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Drug Info

Does azithromycin make you tired? How to avoid fatigue

It isn’t common, but there are ways to manage it
Vanessa Ling headshot
By | Jul. 15, 2025 Medically reviewed by Samantha Marr, DNP, APN, AGPCNP-BC, CCRN
A pillow with a blue capsule on it: Does azithromycin make you tired? How to avoid fatigue

Key takeaways

  • Azithromycin can make you tired, but it’s not a common side effect of this antibiotic.

  • Eating well, sleeping well, and staying hydrated can help your energy levels while taking azithromycin.

  • If you have severe or prolonged fatigue, talk to your healthcare provider to seek possible alternatives.

In this article:

Azithromycin, sold under brand names like Zithromax, is a common antibiotic used to treat bacterial infections like ear infections, throat infections, and sinusitis. Though generally well-tolerated, some people may feel tired or sluggish after taking azithromycin, which is an uncommon side effect listed on its drug label. We’ll break down how azithromycin works, how it might lead to fatigue, what you can do about it, and what your healthcare provider may consider if it’s not the right fit. 

Why does azithromycin make you tired?

Certain medications can make you tired, and antibiotics are no exception. However, fatigue is an uncommon side effect of azithromycin. 

According to the drug’s prescribing information, fewer than 1% of people report feeling tired while taking it. Austin Shuxiao, MD, internal medicine doctor and founder and medical director of PeachIV, shares, “When rounding on patients who are receiving intravenous (IV) antibiotics in the hospital, I often hear patients describing their fatigue and weakness, sometimes to the point of not being able to get out of bed.”

The exact reason azithromycin may cause fatigue isn’t fully understood, but it’s likely due to a combination of factors. Azithromycin works by stopping bacteria from growing, allowing your immune system to clear an infection. However, while the drug targets bacteria, it can also have indirect effects on some people that leave them feeling drained. Some research suggests antibiotics like azithromycin may affect blood cells in ways that contribute to fatigue.

In some people, azithromycin can cause abnormal liver function and liver inflammation (hepatitis), which could lead to more serious conditions like liver failure. Drug-induced liver injury can cause fatigue and tiredness, even if it’s mild. There are no definitive risk factors for drug-induced liver injury, but pre-existing liver disease and genetic susceptibility can predispose some people.

If you’re feeling unusually tired while taking azithromycin, it may be due to a combination of the medication, your body’s inflammatory response, and the physical toll of fighting an infection. If the fatigue doesn’t improve after you finish your course, it’s a good idea to check in with your healthcare provider.

How to combat fatigue from antibiotics

Recovering from an infection is hard work for your body, and even with effective antibiotic treatment like azithromycin, it’s normal to feel tired. If fatigue sets in during your antibiotic course, the same supportive strategies that help you fight off an illness can also help restore your energy. Here are some tips to combat fatigue from antibiotics.

Prioritize sleep and rest

Sleep and rest allow your body to heal. Taking the day off from work or school can help your body clear the infection and manage any side effects of your medications. “If they are experiencing fatigue, they should try to get rest and adequate sleep, and not overexert themselves while recovering. Feeling fatigued may just be a sign of their body’s heightened metabolism while fighting off infection,” Dr. Shuxiao says.

Stay hydrated

Fatigue can be a symptom of dehydration. Fluids can help circulate byproducts of infection, but they can also help circulate medication and nutrients to support overall body functions. Drink water, tea, or soup throughout the day to stay hydrated, especially if you’ve had a fever or have been sweating.

Eat nourishing, balanced meals

Nutrient-rich foods provide the fuel your immune system needs to bounce back. Vitamins and minerals can help your immune system function better, and the best way to get them is through a healthy, balanced diet. Focus on meals with protein, healthy fats, fruits, and vegetables to help your body recover and regain energy.

Consider probiotics

Antibiotics like azithromycin can also affect the balance of healthy gut bacteria, which may contribute to feeling “off” or sluggish. A probiotic supplement or fermented foods (like yogurt, kefir, kimchi, or sauerkraut) may help your gut, especially if you’re experiencing digestive issues alongside fatigue when taking azithromycin. A 2023 review found that healthy athletes who took probiotics for four weeks reported improved energy levels. In another study, people recovering from a viral infection saw benefits in their energy levels after six months of taking probiotics. 

In most cases, these simple strategies can support your recovery and help restore your energy levels. If your fatigue is severe or not improving, talk to your healthcare provider. They can help determine whether it’s a side effect of the medication or something else that needs separate medical attention.

Other common azithromycin side effects 

According to azithromycin’s prescribing information, its most common side effect is diarrhea or loose stools, occurring in about 4%–5% of adults. Other common side effects of this drug include:

  • Nausea
  • Abdominal pain
  • Rash
  • Headache 
  • Vomiting

Although these side effects are listed to occur in a small percentage of people, healthcare providers may see them more often in their patients. Dr. Shuxiao shares, “Whether it’s abdominal cramping, nausea, diarrhea, I pretty much expect patients to have some sort of GI disturbance while taking azithromycin. Though the statistics show the side effects only occur in 10% of patients, anecdotally, it feels more common.”

To avoid side effects of azithromycin, always take the medication as directed, following the schedule your healthcare provider prescribes. People on higher doses of azithromycin may have a higher risk of side effects, which can also occur if you take a dose too soon.

Although azithromycin can be taken with or without food, taking the medication after food may help to avoid digestion-related side effects. “For mild symptoms like stomach upset, I typically recommend patients take azithromycin with food and maintain hydration,” recommends Martina Ambardjieva, MD, urologist at Dr. Telx. 

Dr. Shuxiao recommends considering light and plain foods to avoid irritating the digestive system. “They can also eat smaller, bland meals and avoid spicy or greasy food while taking azithromycin.” 

Dr. Ambardjieva explains that there are some serious side effects of azithromycin that need immediate medical attention. She says people taking azithromycin should immediately contact their healthcare provider if they develop: 

  • A severe rash, swelling, or difficulty breathing, as it could be an allergic reaction
  • Yellowing of the skin or the eyes, indicating possible liver injury
  • An irregular heartbeat or lightheadedness, which could be caused by changes in your heart rhythm
  • Severe or persistent diarrhea, which could indicate a C. diff infection

“These are signs of rare but potentially serious adverse reactions that warrant prompt discontinuation and further management,” Dr. Ambardjieva says. 

Azithromycin alternatives

If your healthcare provider determines that azithromycin isn’t the best option for you, there are other antibiotics that can treat your infection without the same side effects. Azithromycin is a macrolide antibiotic that works by interfering with bacterial growth. Other macrolide antibiotics like erythromycin and clarithromycin can be used instead of azithromycin. 

Antibiotics from other classes may also be considered, depending on the type of infection. Other azithromycin alternatives include:

If you’re concerned about fatigue while on azithromycin, tell your healthcare provider. They will weigh the risks and benefits of each alternative. For example, they may avoid prescribing vancomycin, a glycopeptide antibiotic that can cause fatigue in 5% of adults. On the other hand, doxycycline is a tetracycline antibiotic that doesn’t typically cause fatigue and may be a better option. “Doxycycline is a common alternative and can be used for many similar-use conditions like community-acquired pneumonia or sinusitis,” Dr. Shuxiao says.

Bottom line

Azithromycin is an antibiotic drug that may make you feel tired, but only a small percentage of people reported fatigue in its clinical trials, making it an uncommon side effect.  The most common reported side effects of azithromycin are digestive symptoms such as diarrhea, loose stools, nausea, and abdominal pain.

It’s not clear how azithromycin causes fatigue, but it may result from a combination of the drug’s effects on your body and the toll of fighting an infection. Some research suggests that antibiotics can affect blood cells or liver function, which may contribute to feeling tired.

If you’re experiencing fatigue after taking azithromycin, it’s a good idea to contact your healthcare provider. They may consider alternative antibiotics for you, such as erythromycin, amoxicillin, and doxycycline. Your healthcare provider can help find the most effective treatment with the fewest side effects.