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Azithromycin Dihydrate side effects: what 58,299 FDA adverse event reports show

Azithromycin Dihydrate · 1,237 reaction terms · 271,123 drug–reaction co-reports · data 2026-09-14
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Drug class

Macrolide antibacterial drug

FDA label, Indications wording

Who reports

58,299 reports · 75% serious · 5,236 with death outcome · 61% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Azithromycin tablet is a macrolide antibacterial drug indicated for treatment of patients with mild to moderate infections caused by susceptible strains of the designated microorganisms in the specific conditions listed below: Acute bacterial exacerbat.

FDA label, Indications and Usage

What it is

Azithromycin tablets USP contain the active ingredient azithromycin, a macrolide antibacterial drug, for oral administration. Azithromycin has the chemical name (2R,3S,4R,5R,8R,10R,11R,12S,13S.

FDA label, Description section

Boxed warning

None in the current label

How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled (related wording) 3Likely indication confounding 7Reporting / coding artifact 1Lab value / disease marker 3Not in label — unassessed 26
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only (and, for the 300 most-reported drugs, adjusted for age band), and flags pairs whose reports are unusually skewed by sex or come mostly from consumers. Each row also shows the PRR against the other drugs of the same FDA class, which removes most confounding by the condition being treated, and a calibrated p-value: on validation, known non-causes average an ROR of about 2, so significance is judged against that empirical null (✓ = p < 0.05 after calibration). 1,197 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Normal labour1232,720.2
1,615.9–4,579.2ROR 2,725.9 · calibrated p 2e-20 ✓
299.4 EB05 257.5 · IC025 +6.8
3/3 methods agree
Not in label — unassessedserious n=123 · ♀ 100% (drug 61%) · 100% cliniciannot reported in cached trials
Vaginal flatulence169449.6
358.3–564.2ROR 450.9 · calibrated p 3e-13 ✓
194.2 EB05 170.9 · IC025 +6.7
3/3 methods agree
Not in label — unassessedserious n=169 · ♀ 100% (drug 61%)not reported in cached trials
Congenital hiatus hernia112370.4
284.2–482.7ROR 371.1 · calibrated p 3e-12 ✓
176.1 EB05 150.4 · IC025 +6.3
3/3 methods agree
Not in label — unassessedserious n=112 · ♀ 0% (drug 61%) · 100% cliniciannot reported in cached trials
Total lung capacity increased118274.7
216.0–349.3ROR 275.2 · calibrated p 4e-11 ✓
151.3 EB05 129.8 · IC025 +6.2
3/3 methods agree
Not in label — unassessedserious n=118 · ♀ 100% (drug 61%) · 100% cliniciannot reported in cached trials
Pulmonary vasculitis189200.8
168.0–240.0ROR 201.5 · calibrated p 5e-10 ✓
126.9 EB05 112.4 · IC025 +6.3
3/3 methods agree
Not in label — unassessedserious n=189 · ♀ 0% (drug 61%)not reported in cached trials
Total lung capacity abnormal134195.9
158.7–241.9ROR 196.4 · calibrated p 7e-10 ✓
124.3 EB05 107.6 · IC025 +6.1
3/3 methods agree
Not in label — unassessedserious n=133 · ♀ 0% (drug 61%)not reported in cached trials
Asthma-chronic obstructive pulmonary disease overlap syndrome155152.8
126.6–184.4ROR 153.2 · calibrated p 5e-9 ✓
105.6 EB05 92.4 · IC025 +6.1
3/3 methods agree
Not in label — unassessedserious n=155not reported in cached trials
Capillaritis60103.6
77.7–138.1ROR 103.7 · calibrated p 2e-7 ✓
78.4 EB05 63.1 · IC025 +5.2
3/3 methods agree
Not in label — unassessedserious n=60 · ♀ 0% (drug 61%)not reported in cached trials
Spirometry abnormal11991.3
74.7–111.7ROR 91.5 · calibrated p 3e-7 ✓
72.0 EB05 61.8 · IC025 +5.5
3/3 methods agree
Lab value / disease markerserious n=119 · ♀ 0% (drug 61%)not reported in cached trials
Delivery13390.3
74.7–109.3ROR 90.5 · calibrated p 3e-7 ✓
71.5 EB05 61.8 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=127 · ♀ 100% (drug 61%) · 90% cliniciannot reported in cached trials
Mite allergy11579.0
64.6–96.7ROR 79.2 · calibrated p 8e-7 ✓
64.1 EB05 54.9 · IC025 +5.4
3/3 methods agree
Not in label — unassessedserious n=114 · ♀ 0% (drug 61%)not reported in cached trials
Mycotic allergy11456.2
46.1–68.4ROR 56.3 · calibrated p 8e-6 ✓
48.3 EB05 41.3 · IC025 +5.0
3/3 methods agree
Not in label — unassessedserious n=112 · ♀ 0% (drug 61%)not reported in cached trials
Antineutrophil cytoplasmic antibody positive9453.2
42.9–66.1ROR 53.3 · calibrated p 1e-5 ✓
46.0 EB05 38.7 · IC025 +4.9
3/3 methods agree
Lab value / disease markerserious n=94 · ♀ 0% (drug 61%)not reported in cached trials
Mycobacterium avium complex infection34152.8
47.1–59.1ROR 53.1 · calibrated p 1e-5 ✓
46.0 EB05 42.0 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=330not reported in cached trials
Mycobacterium abscessus infection8951.9
41.5–64.8ROR 52.0 · calibrated p 1e-5 ✓
45.0 EB05 37.7 · IC025 +4.8
3/3 methods agree
Not in label — unassessedserious n=88 · 100% cliniciannot reported in cached trials
Dust allergy12051.0
42.2–61.8ROR 51.1 · calibrated p 1e-5 ✓
44.4 EB05 38.2 · IC025 +4.9
3/3 methods agree
Not in label — unassessedserious n=120 · ♀ 0% (drug 61%)not reported in cached trials
Neuritis18549.1
42.1–57.2ROR 49.2 · calibrated p 2e-5 ✓
43.0 EB05 38.1 · IC025 +5.0
3/3 methods agree
Not in label — unassessedserious n=183 · ♀ 0% (drug 61%)not reported in cached trials
Bronchopulmonary aspergillosis allergic11049.0
40.1–59.8ROR 49.1 · calibrated p 2e-5 ✓
42.8 EB05 36.5 · IC025 +4.9
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=109not reported in cached trials
Female genital tract fistula17640.9
35.0–47.8ROR 41.0 · calibrated p 5e-5 ✓
36.6 EB05 32.3 · IC025 +4.8
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=176 · ♀ 100% (drug 61%)not reported in cached trials
Pulmonary function test abnormal15439.3
33.2–46.4ROR 39.4 · calibrated p 6e-5 ✓
35.3 EB05 30.9 · IC025 +4.7
3/3 methods agree
Reporting / coding artifactserious n=153not reported in cached trials
Abortion incomplete17035.5
30.4–41.6ROR 35.6 · calibrated p 1e-4 ✓
32.3 EB05 28.4 · IC025 +4.6
3/3 methods agree
Not in label — unassessedserious n=47 · ♀ 100% (drug 61%) · 100% cliniciannot reported in cached trials
Bronchiectasis59635.3
32.4–38.4ROR 35.6 · calibrated p 1e-4 ✓
32.1 EB05 30.0 · IC025 +4.8
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=592not reported in cached trials
Chronic sinusitis33535.2
31.5–39.4ROR 35.4 · calibrated p 1e-4 ✓
32.1 EB05 29.3 · IC025 +4.8
3/3 methods agree
Likely indication confounding
term in indications
serious n=331 · ♀ 91% (drug 61%)not reported in cached trials
Eosinophilic granulomatosis with polyangiitis16131.1
26.5–36.5ROR 31.2 · calibrated p 2e-4 ✓
28.6 EB05 25.1 · IC025 +4.5
3/3 methods agree
Not in label — unassessedserious n=161 · ♀ 0% (drug 61%)not reported in cached trials
Breath sounds abnormal38530.4
27.4–33.7ROR 30.6 · calibrated p 2e-4 ✓
28.0 EB05 25.8 · IC025 +4.6
3/3 methods agree
Not in label — unassessedserious n=378not reported in cached trials
Forced expiratory volume decreased21930.0
26.2–34.5ROR 30.1 · calibrated p 3e-4 ✓
27.7 EB05 24.8 · IC025 +4.5
3/3 methods agree
Lab value / disease markerserious n=217 · ♀ 22% (drug 61%)not reported in cached trials
Chronic kidney disease-mineral and bone disorder8129.2
23.3–36.6ROR 29.3 · calibrated p 4e-4 ✓
26.9 EB05 22.3 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious n=81not reported in cached trials
Radiculopathy19729.0
25.1–33.5ROR 29.1 · calibrated p 3e-4 ✓
26.8 EB05 23.8 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=196 · ♀ 100% (drug 61%)not reported in cached trials
Proctitis18925.9
22.4–30.1ROR 26.0 · calibrated p 6e-4 ✓
24.2 EB05 21.4 · IC025 +4.3
3/3 methods agree
Not in label — unassessedserious n=189 · ♀ 100% (drug 61%)not reported in cached trials
Biliary dyskinesia11325.3
20.9–30.6ROR 25.4 · calibrated p 7e-4 ✓
23.6 EB05 20.2 · IC025 +4.1
3/3 methods agree
Not in label — unassessedserious n=114 · ♀ 100% (drug 61%)not reported in cached trials
Cystic fibrosis36124.9
22.4–27.7ROR 25.0 · calibrated p 7e-4 ✓
23.3 EB05 21.4 · IC025 +4.3
3/3 methods agree
Likely indication confounding
term in indications
serious n=352not reported in cached trials
Bronchial wall thickening4624.3
18.0–32.7ROR 24.3 · calibrated p 1e-3 ✓
22.6 EB05 17.6 · IC025 +3.7
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=45 · ♀ 100% (drug 61%)not reported in cached trials
Hyperparathyroidism secondary16024.2
20.6–28.4ROR 24.3 · calibrated p 8e-4 ✓
22.7 EB05 19.9 · IC025 +4.1
3/3 methods agree
Not in label — unassessedserious n=160not reported in cached trials
Infective pulmonary exacerbation of cystic fibrosis34524.1
21.6–26.9ROR 24.2 · calibrated p 8e-4 ✓
22.6 EB05 20.7 · IC025 +4.3
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=315not reported in cached trials
Total lung capacity decreased9923.6
19.3–29.0ROR 23.7 · calibrated p 1e-3 ✓
22.1 EB05 18.7 · IC025 +4.0
3/3 methods agree
Not in label — unassessedserious n=98 · ♀ 100% (drug 61%)not reported in cached trials
Nasal polyps29123.0
20.5–25.9ROR 23.1 · calibrated p 0.001 ✓
21.7 EB05 19.6 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious n=288 · ♀ 91% (drug 61%)not reported in cached trials
Malignant melanoma in situ7623.0
18.3–29.0ROR 23.1 · calibrated p 0.001 ✓
21.6 EB05 17.8 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=76 · ♀ 0% (drug 61%) · 100% cliniciannot reported in cached trials

Clinical concept groups

MedDRA splits one clinical problem across several terms (e.g. "neutropenia", "neutrophil count decreased", "agranulocytosis"), which dilutes term-level signals. These rows count reports with any term in a concept group (an exact union, not a sum), compared with all other drugs. Groups are hand-built and listed in the methods.

ConceptReportsPRR 95% CIReading
Severe cutaneous reaction8344.13.8–4.3signal
Interstitial lung disease8403.23.0–3.4signal
Kidney injury3,6892.92.8–3.0signal
Arrhythmia / qt1,5302.92.7–3.0signal
Venous thromboembolism1,6412.72.6–2.9signal
Serious infection5,2712.52.4–2.5signal
Liver injury1,9202.32.2–2.4signal
Anaphylaxis / angioedema7642.22.0–2.4signal
Tendon disorder2302.21.9–2.5raised
Anaemia1,6762.01.9–2.1raised
Rhabdomyolysis / myopathy4442.01.8–2.2raised
Depression1,4161.81.7–1.9raised
Opportunistic infection6791.81.7–1.9raised
Hyponatraemia3681.61.5–1.8raised
Pancreatitis3461.51.4–1.7raised
Gi bleeding7281.41.3–1.5raised

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Azithromycin as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (0 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Off label use (used outside approved label)5,0812.1
2.1–2.2ROR 2.2 · calibrated p 0.943
2.1 EB05 2.1 · IC025 +1.0
3/3 methods agree
Reporting / coding artifactage-adj. PRR 2.2 · serious PRR 2.4not reported in cached trials
Drug ineffective (drug did not work)5,0321.4
1.3–1.4ROR 1.4 · calibrated p 0.583
1.4 EB05 1.3 · IC025 +0.4Reporting / coding artifactage-adj. PRR 1.6 · serious PRR 2.3not reported in cached trials
Dyspnoea (shortness of breath)4,5852.9
2.9–3.0ROR 3.1 · calibrated p 0.596
2.9 EB05 2.8 · IC025 +1.5
3/3 methods agree
Not in label — unassessedage-adj. PRR 2.8 · serious PRR 2.7not reported in cached trials
Nausea3,4371.6
1.5–1.6ROR 1.6 · calibrated p 0.709
1.6 EB05 1.5 · IC025 +0.6Labeled adverse reaction
exact term
age-adj. PRR 1.5 · serious PRR 1.8not reported in cached trials
Pain3,2481.9
1.8–2.0ROR 2.0 · calibrated p 0.920
1.9 EB05 1.8 · IC025 +0.9Labeled adverse reaction
exact term
age-adj. PRR 2.2 · serious PRR 2.0not reported in cached trials
Pneumonia (lung infection)3,2033.6
3.5–3.7ROR 3.7 · calibrated p 0.430
3.6 EB05 3.5 · IC025 +1.8
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
age-adj. PRR 3.3 · serious PRR 2.8NCT02047981: 1/97,047 (0.0%) on Azithromycin (serious AE)
Cough3,0624.0
3.8–4.1ROR 4.1 · calibrated p 0.354
3.9 EB05 3.8 · IC025 +1.9
3/3 methods agree
Labeled adverse reaction
exact term
age-adj. PRR 3.6 · serious PRR 4.2not reported in cached trials
Diarrhoea (diarrhea)2,9301.6
1.6–1.7ROR 1.7 · calibrated p 0.754
1.6 EB05 1.6 · IC025 +0.7Labeled adverse reaction
exact term
age-adj. PRR 1.5 · serious PRR 1.6NCT04224987: 1/104,374 (0.0%) on Azithromycin (serious AE)
Fatigue (tiredness)2,8661.3
1.3–1.4ROR 1.3 · calibrated p 0.538
1.3 EB05 1.3 · IC025 +0.3Labeled adverse reaction
exact term
age-adj. PRR 1.2 · serious PRR 1.5not reported in cached trials
Headache2,6091.5
1.4–1.6ROR 1.5 · calibrated p 0.657
1.5 EB05 1.5 · IC025 +0.5Labeled adverse reaction
exact term
age-adj. PRR 1.4 · serious PRR 1.8not reported in cached trials
Vomiting2,2851.8
1.7–1.8ROR 1.8 · calibrated p 0.822
1.8 EB05 1.7 · IC025 +0.7Labeled adverse reaction
exact term
age-adj. PRR 1.5 · serious PRR 1.6NCT04224987: 1/104,374 (0.0%) on Azithromycin (serious AE)
Anxiety2,2422.8
2.7–3.0ROR 2.9 · calibrated p 0.655
2.8 EB05 2.7 · IC025 +1.4
3/3 methods agree
Labeled adverse reaction
exact term
age-adj. PRR 2.9 · serious PRR 2.9not reported in cached trials
Condition aggravated2,1552.6
2.5–2.7ROR 2.6 · calibrated p 0.756
2.6 EB05 2.5 · IC025 +1.3
3/3 methods agree
Reporting / coding artifactage-adj. PRR 2.5 · serious PRR 2.7not reported in cached trials

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

✓ A hand-written Bradford Hill causality assessment exists for this drug: Azithromycin (macrolides) ↔ QT prolongation / torsades.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Azithromycin?

In FDA FAERS, the most frequently co-reported reaction terms for Azithromycin are dyspnoea, nausea, pain, pneumonia, cough, drug hypersensitivity. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Azithromycin have an FDA boxed warning?

No. The FDA label retrieved for Azithromycin has no boxed warning; see the label's Warnings and Precautions for the recognised risks.

Do FAERS signals prove that Azithromycin causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-14. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.