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Amoxicillin: uses, dosage and side effects

Amoxicillin is a penicillin antibiotic. It is prescription-only in Ireland and is used for bacterial infections such as chest, ear, sinus, dental and some urinary infections. This page explains what it is used for, how it is taken, its side effects and why a new infection always needs a fresh medical assessment rather than a repeat of an old course. It is information, not a recommendation to take an antibiotic.

What amoxicillin is used for

Amoxicillin treats infections caused by bacteria that are sensitive to it, and it is prescribed in Ireland for conditions such as chest infections, middle ear infection, sinusitis, some dental infections and certain urinary tract infections. It belongs to the penicillin family and works by stopping bacteria from building their cell wall. It is also used, in combination with other medicines, as part of treatment to clear Helicobacter pylori from the stomach. What it does not do is treat viral illness. Colds, most sore throats, flu and the great majority of coughs are viral, and an antibiotic will not shorten them, will not prevent complications and will expose you to side effects for nothing. It also contributes to antimicrobial resistance, which is the reason a prescriber will sometimes assess you and then decide against an antibiotic. That decision is a clinical one, made on the evidence available about your particular illness.

Side effects of amoxicillin

The effects reported most often are nausea, diarrhoea and skin rash, and many people take a full course with nothing worse than mild digestive upset. Thrush in the mouth or genital area can follow a course, because the antibiotic disturbs the normal balance of organisms. Two situations need urgent attention. The first is allergy to penicillin: swelling of the face, lips, tongue or throat, difficulty breathing, a widespread hive-like rash or feeling faint can indicate a serious allergic reaction, and you should stop the medicine and call an emergency service on 112 or 999. The second is severe, watery or bloody diarrhoea starting during or after the course, which can signal an infection of the bowel needing assessment rather than an anti-diarrhoeal medicine bought over the counter. A rash is also common when amoxicillin is given to someone who actually has glandular fever, which is one reason a doctor asks about your symptoms in detail before prescribing.

Dosage and how to take amoxicillin

Amoxicillin is taken by mouth, often three times a day, and both the dose and the length of the course are set by the prescriber according to the infection being treated, body weight where relevant and kidney function. Capsules are swallowed whole with water; a liquid form exists for children and for anyone who cannot swallow capsules, and it should be measured with the device supplied rather than a kitchen spoon. Space the doses evenly through the day so the level in the body stays steady. If you forget a dose, take it when you remember unless the next one is nearly due, and never take two together. Complete the course you were given even if you feel better after a couple of days, unless a doctor tells you to stop. Do not keep leftover capsules for the next time you feel unwell and do not take a course prescribed for someone else: the dose, the length and the choice of antibiotic are specific to one infection in one person.

Is amoxicillin available without a prescription in Ireland?

No. Amoxicillin is a prescription-only medicine in Ireland and cannot be supplied by a pharmacy without a valid prescription. This applies to every strength and to the liquid form. Sites offering antibiotics without a prescription are operating outside the law, and antibiotics obtained that way are among the clearest drivers of resistance in the community. Amoxicillin is not a controlled drug, so it is not among the substances excluded from cross-border prescriptions under Article 11(6) of Directive 2011/24/EU, and a prescription issued by a prescriber elsewhere in the EU or EEA can be presented in an Irish pharmacy. The Pharmaceutical Society of Ireland has published guidance for pharmacists on dispensing such prescriptions. The pharmacist still applies professional judgement to each one and may decline if anything is unclear, so the document must carry the full set of fields set out in the Annex to Implementing Directive 2012/52/EU and name the active substance.

Antibiotics and repeat prescriptions: what a doctor can and cannot renew

A new infection is not a continuation of an old course, and that is the most important thing to understand before requesting anything. If you have a fresh illness, the right step is an assessment of that illness, not a copy of a prescription written for something that happened months ago. A doctor reviewing a questionnaire will decline an antibiotic where the description does not support one, and declining is a normal clinical outcome rather than a failure of the service. Where a doctor has already assessed you and an established course of treatment needs to be continued, you can submit our medical questionnaire. A doctor reviews what you write and, if continuation is appropriate, issues a cross-border prescription as a PDF by e-mail; you bring it with photo identification to any pharmacy. There is no PIN code and no video consultation, because the review is asynchronous. Documents are issued by lek. Damian Wojno, a doctor registered in Poland, PWZ no. 3211301. The fee of 19,90 € covers the consultation, not the issuing of a document; it is returned if the doctor declines on medical grounds, and it is not refunded if you do not supply documentation the doctor asks for. If you are seriously unwell or short of breath, contact your GP or 112 or 999 instead.

Cost and reimbursement in Ireland

The price of amoxicillin at the counter depends on the pack size, the manufacturer and the pharmacy, and it is set by the pharmacy rather than by us. Generic amoxicillin is inexpensive relative to many medicines, and the pharmacist will tell you the cost before dispensing if you ask. We do not sell medicines and we do not quote prices for them. On the state side, the HSE operates the medical card scheme and the Drugs Payment Scheme, which limits what a household pays for approved prescribed medicines in a calendar month. Whether a given prescription is covered, and how a prescription written by a prescriber in another EU country is handled under those schemes, is decided by the HSE and applied at the pharmacy counter, so confirm it there rather than assuming. Our own charge is the consultation fee described above and is entirely separate from what the pharmacy charges for the medicine.

Interactions and alcohol

Tell the prescriber about every medicine you take, because amoxicillin has several interactions worth checking. Methotrexate levels can rise when it is given with a penicillin, which matters because methotrexate is toxic at high levels. Allopurinol taken together with amoxicillin makes a rash more likely. If you take warfarin, your INR may change during a course and your clinic may want to check it. Some other antibiotics should not be combined with it. Alcohol does not stop amoxicillin working and there is no absolute prohibition, unlike with metronidazole. It is still sensible to go easy: alcohol adds to nausea, disturbs sleep and does nothing for recovery from an infection. One practical point on contraception: current guidance is that antibiotics of this type do not reduce the effect of the combined pill, but severe vomiting or diarrhoea during an illness can, so read the pill leaflet or ask your pharmacist if that happens.

Who should not take amoxicillin

Anyone who has had an allergic reaction to amoxicillin, to another penicillin or to a beta-lactam antibiotic should not take it, and a previous reaction should always be described to the prescriber in detail, including what happened and how quickly. A rash years ago and a swollen throat are not the same thing clinically, and the difference changes what can be prescribed. Care is needed if you have reduced kidney function, because the dose may need adjusting, and if you have had liver problems associated with a penicillin in the past. Tell the prescriber if you have glandular fever or symptoms that could be glandular fever, since a rash is common in that situation. This is not an exhaustive list. The full set of contraindications and warnings for your particular product is in its leaflet and in the summary of product characteristics published by the HPRA, and only a doctor who knows your history can apply them to you.

Generic and brand names

Amoxicillin is the international non-proprietary name of the active substance and is dispensed in Ireland mainly as generic amoxicillin carrying the manufacturer's name, in capsules, tablets and an oral suspension. Combination products exist in which amoxicillin is paired with clavulanic acid; these are a different medicine with a different spectrum and different side effects, so do not treat the two as interchangeable. At the counter, check the active substance and the strength on the box rather than the brand, because the supplier can change between one course and the next. A cross-border prescription names the active substance rather than a brand, which is exactly what allows a pharmacist in another country to dispense the equivalent product authorised there. If you have previously reacted to a specific formulation, or you need the liquid rather than capsules, say so to both the prescriber and the pharmacist.

Amoxicillin in pregnancy and breastfeeding

Penicillins are among the antibiotics with the longest record of use in pregnancy, and amoxicillin is commonly chosen when a pregnant woman needs treatment for a bacterial infection, but the decision belongs to a doctor who knows the pregnancy and the infection. Tell any prescriber that you are pregnant, think you might be, or are breastfeeding, before the prescription is written. Small amounts pass into breast milk. That is usually compatible with continued breastfeeding, though a baby may have looser stools or oral thrush, and a doctor or midwife can advise if you notice anything. What should not happen is self-treatment in pregnancy with capsules left over from a previous course. If you are pregnant and have symptoms of an infection, particularly a urinary infection or a fever, contact your GP or your maternity service rather than using our questionnaire, because untreated infection in pregnancy needs prompt in-person assessment.

Where to find the patient information leaflet

Every medicine authorised in Ireland has a patient information leaflet, and the leaflet inside your own pack is the version that applies to you. The Health Products Regulatory Authority (HPRA) keeps a public database of medicines authorised here, where you can look up the leaflet and the summary of product characteristics for the exact strength and manufacturer you have been given. For centrally authorised medicines the European Medicines Agency publishes the same documents. Read the leaflet before the first dose and again if the pack you collect looks different from the last one, because generic versions can differ in their inactive ingredients even when the active substance and the strength are identical. If anything in the leaflet does not match what you were told, ask your pharmacist before taking the medicine. A leaflet is written for the whole patient population, so it lists effects that are uncommon; it is not a prediction of what will happen to you.

Is amoxicillin prescription-only in Ireland?

Yes. Every strength and form of amoxicillin, including the liquid, requires a valid prescription in Ireland. It is not a controlled drug, so it is not excluded from cross-border prescriptions under Article 11(6) of Directive 2011/24/EU.

How long does amoxicillin take to work?

People commonly start to feel better after a few days, though this depends on the infection. If you are no better after several days, or you get worse at any point, contact a doctor rather than continuing to wait. Finish the course you were given unless a doctor tells you to stop.

What are the common side effects of amoxicillin?

Nausea, diarrhoea and rash are reported most often, and thrush can follow a course. Stop the medicine and call 112 or 999 for swelling of the face or throat, difficulty breathing or a widespread hive-like rash. Severe or bloody diarrhoea during or after a course needs medical assessment.

Can I drink alcohol while taking amoxicillin?

There is no absolute prohibition, unlike with some other antibiotics, and alcohol does not stop amoxicillin working. It does add to nausea and poor sleep and does nothing to help you recover, so moderation is sensible while you are unwell.

Can I get a repeat prescription for amoxicillin for a new infection?

A new infection is not a continuation of an old course, and a doctor will decline where an antibiotic is not appropriate for what you describe. Our questionnaire is for continuing treatment a doctor has already assessed. If you are unwell now, contact your GP, an out-of-hours service or 112 or 999.