Amoxicillin / clarithromycin / lansoprazole Disease Interactions
There are 8 disease interactions with amoxicillin / clarithromycin / lansoprazole:
- Renal Dysfunction
- Renal Dysfunction
- Liver Disease
- Myasthenia Gravis
Patients with mononucleosis treated with an aminopenicillin antibiotic, particularly ampicillin, quite frequently develop a pruritic erythematous maculopapular skin rash that generally occurs 5 to 10 days after therapy is initiated. The rash is usually self-limiting and resolves within days of discontinuing the offending agent. An altered drug metabolism or an immune-mediated process unrelated to drug hypersensitivity has been proposed as the underlying mechanism. Clinicians should recognize that a skin eruption under this circumstance does not necessarily indicate a life-long allergy to these agents or other penicillin derivatives. Therapy with aminopenicillin antibiotics may not be appropriate in patients with mononucleosis.
- "Product Information. Polycillin (ampicillin)." Apothecon Inc, Plainsboro, NJ.
- Chan HL "Fixed drug eruption to bacampicillin (ampicillin)." Arch Dermatol 120 (1984): 542
- "Product Information. Spectrobid (bacampicillin)." Roerig Division, New York, NY.
Augmentin (brand of amoxicillin-clavulanate) chewable tablets contain 2.1 mg of phenylalanine per each 200 mg tablet and 4.2 mg of phenylalanine per each 400 mg tablet. Augmentin oral suspension contains 7 mg of phenylalanine per each 5 mL of reconstituted suspension for both the 200 mg/5 mL and 400 mg/5 mL strengths. The phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).
- "Product Information. Augmentin (amoxicillin-clavulanate)." SmithKline Beecham, Philadelphia, PA.
Pseudomembranous colitis has been reported with most antibacterial agents and may range in severity from mild to life-threatening, with an onset of up to two months following cessation of therapy. Antibiotic therapy can alter the normal flora of the colon and permit overgrowth of Clostridium difficile, whose toxin is believed to be a primary cause of antibiotic-associated colitis. The colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus. The most common culprits are clindamycin, lincomycin, the aminopenicillins (amoxicillin, ampicillin), and the cephalosporins. Therapy with broad-spectrum antibiotics and other agents with significant antibacterial activity should be administered cautiously in patients with a history of gastrointestinal diseases, particularly colitis. There is some evidence that pseudomembranous colitis, if it occurs, may run a more severe course in these patients and that it may be associated with flares in their underlying disease activity. The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically. A large bowel endoscopy may be considered to establish a definitive diagnosis in cases of severe diarrhea.
- Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
- Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
- Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
Most beta-lactam antibiotics are eliminated by the kidney as unchanged drug and, in some cases, also as metabolites. The serum concentrations of beta-lactam antibiotics and their metabolites may be increased and the half-lives prolonged in patients with impaired renal function. Dosage adjustments may be necessary and modifications should be based on the degree of renal impairment as well as severity of infection in accordance with the individual product package labeling. Renal function tests should be performed periodically during prolonged and/or high-dose therapy, since nephrotoxicity and alterations in renal function have occasionally been associated with the use of these drugs.
- "Product Information. Geocillin (carbenicillin)." Roerig Division, New York, NY.
- Sjovall J, Westerlund D, Alvan G "Renal excretion of intravenously infused amoxycillin and ampicillin." Br J Clin Pharmacol 19 (1985): 191-201
- Jackson EA, McLeod DC "Pharmacokinetics and dosing of antimicrobial agents in renal impairment, part I." Am J Hosp Pharm 31 (1974): 36-52
Clarithromycin and its primary, active metabolite are both eliminated by the kidney to some extent. The daily dosage should be halved in patients with severe renal impairment (CrCl < 30 mL/min). Dosage adjustments are usually not necessary in patients with mild to moderate renal impairment, although theoretically, drug accumulation could occur in these patients if they have concomitant liver disease.
- Hardy D, Guay D, Jones R "Clarithromycin, a unique macrolide." Diagn Microbiol Infect Dis 15 (1992): 39-53
- Zuckerman JM, Kaye KM "The newer macrolides: azithromycin and clarithromycin." Infect Dis Clin North Am 9 (1995): 731-45
- Peters D, Clissold S "Clarithromycin: a review of its antimicrobial activity, pharmacokinetic properties and therapeutic potential." Drugs 44 (1992): 117-64
Lansoprazole is primarily metabolized by the liver. Although the drug is generally well-tolerated, dosage adjustments with cautious titration should be considered in patients with severe hepatic impairment.
- "Product Information. Prevacid (lansoprazole)." TAP Pharmaceuticals Inc, Deerfield, IL.
- Pichard L, Curi-Pedrosa R, Bonfils C, Jacqz-Aigrain E, Domergue J, Joyeux H, Cosme J, Guengerich FP, Maurel P "Oxidative metabolism of lansoprazole by human liver cytochromes P450." Mol Pharmacol 47 (1995): 410-8
- Delhotal-Landes B, Flouvat B, Duchier J, Molinie P, Dellatolas F, Lemaire M "Pharmacokinetics of lansoprazole in patients with renal or liver disease of varying severity." Eur J Clin Pharmacol 45 (1993): 367-71
The use of macrolide antibiotics has been reported to exacerbate symptoms of myasthenia gravis and trigger new onset of symptoms of myasthenic syndrome. Limited data suggest presynaptic suppression of acetylcholine release. Therapy with these agents should be administered cautiously in patients with a history of myasthenia gravis.
- May EF, Calvert PC "Aggravation of myasthenia gravis by erythromycin." Ann Neurol 28 (1990): 577-9
- "Product Information. Ery-tab (erythromycin)." Abbott Pharmaceutical, Abbott Park, IL.
Penicillin antibiotics (except for agents in the penicillinase-resistant class) are removed by hemodialysis. Doses should either be scheduled for administration after dialysis or supplemental doses be given after dialysis.
- Francke EL, Appel GB, Neu HC "Kinetics of intravenous amoxicillin in patients on long-term dialysis." Clin Pharmacol Ther 26 (1979): 31-5
- Davies BE, Boon R, Horton R, Reubi FC, Descoeudres CE "Pharmacokinetics of amoxycillin and clavulanic acid in haemodialysis patients following intravenous administration of augmentin." Br J Clin Pharmacol 26 (1988): 385-90
- Reitberg DP, Marble DA, Schultz RW, Whall TJ, Schentag JJ "Pharmacokinetics of cefoperazone (2.0 g) and sulbactam (1.0 g) coadministered to subjects with normal renal function, patients with decreased renal function, and patients with end-stage renal disease on hemodialysis." Antimicrob Agents Chemother 32 (1988): 503-9
You should also know about...
amoxicillin / clarithromycin / lansoprazole drug Interactions
There are 810 drug interactions with amoxicillin / clarithromycin / lansoprazole
amoxicillin / clarithromycin / lansoprazole alcohol/food Interactions
There is 1 alcohol/food interaction with amoxicillin / clarithromycin / lansoprazole
Drug Interaction Classification
The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
|Major||Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderate||Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|Minor||Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.|
Do not stop taking any medications without consulting your healthcare provider.
Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2014 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.