7 Amoxicillin Interactions You Should Know About

At some point, you or a loved one have likely received a prescription for amoxicillin. It’s a common, low-cost penicillin antibiotic that’s available at pharmacies across the U.S. It treats bacterial infections ranging from skin infections to infections of the ears, nose, and throat. 

Amoxicillin is also considered safe to take. However, interactions with other medications are still possible. Some interactions can worsen amoxicillin’s side effects, while others may impact the effectiveness of the interacting medication. It’s helpful to be aware of possible amoxicillin interactions before you start taking it. We’ll discuss seven of them below.

1. Warfarin

Warfarin (Coumadin, Jantoven) is a blood thinner that treats and prevents blood clots. If you take warfarin, your healthcare provider likely warned you about possible interactions with food, medications, and even supplements. Some interactions enhance warfarin’s effects, which worsens the risk of easy bleeding or bruising. Others make warfarin less effective, which raises the risk of blood clots.

Many antibiotics, including amoxicillin, might increase the risk of bleeding with warfarin. As a precaution, your healthcare provider might check your blood work more often while you’re taking the combination. Based on test results, they might adjust your warfarin dose to help prevent side effects.

Listening to your body is another good precaution to take. Watch for any signs of unusual bruising or bleeding when taking warfarin. This could include black or red stools, bleeding gums, or unexplained nosebleeds. Report these to your healthcare provider if they happen.

2. Allopurinol

Allopurinol (Zyloprim) is a common medication for gout. But allopurinol has a risk of causing skin rashes, which can range from mild to severe. Skin rashes are also a possible side effect of amoxicillin. If you take them together, there’s a bigger risk of developing skin rashes.

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In rare cases, this combination could lead to a dangerous condition called drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. This is a severe allergic reaction to a medication. Possible symptoms include fever, a widespread peeling rash, and swollen lymph nodes.

If you notice a skin rash of any severity while taking allopurinol, stop taking the medication and contact your healthcare provider for advice. You should get medical help right away if you develop a blistering skin rash with a fever. This could be a sign of a severe skin reaction, including DRESS syndrome.

Skin rashes have another layer of complexity. Some amoxicillin rashes may be related to a penicillin allergy. Call 911 or seek emergency help if you notice symptoms like hives, trouble breathing, or swelling in the face, tongue, or throat.

3. Probenecid

Probenecid is another gout medication that can interact with amoxicillin. It makes amoxicillin stick around for longer in your body.

If you take probenecid and amoxicillin together, there’s a higher risk of developing amoxicillin side effects, such as new or worsening nausea, vomiting, or diarrhea. These symptoms can be bothersome, so make sure to reach out to your healthcare provider if they feel intense or get worse at any point.

This interaction isn’t always bad, though. This interaction is beneficial in certain situations. These medications are sometimes prescribed together to treat sexually transmitted infections, like gonorrhea.

4. Certain antibiotics

Amoxicillin doesn’t get along with all antibiotics. The significance of the interaction isn’t clear, but it may interact with antibiotics like sulfamethoxazole / trimethoprim (Bactim), tetracyclines (tetracycline, doxycycline), and macrolides (azithromycin, clarithromycin). These medications could make amoxicillin less effective. Lab data suggests this could lead to an undertreated infection, but this hasn’t been confirmed.

Thankfully, this interaction is pretty easy to avoid. Your healthcare provider likely won’t prescribe these antibiotics at the same time. But if they do, they can tell you about the pros and cons of taking them together.

5. Certain live vaccines

Vaccines help our bodies learn to fight infections before we come across the viruses or bacteria that cause them. But many antibiotics — including amoxicillin — can make some live vaccines less effective. Top ones to keep in mind are the live cholera vaccine (Vaxchora) and the live typhoid (Vivotif) vaccine. These are vaccines you might receive before you travel to certain countries.

If you plan to get vaccines like these in the future, your healthcare provider may recommend separating them from your antibiotic. These are the general guidelines to follow: 

• Vaxchora: Separate Vaxchora and your last amoxicillin dose by at least 14 days (2 weeks).

• Vivotif: Separate Vivotif and your last amoxicillin dose by at least 72 hours (3 days).

Of note: Not all live vaccines interact with amoxicillin. Only a few are affected. This interaction is also not a concern for other types of vaccines, including COVID-19 vaccines and flu shots.

6. Alcohol

“Can I drink alcohol with my antibiotic?” This is a common question that pharmacists hear. For good reason, too. Mixing some antibiotics with alcohol may cause unpleasant, and even dangerous, side effects. It can also make it harder for antibiotics to do their job.

Amoxicillin alone can cause side effects like nausea, vomiting, and diarrhea. But alcohol can also cause these side effects. When they’re combined, they may feel more intense. What’s more, alcohol can weaken your immune system. This can make it harder for amoxicillin and your immune system to fight your infection.

Because of these risks, it’s best to not mix alcohol with amoxicillin. But if you’re interested in raising your glass, talk to your healthcare provider to see if it's safe to drink in moderation while taking amoxicillin.

7. Birth control pills

It’s a common myth that all antibiotics make birth control pills less effective. This is only true for some antibiotics, like rifampin and rifabutin. These rifamycin antibiotics can lower the amount of hormones that your body absorbs from your birth control.

This isn’t the case for antibiotics like amoxicillin. If you’re taking amoxicillin, it shouldn’t interfere with your birth control. Studies show that non-rifamycin antibiotics don’t lower the effectiveness of birth control.

Still, if you’re worried about pregnancy while taking antibiotics, there are other precautions you can take. Talk to your healthcare provider about other birth control options that may fit your lifestyle, such as condoms.

Can you take Tylenol with amoxicillin?

Yes, it’s OK to take Tylenol (acetaminophen) with amoxicillin. There aren’t any interactions between the two medications. If your infection is causing pain or a fever, Tylenol is one option to help calm your symptoms. Kids and adults can both take it.

But keep in mind that Tylenol isn’t safe for everyone to take. If you have liver problems, have a high alcohol intake, or are fasting, ask your healthcare provider if taking Tylenol is a good idea. You may be told to skip it or take a lower dose.

What about taking ibuprofen with amoxicillin?

Yes, you can also take ibuprofen (Advil, Motrin) with amoxicillin. If you need pain or fever relief, you can turn to ibuprofen. You can also alternate back and forth between Tylenol and ibuprofen since they work differently. However, if you have kidney problems, ask your healthcare provider if ibuprofen is safe for you to take.

How can I avoid or manage potential interactions with amoxicillin?

Make sure you give your healthcare provider and pharmacist your most current medication list. The list should include all prescription and over-the-counter medications you take. Don’t forget vitamins and herbal supplements, either. This information will help them prevent and manage interactions.

This is especially important if you have medications from multiple healthcare providers or you fill medications at more than one pharmacy. One person might not be aware that you’re taking medication from somewhere else.

When should I contact my healthcare provider about an amoxicillin interaction?

Nausea, vomiting, and diarrhea are common side effects of amoxicillin. They’re not nice to deal with, but they should go away after stopping the medication.

If side effects like these become concerning or don’t go away, contact your healthcare provider as soon as you can. They can help you manage your symptoms. And if your symptoms feel severe, don’t hesitate to call for emergency help instead.

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Written by:

Nicole Apa, PharmD Candidate

Nicole Apa is a Doctor of Pharmacy candidate at Butler University in Indianapolis. Prior to pharmacy school, Nicole worked as a pharmacy technician for multiple years at a community pharmacy.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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