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Docket card · Antibiotic docket

Zithromax 250 mg Z-Pak is six tablets, not a leftover cold wallet

Last reviewed · 11 min read · Updated

A US Z-Pak is six azithromycin 250 mg tablets: 500 mg on day one, then 250 mg daily on days two through five. That is the Uxora lock. Liquid and 500 mg packs are other NDCs.

Macrolides can prolong QT. The FDA strengthened that warning in 2013. People with a long QT story, low potassium or magnesium, or other QT drugs need a clinician look before the first 500.

The leftover myth is simple and wrong: save two tablets for the next cold. Colds are viral. Two orphan 250s are not a course. Read the course-seal memo and the QT-flag memo.

Docket card

OnsetTissue levels build from the day-one 500 mg
DurationLong tissue persistence after day five
FoodTablets with or without food; antacids delay
AlcoholNo green light to drink through a pneumonia

01Six tablets is a five-day course, not a snack pack

Intake: name the six-tablet math, the QT flag, and the leftover myth before anyone talks 'Z-pack for travel.'

People count six pills and invent a six-day plan, or they take 250 on day one because the blister looks even. The labeled community-course pattern for the Z-Pak is 500 mg (two tablets) on day one, then one 250 mg tablet daily for four more days.

Azithromycin hangs in tissue long after the last swallow. That is why a short oral course can cover days. It is also why leftover tablets are not a fresh start three weeks later when a virus arrives.

This desk does not treat a viral URI with a macrolide. If a clinician wrote the Z-Pak for a suspected bacterial indication, finish that plan unless they stop it. Do not 'save some' because you feel better on day three.

Uxora does not dispense. The fill cards on this page name real US chains. Mail [email protected] about the caption, not about a refill for a cold.

Zithromax 250 mg Z-Pak wallet on a course calendar

02Not a viral wallet, and not a tizanidine-safe default

Green mucus does not prove bacteria. A three-day sniffle is still usually a virus. Azithromycin does not earn a travel kit slot next to ibuprofen.

If the reader also holds tizanidine 4 mg, remember the absolute CYP1A2 wall is ciprofloxacin, not azithromycin. That does not make the macrolide a free add. QT plus sedation plus an infection is still a clinician pile.

Myasthenia gravis can worsen. Severe hepatic injury is rare and a stop. C. difficile diarrhea can follow any antibacterial, including this one. Watery late diarrhea is a call, not another leftover tablet.

03Antacids, warfarin, and the window row

Aluminum or magnesium antacids delay azithromycin absorption. Separate them. Food with tablets is acceptable on many inserts. Follow the leaflet in the pack you hold.

Warfarin users can see INR shifts. That is a clinic check, not a 'macrolides never touch INR' slogan.

The Uxora fill is one Z-Pak, six 250 mg tablets. We quote the sourced cash band for that pack. We do not invent a twelve-tablet travel price.

Walgreens

250 mg Z-Pak (6 tablets)

Finish the five-day blister even if symptoms ease

Walmart

250 mg Z-Pak (6 tablets)

Macrolide QT pairs still matter on day one

Publix

250 mg Z-Pak (6 tablets)

Liquid suspension is a different NDC

Rite Aid

250 mg Z-Pak (6 tablets)

Not a viral cold fill

Generic azithromycin 250 mg Z-Pak, six tablets, the Uxora Zithromax lock, August 2026. GoodRx lists one Z-Pak at $34.98 average retail and $4.97 with a coupon. Five-hundred-milligram courses use another count. Uxora does not dispense.

04What a missed Z-Pak day actually means

Miss the day-one 500 and the load never happened. Call. Do not invent a 250-for-six-days grid because the pack looks even.

Miss one of days two to five: take it when remembered unless the next tablet is due. Do not swallow two 250s at once to 'catch the tissue half-life.' The tissue half-life is why a single miss is less catastrophic than a missed load, not why you double.

Vomit within a short window of a tablet: ask the pharmacist with the exact minutes. This card will not give a universal re-dose minute count. Different leaflets write different windows.

Travel across time zones: keep twenty-four hours between the 250s after the load, not a hotel-breakfast ritual that collapses two days.

If the diagnosis was wrong and the clinician stopped the course, leftover tablets go to a take-back, not a wash bag. That is the leftover myth in its second costume.

05Who should not treat a cheap Z-Pak as a first reach

Known long QT, prior torsades, a class III antiarrhythmic, uncorrected low potassium: the QT-flag memo is the first chapter, not the course-seal.

Myasthenia gravis can worsen. 'Short and cheap' does not delete that warning.

Neonates have a pyloric-stenosis warning. Adult 250s are not a home crush for a two-week-old.

Severe hepatic disease gets more caution. Jaundice on day four is a stop, even if course-seal said empty the blister. Empty applies to an ordinary bacterial course, not to a liver warning.

If tizanidine 4 mg is on the chart, remember the absolute wall is ciprofloxacin. Do not refuse a needed Z-Pak for the wrong enzyme reason, and do not accept cipro because a shop said macrolides are weaker.

06Infants, livers, and the rare ugly endings

Infantile hypertrophic pyloric stenosis has been reported after neonatal azithromycin. Vomiting or feeding irritability in that age band is a physician call.

Hepatotoxicity: stop for jaundice, dark urine, or marked right-upper-quadrant pain. Allergy and severe skin reactions (including DRESS and SJS in postmarketing) are stops.

Renal impairment does not usually rewrite the Z-Pak the way some drugs do. Hepatic disease does get more caution. Do not crowdsource that cut.

Sofia files this as a short course with a long tissue echo. If the reader wanted a perpetual sinus tablet, they have the wrong macrolide story.

ADME slip
AbsorptionOral tablets; antacids with Al/Mg delay absorption.
DistributionExtensive tissue distribution; high intracellular levels.
MetabolismHepatic; not a CYP3A4 victim the way some macrolides are.
ExcretionBiliary excretion; long terminal tissue half-life (~68 h often quoted).

07QT is a day-one flag, not a day-five surprise

Azithromycin can prolong QTc. Torsades has been reported. The 2013 FDA communication told clinicians to think about that risk before the first dose, especially with known long QT, prior torsades, bradycardia, uncompensated heart failure, or uncorrected low potassium or magnesium.

Class IA and class III antiarrhythmics (quinidine, procainamide, dofetilide, amiodarone, sotalol) sit in the higher-risk pile. Other QT drugs add. The QT-flag memo is the short list for a busy counter.

Observational work has flagged a short-term rise in cardiovascular death versus some other antibacterials in adults. That is a benefit-risk sentence for the prescriber, not a reason for a patient to skip a needed course or to take a leftover 'just in case.'

Syncope, palpitations, or a family long-QT story should be on the intake before the blister leaves the window. This thread cannot read an ECG.

08How the blister is supposed to empty

Day one: two 250 mg tablets. Days two to five: one tablet each day. Miss a maintenance day and take it when remembered unless the next dose is due; do not double to 'catch the load.' Missing the day-one 500 is a bigger hole than missing one later 250.

Feeling better on day three is common and is not a stop rule for a labeled bacterial course. Stopping early and pocketing the last two tablets is how the leftover myth is born.

Those two tablets will not treat the next viral week. They also will not treat a new bacterial problem at a proper load. They sit in a drawer, degrade, and get offered to a cousin. That is the myth the course-seal memo exists to kill.

Five-hundred-milligram daily packs and suspension bottles are different counts. Do not crush tablet math onto a child's mL plan.

Table 1. Emptying a six-tablet Z-Pak
DayZ-Pak 250 mg tabletsRunning total
1Two tablets (500 mg)500 mg
2-5One tablet each day1500 mg over five days
Drawer after day 3Not a planLeftover myth starts here

09Empty the blister or do not start it

Zithromax 250 mg Z-Pak means six tablets and a five-day labeled rhythm. QT is a first-dose question. Leftovers are not a next-virus plan.

A clinician can stop a course if the diagnosis changes. A drawer cannot restart it later. Read the disclaimer. This desk does not sell packs.

Six tablets. Two on day one. One on days two through five. A gentle one-tablet start is a missed load.

Leftovers are not a next-virus wallet, not a plane kit, and not a cousin's sinus week. Take-back if the clinician stopped the course.

QT is a day-one flag. Amiodarone, sotalol, low potassium, family long QT: ask before the 500 mg.

Faint stops the pack. Course-seal yields to a rhythm event. Do not finish a cheap blister through a grey-out.

Cipro plus tizanidine is the CYP wall. This Z-Pak is not that wall. Name the INNs.

Myasthenia can worsen. Neonatal pyloric-stenosis warnings are a physician call, not a home crush of adult 250s.

Late watery diarrhea can be C. difficile. More azithromycin is not the answer.

Aluminum or magnesium antacids delay absorption. Warfarin users tell the INR clinic.

We quote one Z-Pak. We do not invent a twelve-tablet travel price.

Sofia files a short course with a long tissue echo. A perpetual sinus tablet is the wrong story.

Two leftover 250 mg tablets are not Friday's cold plan. A new illness needs a new named owner.

A wrist watch is not a QT assay. High-risk hearts still belong to cardiology.

Magnesium and aluminum can need a gap. Ask the pharmacist, do not invent one.

Myasthenia gravis can worsen. Neurology owns that call before the 500 mg load.

Pregnancy and the Z-Pak are not a drawer decision.

Wine does not cancel day three. Finish the course or call if you cannot keep tablets down.

A spare Z-Pak is still leftover tablets waiting for the next myth.

Do not add ciprofloxacin at home. Two antibiotics is not a sinus upgrade.

The 2013 QT communication still sits on this docket. A five-day course does not erase it.

Food is usually allowed with 250 mg. That is not a license to skip the last two tablets.

Hepatitis history belongs on the first call. Jaundice during the course is a stop.

This desk will not quote a dollar for a Z-Pak. The lock is six by 250, not a sale.

The Z-Pak lock is six by 250 mg: 500 mg on day one, then 250 mg on days two through five. That is the whole pack. There is no day six from leftovers.

Feeling well on day three does not write a leftover bank. Saving tablets writes the next-cold myth. Finish the named course or ask how to dispose.

The 2013 FDA QT communication still sits here. A five-day course does not erase it. High-risk hearts, other QT drugs, low potassium, and methadone stories need the clinician before the first 500 mg.

A consumer watch is not a 12-lead. This docket will not bless a home ECG. Cardiology owns the high-risk start.

Myasthenia can worsen on macrolides. Pregnancy is a named-owner call, not a drawer start. Pediatric ears are not an adult six-pack.

Magnesium and aluminum can need a gap. Ask the pharmacist. Do not invent an hour from a comment.

Do not add ciprofloxacin at home to a Z-Pak. Two antibiotics is not a sinus upgrade. Sharing two 250 mg tablets is a second unlabeled start.

Wine does not cancel day three. If you cannot keep a 250 mg down, call. Do not take a silent second tablet from the leftover story.

This desk will not quote a dollar for a Z-Pak. The lock is the six-count and the QT flag, not a sale.

Sofia Mendes peer-passes the course. She does not restart a pack from Cedofeita 455. [email protected] can correct a wrong day count on this page. It cannot become a second script.

Jaundice, severe rash, or fainting are stops. A leftover two-tablet envelope is not a clinic.

Prescribed-online still means a licensed clinician where you live. Uxora stops at the card.

Two leftover 250 mg tablets never become Friday's cold or a homemade day six. The pack is 500 then four days of 250. That is the whole Z-Pak.

The 2013 QT note still sits next to the leftover myth. High-risk hearts ask before the first 500 mg. This docket will not invent a dollar for a spare pack.

Sources

  1. Pfizer ZITHROMAX US prescribing information
  2. FDA 2013 azithromycin QT communication
  3. Z-Pak community course: 500 mg day 1, then 250 mg days 2-5 (six 250 mg tablets).
  4. Warnings: QT/TdP, CV death observational signal, C. difficile, myasthenia, hepatotoxicity, neonatal IHPS.

Checked against the current label and reviewed by Dr. Sofia Mendes. See Intake, Markup, Peer-pass, File.

Azithromycin 4.8 / 5 from 2443 reader ratings

Docket thread

Docket thread for the 250 mg Z-Pak. Faint, chest pain, or bloody diarrhea: 112 in Portugal or local emergency care.

Celso Prestes, MG clinic They said maybe. I already bought the cheap pack. Start?

Desk reply

Bought is not an indication. Myasthenia can worsen. Wait for the MG clinician. Do not start a leftover because the blister was on sale.

Rosa Dias, myasthenia Old MG. Z-Pak ok?

Desk reply

Myasthenia can worsen on macrolides. Call the neurology desk before the first 500.

Lidia Semedo, time zone Flight at day three. Take today's 250 at the gate and another at landing?

Desk reply

Keep about twenty-four hours between the 250s after the load. Two tablets around one flight is a double, not a time-zone fix.

Hugo Leal, pregnancy Pregnant. Keep the Z-Pak?

Desk reply

Pregnancy is a named-owner call, not a leftover decision. Do not start from a drawer.

Benedita Crasto, day-three smile Sinus pressure gone. Keep the last two for the plane next month?

Desk reply

No. Finish today's labeled plan unless the prescriber stopped it. Two orphan 250s are not a travel course and not a viral insurance policy. The course-seal memo is this answer in short form.

Graça Magalhães, antacid habit I chew magnesium tablets all day. Space them or stop them?

Desk reply

Aluminum and magnesium antacids delay azithromycin. Separate them from the dose. Ask the pharmacist for a gap that fits your pack leaflet. Do not skip the antibiotic to keep the antacid.

Rosa Magalhães, take-back Clinician stopped me day two. Two tablets left. Plane kit?

Desk reply

Take-back, not a plane kit. That is the leftover myth with a boarding pass. See the course-seal memo.

Palmira Lage, second sinus New sinus week after a Z-Pak. Open a spare?

Desk reply

A spare pack is the leftover myth with six extra tablets. A new illness needs a new named owner. This desk does not stock car spares.

Lurdes Amaral, infant nephew Two-week-old was given a macrolide in hospital. Vomiting now. Related?

Desk reply

Neonatal azithromycin has a pyloric-stenosis warning. Feeding vomiting or irritability is a physician call now. This desk cannot examine an infant. Do not wait on a comment.

Valentim Semedo, day-one 250 I took one tablet this morning because six days felt neater. Add one tonight?

Desk reply

Call the prescriber or pharmacist today. The load is two tablets on day one. Do not invent a catch-up from a comment. Bring the blister so they can see what is left.

Teolinda Bastão, desk seal Sentence to keep.

Desk reply

Six 250 mg tablets. Two on day one. QT before the first 500. No leftover for a virus. Mail [email protected] about the card, not about a refill.

Bento Cravo, vomit twenty minutes Threw up the day-one pair. Repeat both tablets?

Desk reply

Call the pharmacist with the minutes. This card will not invent a universal re-dose clock. Do not silently swallow two more 250s and also stay on the original grid.

Bento Cruz, leftover cold Two 250 left. New cold Friday?

Desk reply

No. Leftover 250 mg tablets are not a second Z-Pak. Finish or dispose. A new illness needs a new named owner.

Carla Sousa, cipro add Add Cipro to the Z-Pak for sinus?

Desk reply

Do not stack antibiotics at home. A second INN needs a named owner and a reason.

Deolinda Furtado, myasthenia MG clinic said macrolides can drop strength. Is a Z-Pak still 'cheap and short' enough to try?

Desk reply

Short does not erase the myasthenia warning. Weakness can worsen. The MG clinician owns the antibacterial choice. Do not start a leftover because the blister is only six tablets.

Cesária Lobo, watery day eight Course finished. Now diarrhea. Take the cousin's leftover two?

Desk reply

No. Late watery diarrhea after a macrolide can be C. difficile. More azithromycin is not the answer. Call the prescriber. Blood or fever is urgent care.

Hortênsia Prestes, amiodarone clinic Walk-in wrote a Z-Pak. I did not mention the rhythm drug.

Desk reply

Mention it now. Amiodarone plus azithromycin is a QT pile. The QT-flag memo exists for this exact miss. Do not take the evening 250 until someone who can see both files answers.

Camilo Brandão, warfarin INR next week anyway. Fine to start the six?

Desk reply

Tell the INR clinic you started a macrolide. Shifts happen. Do not assume the next scheduled stick is soon enough if you bleed. This card is not an INR protocol.

Quintino Vale, school nurse drawer We keep a Z-Pak 'for strep days.' Legal on this card?

Desk reply

No. A standing leftover is not a protocol and not an indication. Strep needs a diagnosed plan, often a different class. Cheap on a search title is not a school standing order.

Lidia Rocha, QT watch Watch and 250. Safe?

Desk reply

A watch is not a 12-lead. High-risk hearts still need the clinician. This desk will not bless a home ECG.

Adelino Cravo, green mucus Three days of colored mucus. Friend swears Z-Pak. Your lock is cheap. Why not?

Desk reply

Cheap is not an indication. Most short URIs are viral. This desk will not bless a leftover or a borrowed blister. If a clinician thinks bacteria, they write the course and own the QT question.

Paulo Henriques, second pack Buy two Z-Paks so I have a spare?

Desk reply

A spare pack is a leftover myth with extra tablets. This desk does not stock extras for later colds.

Romão Pires, tizanidine 4 mg Spasm tablet daily. Friend said cipro is the wall, so Z-Pak is fine.

Desk reply

Ciprofloxacin plus tizanidine is an absolute CYP1A2 contraindication. Azithromycin is not that wall. Fine is still the wrong word. Infection plus QT plus a sedating spasm drug needs a named clinician. See the tizanidine docket.

Aníbal Feio, potassium 3.1 Low K on last labs. Clinic still handed a Z-Pak for bronchitis.

Desk reply

Uncorrected hypokalemia sits in the QT-risk pile. Ask them to see the number before the 500 mg load. Do not start tonight to 'get ahead of the weekend.'

Quim Lage, QT plus leftover Palpitations on day two and two tablets left. Finish?

Desk reply

Palpitations on a QT-flagged macrolide are a stop-and-call. Two leftover 250 mg tablets are not a finish-the-myth plan and not Friday's cold. Emergency services own fainting or severe racing.

Celso Nunes, antacid hour Magnesium an hour after 250?

Desk reply

Ask the pharmacist. Separate some cations. Do not invent a gap from a comment.

Teresa Melo, alcohol Wine on day 3 of 250?

Desk reply

Alcohol is not a stated antidote. Finish the five-day clock. Call if vomiting starts.

Orlando Lage, QT leftover Finish two leftovers after a skipped beat?

Desk reply

No. A skipped beat on a QT-flagged course is a call. Two leftover 250 mg tablets are not a finish plan.

Ilda Rebocho, jaundice day four Yellow eyes. Finish the last two anyway?

Desk reply

Stop and get seen. Hepatotoxicity is a labeled stop. Do not finish a blister through jaundice because a course-seal memo said empty the pack. Empty applies to an ordinary bacterial course, not to a liver warning.