Drug Interactions between amoxicillin / clarithromycin / vonoprazan and peppermint oil

ADJUST DOSING INTERVAL: Administration of enteric-coated, gastro-resistant formulations of peppermint oil (e.g., delayed or sustained release capsules) concurrently with antacids may cause premature dissolution of the enteric coating and early release of the peppermint oil, which could lead to gastrointestinal irritation and reduced therapeutic effects. The use of other medications that can reduce gastric acid, such as H2-receptor antagonists and proton pump inhibitors, may also cause similar issues.

MANAGEMENT: Acid-lowering medications should not be administered at the same time as enteric-coated, gastro-resistant formulations of peppermint oil. In general, H2-receptor antagonists and proton pump inhibitors should preferably be avoided, while antacids should be administered at least 2 hours before or 2 hours after the peppermint oil preparation. The labeling for the specific product should be consulted for administration recommendations and other guidance.

Although some in vitro data indicate synergism between macrolide antibiotics and penicillins, other in vitro data indicate antagonism. When these drugs are given together, neither has predictable therapeutic efficacy. Data are available for erythromycin, although theoretically this interaction could occur with any macrolide. Except for monitoring of the effectiveness of antibiotic therapy, no special precautions appear to be necessary.