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Drug Interaction Report

4 potential interactions and/or warnings found for the following 4 drugs:

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Interactions between your drugs

Minor

amoxicillin clarithromycin

Applies to: amoxicillin, Biaxin (clarithromycin)

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.

References

  1. Strom J. Penicillin and erythromycin singly and in combination in scarlatina therapy and the interference between them. Antibiot Chemother. 1961;11:694-7.
  2. Cohn JR, Jungkind DL, Baker JS. In vitro antagonism by erythromycin of the bactericidal action of antimicrobial agents against common respiratory pathogens. Antimicrob Agents Chemother. 1980;18:872-6.
  3. Penn RL, Ward TT, Steigbigel RT. Effects of erythromycin in combination with penicillin, ampicillin, or gentamicin on the growth of listeria monocytogenes. Antimicrob Agents Chemother. 1982;22:289-94.

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Minor

clarithromycin esomeprazole

Applies to: Biaxin (clarithromycin), Nexium (esomeprazole)

Clarithromycin may increase the plasma concentration of esomeprazole. The mechanism may be related to clarithromycin inhibition of hepatic cytochrome P450 enzymes responsible for esomeprazole metabolism. The systemic exposure (AUC) to esomeprazole doubled after coadministration with clarithromycin 500 mg twice daily. The clinical significance is unknown and dose adjustments are not required.

References

  1. Cerner Multum, Inc. UK Summary of Product Characteristics.
  2. Cerner Multum, Inc. Australian Product Information.

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No other interactions were found between your selected drugs. However, this does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

esomeprazole food

Applies to: Nexium (esomeprazole)

ADJUST DOSING INTERVAL: Food may interfere with the absorption of esomeprazole. The manufacturer reports that the area under the concentration-time curve for esomeprazole following a single 40 mg dose was 33% to 53% lower when administered after food intake as opposed to during fasting conditions.

MANAGEMENT: Esomeprazole should be taken at least one hour before meals. When administered to patients receiving continuous enteral nutrition, some experts recommend that the tube feeding should be interrupted for at least 1 hour before and 1 hour after the dose of esomeprazole is given.

References

  1. Product Information. Nexium (esomeprazole). Astra-Zeneca Pharmaceuticals. 2001;PROD.
  2. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT. Recommendations for the use of medications with continuous enteral nutrition. Am J Health Syst Pharm. 2009;66:1438-67.

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Minor

clarithromycin food

Applies to: Biaxin (clarithromycin)

Grapefruit juice may delay the gastrointestinal absorption of clarithromycin but does not appear to affect the overall extent of absorption or inhibit the metabolism of clarithromycin. The mechanism of interaction is unknown but may be related to competition for intestinal CYP450 3A4 and/or absorptive sites. In an open-label, randomized, crossover study consisting of 12 healthy subjects, coadministration with grapefruit juice increased the time to reach peak plasma concentration (Tmax) of both clarithromycin and 14-hydroxyclarithromycin (the active metabolite) by 80% and 104%, respectively, compared to water. Other pharmacokinetic parameters were not significantly altered. This interaction is unlikely to be of clinical significance.

References

  1. Cheng KL, Nafziger AN, Peloquin CA, Amsden GW. Effect of grapefruit juice on clarithromycin pharmacokinetics. Antimicrob Agents Chemother. 1998;42:927-9.

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Therapeutic duplication warnings

No duplication warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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