidence demonstrating the possibility of a hypersensitivity rash developing from amoxicillin in patients with infectious mononucleosis, also known as “mono”. It is not clear what mechanism of action is related to the development of this rash. Skin tests can be performed to determine if an individual becomes sensitive to penicillins while having infectious mononucleosis.

How to avoid Augmentin side effects

Patients should disclose a full medication list, health history, and allergies before taking Augmentin. This includes all medications and supplements, any medical conditions the patient has, or any allergic reactions they have had to medications in the past.
Follow medical advice while taking this medication. Take only the dose prescribed by a healthcare professional. Do not take more medication and do not take less. Always finish the prescribed course of antibiotics. Take all of the doses how and when they are prescribed. If you have a missed dose, take the next dose as soon as you remember. Patients should continue taking the medication as prescribed even if they feel better after the first few doses.
Augmentin, and antibiotics in general, should only be taken for the exact amount of time recommended by your healthcare provider. For most bacterial infections, Augmentin is taken daily for up to 14 days. For some very serious infections, Augmentin may be prescribed for longer.
Swallow the tablet whole or take the suspension exactly as it was prepared. Do not crush, break, or chew the tablet or dilute the suspension.
Take Augmentin at the start of a meal or with a glass of milk. Taking Augmentin with a meal will enhance the absorption, and reduce the chance of stomach upset.
Refrigerate liquid Augmentin. Augmentin tablets should be stored at room temperature (68 to 77 degrees Fahrenheit). Liquid Augmentin oral suspension should be refrigerated.
Patients should immediately seek medical care if they experience any type of allergic reaction to this medication. Allergic responses and hypersensitivity reactions to Augmentin could be fatal and should be reported and treated as early as possible.