Amoxicillin and zoloft (Is there any interaction?)

In this blog, we are going to talk about the possible interactions between amoxicillin and zoloft. We will also cover tips that should be followed while using amoxicillin and zoloft together. 

Can you take amoxicillin and zoloft together? 

Yes, you can take amoxicillin and zoloft together, if prescribed by your doctor. There is no such harmful interaction reported between these two drugs, but it doesn’t indicate that no interactions exist. 

Certain people have reported extreme gastrointestinal side effects, including nausea, vomiting and diarrhoea, after the concomitant use of these two agents. 

It’s quite common to catch bacterial infections every once in a while. Our lifestyle makes us exposed to different kinds of infections and almost every infection needs an antibiotic for proper treatment. 

They could be of any type. Most common infections that people suffer from include throat infections, ear infections, urinary tract infections, eye infections and skin infections etc. 

Amoxicillin is a penicillin-type antibiotic. It inhibits biosynthesis of the bacterial cell wall and causes bacterial cell death. It is usually prescribed to fight against a number of gram positive bacterial infections. Zoloft, on the other hand, is an antidepressant and it requires proper adherence.

You need to take zoloft daily for it to start making sufficient changes in your system. Depression does not progress overnight. Similarly, you can not eradicate it overnight. 

What does research say? 

A 2015 study revealed that zoloft can increase the efficacy of antibiotics. One possible reason for this effect is the antimicrobial property of zoloft itself. 

A 2009 research project studies the antimicrobial effect of zoloft of 224 different bacterial strains. The study concluded that sertraline indeed possesses antimicrobial activity, specifically against gram positive bacteria. 

This suggests that there might be a need for dose adjustment in case of using amoxicillin and zoloft together. Another study concluded that the concomitant use of zoloft and amoxicillin can increase the intensity of gastrointestinal side effects. 

Antibiotics are well known for producing gastrointestinal side effects. These agents are responsible for destroying bacterial growth. Our gut has natural microflora which regulate a number of functions. They aid in digestion and help control the increased acidity of the stomach. 

The use of antibiotics, while destroying the growth of bad bacteria, can also cause serious damage to our good bacteria and end up destroying them as well. This results in gastrointestinal side effects. Zoloft, on the other hand, is also known for causing acid reflux.

A majority of its users have reported severe acid reflux, heartburn, GERD like symptoms and throat muscle spasm because of the increased production of stomach acid in response to zoloft exposure. 

This indicates that these two drugs together can end up causing severe GIT side effects which can result in dangerous symptoms like:

• Hematemesis (bloody vomiting) 
• Gastrointestinal bleeding 
• Blood in stool
• Throat burn
• Blisters in mouth 
• Bitter taste
• Inability to digest anything, even liquid calories. 
• Diarrhoea 
• Dehydration which can cause electrolyte imbalance. 

Make sure your doctor knows that you’re taking zoloft while prescribing amoxicillin. You’re more likely to suffer from GIT side effects if you already suffer from an upset stomach or usually experience acid reflux. 

Long term use of zoloft can make your stomach weak which can result in decreasing antibiotic tolerance as they are pretty heavy on your stomach. 

How to ensure safe usage of amoxicillin and zoloft?

In usual practice, your healthcare provider prescribes some stomach aid when such meds are taken together. It is important to protect your gastrointestinal microbiome and to keep your increased acidity at bay. 

You doctor might prescribe the following medications, when you’re supposed to use amoxicillin and zoloft together:

Probiotics 

Probiotics are, and should definitely be, prescribed with antibiotics. They are essential when other drugs, like zoloft, are also included in your medication list. 

Probiotics help replenish the good bacteria present in your gastrointestinal microflora which can help relieve some of your side effects. These include:

• Lactobacillus acidophilus (Florajen, intestinex, bacid, zelac etc) 
• Bifidobacterium infantis (provella, prodigen, nature’s bounty probiotic etc) 
• Lactobacillus rhamnosus (culturelle) 

You can also try adding probiotic rich foods in your diet. Natural sources of probiotics include nuts, yoghurt, asparagus, garlic, onions, leeks, banana, barley, oats, apples, cocoa, wheat bran, flaxseeds etc. Add these in your diet while being on zoloft, to strengthen your gut bacteria. 

Over-the-counter drugs to manage acidity 

OTC meds to help relieve acidity include:

Proton pump inhibitors (PPIs)

Proton pump inhibitors or PPIs are also used to inhibit stomach acid secretion. These meds are used worldwide to treat heartburn and indigestion.

These include:

• Lansoprazole (Prevacid)
• Esomeprazole (Nexium)
• Omeprazole (Risek)

Histamine-2 (H2) blockers

Histamine-2-blockers are also used to relieve heartburn. These OTC meds inhibit the production of gastric acid. They can prevent acid reflux and heartburn for up to several hours.

These include:

• Cimetidine 
• Famotidine (Pepcid AC)
• Rimantadine
• Zantac 360
• Nizatidine

Antacids 

Antacids are widely used to relieve heartburn. They are alkaline in nature and once inside your stomach, they neutralise gastric acid.

Common OTC antacids include:

• Magnesium hydroxide, also called milk of magnesia.
• Aluminium hydroxide gel (Alternagel)
• Calcium carbonate (Alka-Seltzer)
• Gaviscon
• Pepto-Bismol

Make sure you ask your doctor first before taking these over-the-counter meds. Some of these drugs might not be suitable for your condition because of some possible drug interactions. 

If you suffer from extreme acidity, inform your healthcare provider. He or she will suggest the suitable medication. 

Few tips to manage your acidity while using amoxicillin and zoloft together 

There a few tips to help you keep your acidity at bay:

• Eat dinner earlier. Studies suggest that you should be done with dinner at least 3 hours before you go to bed.
• Do not fill your plate up. It puts a burden on your stomach to digest large amounts of food at one time.
• Maintaining a moderate body weight can help reduce acidity in the long term.
• Follow a low carb diet. Some researchers suspected that undigested carbs may cause bacterial overgrowth and increased pressure inside the abdomen. 
• Don’t drink too much alcohol. It can exacerbate your acid reflux and heartburn.
• Limit your caffeine intake, as it is often found associated with increased stomach acidity. 
• Limit the intake of carbonated beverages
• Don’t go heavy on citric juices. They contain ascorbic acid, also known as vitamin C, which could cause indigestion if you consume them in large amounts.
• Walk a mile after dinner. It improves your digestion and reduces bloating, acid reflux, constipation and provides relaxation from several other gastrointestinal problems. 
• Add milk and yoghurt in your diet. They are well known to provide relief from gastric acidity. Yoghurt also contains lactobacillus, which is a probiotic, also known as ‘good bacteria’.
• Avoid spicy foods. It can mess up your stomach and is the most common cause of increased acidity in people. 

It’s in your best interest to follow the above mentioned tips and take good care of your eating habits when you’re taking two or more medications that can have a negative impact on your stomach. 

Side by side comparison of side effects 

Amoxicillin	Zoloft
Gastrointestinal side effects including nausea, vomiting and diarrhoea. Dark colored urineVaginal infections Pale skin and eyesDizzinessHeart palpitations Sore throat Restlessness Allergic reaction RashFungal infections in mouth or vagina.	Loss of appetiteTirednessFeeling angry or agitatedWeight gainInability to digest foodNauseaDiarrhoeaLoss of libidoSweating/Night sweatsTremors or shakingInsomniaDecreased sex driveImpotence

When to call your doctor? 

Call your doctor when you can’t seem to tolerate these two meds together and you experience any of the following side effects:

• Bloody vomiting
• Persistent diarrhoea and vomiting 
• Blood in stool
• Unusually fast heart beat
• Extreme suffocation
• Severe burning sensation in stomach, chest or throat. 

These are not common side effects and it is not okay to wait for them to go away on their own. You should seek immediate medical attention if any of the above mentioned side effects occur. 

Conclusion

In this blog, we discussed the possible interactions between amoxicillin and zoloft. We learned that it is considered safe to use the two meds together but a few interactions can occur. 

Experts suggest that zoloft possesses some antibacterial activity itself, which is why it can enhance the antimicrobial action of amoxicillin. 

The concomitant use of these two can end up causing severe gastrointestinal side effects including nausea, vomiting, diarrhoea, severe abdominal pain, dehydration, heartburn, burning sensation in throat and mouth etc. 

Make sure whatever medication you take is approved by your healthcare provider. Do not opt for self-medication. It does you more harm as you can’t be aware of the possible interactions and can not figure out the appropriate dose on your own. 

FAQs: Amoxicillin and zoloft

Can you take amoxicillin and sertraline together?

Yes, you can take amoxicillin and sertraline together if it’s prescribed by your doctor. Do not start the use of any medication on your own. 

Will Zoloft affect antibiotics?

Zoloft can increase the efficacy of antibiotics. One possible reason for this effect is the antimicrobial property of zoloft itself.

What should you not mix with amoxicillin?

You should not mix amoxicillin with:

• Other antibiotics which might interact with its metabolism or excretion, including tetracycline, chloramphenicol etc. 
• Blood thinning agents, including warfarin. 
• Non-steroidal anti-inflammatory drugs (NSAIDS). The combination might increase the risk of gastrointestinal bleeding. 
• Contraceptives taken orally. 

Can I take antibiotics with anxiety medicine?

Yes, you can take antibiotics and anxiety medication. They do not interact or exacerbate your anxiety symptoms. 

What should you not mix with Zoloft?

You should not mix zoloft with:

• Monoaminoxidase inhibitors. The concomitant use increases the risk of serotonin syndrome. 
• Tryptophan rich foods. 
• Non-steroidal anti-inflammatory drugs (NSAIDS). The combination can increase the risk of bleeding 
• Pimozide 

Can I take penicillin with Zoloft?

Yes, you can take penicillin with zoloft. Make sure you’re not allergic to any of these medications. 

References 

• Muhammad Ayaz, Fazal Subhan, and Sajid Hussain (2015) – Sertraline enhances the activity of antimicrobial agents against pathogens of clinical relevance https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449573/#__ffn_sectitle
• Paweł Krzyżek et al. Pathogens. (2019) – In Vitro Activity of Sertraline, an Antidepressant, Against Antibiotic-Susceptible and Antibiotic-Resistant Helicobacter pylori Strains https://pubmed.ncbi.nlm.nih.gov/31717683/
• Bottega, Angelita MSc, Serafin, Marissa B. MSc, da Rosa – Antimicrobial and Antineoplastic Properties of Sertraline https://journals.lww.com/americantherapeutics/Citation/2020/12000/Antimicrobial_and_Antineoplastic_Properties_of.18.aspx
• Ahmet Yilmaz Coban et al. Mikrobiyol Bul. (2009) – Investigation of antibacterial activity of sertralin https://pubmed.ncbi.nlm.nih.gov/20084919/
• Amoxicillin – Uses, Side Effects, and More https://www.webmd.com/drugs/2/drug-1531-3295/amoxicillin-oral/amoxicillin-oral/details
• Nancy C Brahm, Merry C Kelly-Rehm – Antidepressant-mediated gastroesophageal reflux disease https://pubmed.ncbi.nlm.nih.gov/21486738/
• Food and Drug Administration US – Over-The-Counter (OTC) Heartburn Treatment https://www.fda.gov/drugs/information-consumers-and-patients-drugs/over-counter-otc-heartburn-treatment
• J Levy. Am J Gastroenterol. (2000) – The effects of antibiotic use on gastrointestinal function https://pubmed.ncbi.nlm.nih.gov/10634220/