Clarithromycin
The use of the following drugs with clarithromycin is contraindicated due to the potential for serious side effects:
Cisapride, pimozide, terfenadine and astemizole.
When used together with cisapride, pimozide, terfenadine and astemizole, it is possible to increase the concentration of the latter in the blood plasma, lengthen the interval and develop cardiac arrhythmias, including ventricular tachycardia, ventricular fibrillation and ventricular tachycardia of the “pirouette” type (see section “Contraindications”).
Ergot alkaloids
Post-registration studies show that when clarithromycin is used together with ergotamine and dihydroergotamine, the following effects associated with acute poisoning with drugs of the ergotamine group are possible: vascular spasm. ischemia of the limbs and other tissues, including the central nervous system. Concomitant use of clarithromycin with ergot alkaloids is contraindicated (see section "Contraindications").
Midazolam for oral use
When midazolam was co-administered with clarithromycin tablets (500 mg twice daily), midazolam AUC increased 7-fold after oral administration.
Concomitant use of clarithromycin with oral midazolam is contraindicated (see section "Contraindications").
HMG-CoA reductase inhibitors (statins).
Concomitant use of clarithromycin with lovastatin and simvastatin is contraindicated, see section “Contraindications” due to the fact that these statins are largely metabolized by the CYP3A4 isoenzyme and combined use with clarithromycin increases their serum concentrations, which leads to an increased risk of developing myopathy, including rhabdomyolysis. Cases of rhabdomyolysis have been reported in patients taking clarithromycin concomitantly with these drugs. If clarithromycin is necessary, lovastatin or simvastatin should be discontinued during therapy.
Clarithromycin should be used with caution in combination therapy with other statins. If coadministration is necessary, it is recommended to take the lowest dose of statin. It is recommended to use statins that do not depend on the metabolism of the CYP3A isoenzyme (for example, fluvastatin). The development of signs and symptoms of myopathy should be monitored.
Effect of other drugs on clarithromycin
Drugs that are inducers of the CYP3A isoenzyme (for example, rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's wort) can induce the metabolism of clarithromycin. This may result in subtherapeutic concentrations of clarithromycin, resulting in reduced effectiveness. In addition, it is necessary to monitor the concentration of the CYP3A inducer in the blood plasma, which may increase due to inhibition of the CYP3A isoenzyme by clarithromycin. When rifabutin and clarithromycin were used together, an increase in plasma concentrations of rifabutin and a decrease in serum concentrations of clarithromycin were observed with an increased risk of developing uveitis.
The following drugs have a proven or suspected effect on clarithromycin plasma concentrations; if used concomitantly with clarithromycin, dosage adjustments or switching to alternative treatment may be required.
Efavirenz, nevirapine, rifampicin, rifabutin and rifapentine
Strong cytochrome P450 inducers such as efavirenz, nevirapine, rifampicin, rifabutin and rifapentine can accelerate the metabolism of clarithromycin and thus reduce the plasma concentration of clarithromycin, and at the same time increase the concentration of 14(OH)-clarithromycin, a metabolite that is also microbiologically active. Since the microbiological activity of clarithromycin and 14(OH)-clarithromycin differs against different bacteria, the therapeutic effect may be reduced when clarithromycin is used together with enzyme inducers.
Etravirine
The concentration of clarithromycin decreases with the use of etravirine, but the concentration of the active metabolite 14(OH)-clarithromycin increases. Because 14(OH)-clarithromycin has low activity against Mycobacterium avium complex (MAC) infections, overall activity against these pathogens may be altered and alternative treatments should be considered for the treatment of MAC.
Fluconazole
Coadministration of fluconazole 200 mg daily and clarithromycin 500 mg twice daily in 21 volunteers resulted in an increase in mean clarithromycin minimum steady-state concentration (Cmin) and AUC by 33% and 18%, respectively. However, co-administration did not significantly affect the average steady-state concentration of the active metabolite 14(OH)-clarithromycin. No dose adjustment of clarithromycin is required when taking fluconazole concomitantly.
Ritonavir
A pharmacokinetic study showed that coadministration of ritonavir 200 mg every eight hours and clarithromycin 500 mg every 12 hours resulted in a marked suppression of the metabolism of clarithromycin. When co-administered with ritonavir, clarithromycin Cmax increased by 31%, Cmin increased by 182% and AUC increased by 77%. Almost complete suppression of the formation of 14(OH)-clarithromycin was noted.
Due to the wide therapeutic range of clarithromycin, dose reduction is not required in patients with normal renal function. In patients with renal failure, it is advisable to consider the following dose adjustment options: with a CC of 30-60 ml/min, the dose of clarithromycin should be reduced by 50%; with a CC of less than 30 ml/min, the dose of clarithromycin should be reduced by 75%. Ritonavir should not be co-administered with clarithromycin in doses exceeding 1 g/day.
Similar dosage adjustments should be considered in patients with reduced renal function if ritonavir is used as a pharmacokinetic enhancer when using other HIV protease inhibitors, including atazanavir and saquinavir (see section "Bidirectional Drug Interactions").
Effect of clarithromycin on other drugs.
Antiarrhythmic drugs (quinidine and disopyramide).
Torsade de pointes-type ventricular tachycardia may occur with concomitant use of quinidine or disopyramide. When clarithromycin is coadministered with these drugs, the electrocardiogram should be regularly monitored for prolongation of the QT interval, and serum concentrations of these drugs should also be monitored.
During post-registration use, cases of hypoglycemia have been reported when clarithromycin and disopyramide were taken together. It is necessary to monitor the concentration of glucose in the blood while using clarithromycin and disopyramide.
Oral hypoglycemic agents/insulin
When clarithromycin is used together with oral hypoglycemic agents (for example, sulfonylureas) and [or insulin, severe hypoglycemia may occur. Concomitant use of clarithromycin with hypoglycemic drugs (for example, nateglinide, pioglitazone, repaglinide and rosiglitazone) may lead to inhibition of the CYP3A isoenzyme by clarithromycin, which may result in hypoglycemia. Careful monitoring of glucose concentrations is recommended.
Interactions caused by the CYP3A isoenzyme
Co-administration of clarithromycin, which is known to inhibit the CYP3A isoenzyme, and drugs primarily metabolized by the CYP3A isoenzyme, may be associated with a mutual increase in their concentrations, which may enhance or prolong both therapeutic and side effects. Clarithromycin should be used with caution in patients receiving drugs that are substrates of the isoenzyme
CYP3A, especially if these drugs have a narrow therapeutic index (eg, carbamazepine) and/or are extensively metabolized by this enzyme. If necessary, the dose of the drug taken together with clarithromycin should be adjusted. Also, whenever possible, serum concentrations of drugs primarily metabolized by the CYP3A isoenzyme should be monitored.
The following drugs/classes are metabolized by the same CYP3A isoenzyme as clarithromycin, e.g. alprazolam, carbamazepine, cilostazol, cyclosporine, disopyramide, methylprednisolone, midazolam, omeprazole, indirect anticoagulants (e.g. warfarin), atypical antipsychotics (e.g. quetiapine) , quinidine, rifabutin, sildenafil, tacrolimus, triazolam and vinblastine. Also, CYP3A isoenzyme agonists include the following drugs that are contraindicated for combined use with clarithromycin: astemizole, cisapride, pimozide, terfenadine, lovastatin, simvastatin and ergot alkaloids (see section “Contraindications”). Drugs that interact in this manner through other isoenzymes within the cytochrome P450 system include phenytoin, theophylline, and valproic acid.
When taking warfarin and clarithromycin together, bleeding and a marked increase in INR and prothrombin time are possible. In case of combined use with warfarin and other indirect anticoagulants, it is necessary to monitor the INR and prothrombin time.
Omeprazole
Clarithromycin (500 mg every 8 hours) was studied in healthy adult volunteers in combination with omeprazole (40 mg daily). When clarithromycin and omeprazole were used together, steady-state plasma concentrations of omeprazole were increased (Cmax, AUC0-24 and T1/2 increased by 30%, 89% and 34%, respectively). The mean 24-hour gastric pH was 5.2 when omeprazole was taken alone and 5.7 when omeprazole was taken with clarithromycin.
Each of these phosphodiesterase inhibitors is metabolized, at least in part, by the CYP3A isoenzyme. At the same time, the CYP3A isoenzyme can be inhibited in the presence of clarithromycin. Concomitant use of clarithromycin with sildenafil, tadalafil or vardenafil may result in increased phosphodiesterase inhibitory effects. When using these drugs together with clarithromycin, consider reducing the dose of sildenafil, tadalafil and vardenafil.
Theophylline, carbamazepine
When clarithromycin and theophylline or carbamazepine are used together, the concentration of these drugs in the systemic circulation may increase.
Tolterodine
The primary metabolism of tolterodine occurs through the 2D6 isoform of cytochrome P450 (CYP2D6). However, in part of the population lacking the CYP2D6 isoenzyme, metabolism occurs through the CP3A isoenzyme. In this population, inhibition of CYP3A results in significantly higher serum tolterodine concentrations. In a population with a low level of metabolism through the CYP2D6 isoenzyme, a reduction in the dose of tolterodine may be required in the presence of CYP3A isoenzyme inhibitors such as clarithromycin.
Benzodiazepines (eg, alprazolam, midazolam, triazolam)
When midazolam was co-administered with clarithromycin tablets (500 mg twice daily), midazolam AUC increased by 2.7 times after intravenous midazolam administration. If intravenous midazolam is used concomitantly with clarithromycin, the patient's condition should be carefully monitored for possible dose adjustment. Administration of a drug through the oral mucosa, which bypasses presystemic drug elimination, is likely to result in an interaction similar to that observed with intravenous midazolam rather than with oral administration. The same precautions should be applied to other benzodiazepines that are metabolized by CYP3A, including triazolam and alprazolam. For benzodiazepines, the elimination of which does not depend on the CYP3A isoenzyme (temazepam, nitrazepam, lorazepam), a clinically significant interaction with clarithromycin is unlikely.
When clarithromycin and triazolam are used together, effects on the central nervous system (CNS), such as drowsiness and confusion, are possible. Therefore, if coadministration occurs, it is recommended to monitor for symptoms of CNS impairment.
Patient reviews of the drug Lancid
“I have been suffering from peptic ulcers for the past three years. Reflux and chest pain became my constant companions. The gastroenterologist who “guided” me in a regular district clinic advised me to go on a diet consisting of rice, apples, oatmeal, egg whites and a small amount of vegetables.
The diet certainly helped, but any deviation from it led to severe heartburn. And in general, the condition of the skin began to deteriorate (due to a lack of vitamins and minerals due to a poor diet).
As a result, I went to a private specialist and asked to be prescribed medications to relieve pain during periods of exacerbation. The doctor prescribed Lancid for me. I took the first course six months ago, and for almost 3 months I didn’t remember that I had an ulcer. When the negative symptoms began to appear again, I decided to take Lancid without going to the doctor. As a result, there was practically no effect. I’m thinking about trying some analogue with lansoprazole in the composition.”
Korolchuk Irina Petrovna, 42 years old
“I initially took Lancid as prescribed by a gastroenterologist due to diagnosed severe acid reflux. I took the pills for only 3 days and encountered side effects such as nausea, dry mouth and stomach pain. I decided to see another doctor, who ordered a test for H. Pylori.
After receiving a positive result, the gastroenterologist advised me to continue taking Lancid, but with the “Kit” prefix. It turned out that the package contained as many as 3 different types of tablets with different effects on the body. After such shock therapy, I developed other side effects in the form of severe hunger and drowsiness.
As a result, I gained about 5 kilograms while taking the medicine. Repeated tests showed that H. Pylori was not detected. But a week after completing the therapy, I again had a sour, unpleasant taste in my mouth. So I consider the tablets (both Lancid and Lancid Kit) to be ineffective in the treatment of acid reflux.”
Artyushkina Polina Romanovna, 30 years old
“At first I fully supported the few positive reviews about Lancid. Acid reflux and chest pain that accompanied the peptic ulcer disappeared almost immediately after the start of treatment. I needed to take the drug for about 18 weeks.
There were minor side effects during the process (digestion, dizziness, fatigue), but for me this was not a critical problem. Towards the end of the course, I began to experience severe yellow diarrhea and vomiting. Moreover, attacks of the disease could occur at night. In the end, I decided to end treatment with Lancid. After about 2 weeks, GERD relapsed, but the pharmacist advised me to buy Gaviscon).
After about 2-3 weeks I began to feel completely healthy. I think that my doctor incorrectly calculated the duration of taking the drug. A sick stomach simply couldn’t handle such a large amount of chemistry.”
Petrov Igor Konstantinovich, 38 years old
“I can say that the positive reviews from doctors about Lancid Kit are absolutely true.
I suffered from acid reflux for several months, and following folk remedies the condition only worsened. Severe heartburn occurred literally after every meal. After lengthy gastroenterological examinations, I was prescribed Lancid Kit. The price for the set was almost 900 rubles, but in the end I didn’t regret a penny. The heartburn went away after six weeks of therapy. The only side effect was diarrhea, which disappeared immediately after stopping treatment."
Zinoviev Alexey Dmitrievich, 45 years old
Interactions with other drugs
Colchicine
Colchicine is a substrate of both the CYP3A isoenzyme and the P-glycoprotein (Pgp) transporter protein. It is known that clarithromycin and other macrolides are inhibitors of the CYP3A and Pgp isoenzyme. When clarithromycin and colchicine are taken together, inhibition of Pgp and/or the CYP3A isoenzyme may lead to increased effects of colchicine. There have been post-marketing reports of cases of colchicine poisoning when taken concomitantly with clarithromycin, more often in elderly patients. Some of the reported cases occurred in patients with renal failure. Some cases were reported to be fatal. The simultaneous use of clarithromycin and colchicine is contraindicated (see section "Contraindications").
Digoxin
Digoxin is suspected to be a Pgp substrate. Clarithromycin is known to inhibit Pgp. When clarithromycin and digoxin are co-administered, inhibition of Pgp by clarithromycin may result in increased effects of digoxin. Post-marketing studies have shown that coadministration of digoxin and clarithromycin may also result in increased serum concentrations of digoxin. Clinical symptoms of digoxin toxicity, including potentially fatal arrhythmias, have been reported in some patients. Serum digoxin concentrations should be carefully monitored when clarithromycin and digoxin are coadministered.
Zidovudine
Concomitant use of clarithromycin tablets and oral zidovudine in adult HIV-infected patients may result in decreased steady-state zidovudine concentrations.
Because clarithromycin interferes with the oral absorption of zidovudine, the interaction can be largely avoided by taking clarithromycin and zidovudine 4 hours apart.
This interaction was not observed in HIV-infected children taking clarithromycin pediatric suspension with zidovudine or dideoxyinosine. Since clarithromycin may interfere with the absorption of zidovudine when administered concomitantly orally in adult patients, such an interaction is unlikely to occur when clarithromycin is used intravenously.
Phenytoin and valproic acid
There is evidence of interactions between CYP3A isoenzyme inhibitors (including clarithromycin) and drugs that are not metabolized by the CYP3A isoenzyme (phenytoin and valproic acid). For these drugs, when used together with clarithromycin, it is recommended to determine their serum concentrations, as there are reports of their increase.
Bidirectional drug interactions
Atazanavir
Clarithromycin and atazanavir are both substrates and inhibitors of the SURZA isoenzyme. There is evidence of a bidirectional interaction between these drugs. Coadministration of clarithromycin (500 mg twice daily) and atazanavir (400 mg once daily) may result in a twofold increase in clarithromycin exposure and a 70% decrease in 14(OH)-clarithromycin exposure, with a 28% increase in atazanavir AUC. Due to the wide therapeutic range of clarithromycin, dose reduction is not required in patients with normal renal function. In patients with moderate renal failure (creatinine clearance 30 - 60 ml/min), the dose of clarithromycin should be reduced by 50%. In patients with CC less than 30 ml/min, the dose of clarithromycin should be reduced by 75% using the appropriate dosage form of clarithromycin. Clarithromycin in doses exceeding 1000 mg per day should not be used in conjunction with protease inhibitors.
Blockers of "slow" calcium channels
When using clarithromycin simultaneously with blockers of “slow” calcium channels that are metabolized by the CYP3A4 isoenzyme (for example, verapamil, amlodipine, diltiazem), caution should be exercised as there is a risk of arterial hypotension. Plasma concentrations of clarithromycin, as well as slow calcium channel blockers, may increase with simultaneous use. Arterial hypotension, bradyarrhythmia and lactic acidosis are possible when taking clarithromycin and verapamil simultaneously.
Itraconazole
Clarithromycin and itraconazole are substrates and inhibitors of the CYP3A isoenzyme, which determines the bidirectional interaction of the drugs. Clarithromycin may increase plasma concentrations of itraconazole, while itraconazole may increase plasma concentrations of clarithromycin. Patients taking itraconazole and clarithromycin concomitantly should be closely monitored for symptoms of increased or prolonged pharmacological effects of these drugs.
Saquinavir
Clarithromycin and saquinavir are substrates and inhibitors of the CYP3A isoenzyme, which determines the bidirectional interaction of the drugs. Concomitant administration of clarithromycin (500 mg twice daily) and saquinavir (soft gelatin capsules, 1200 mg three times daily) in 12 healthy volunteers increased the AUC and Cmax of saquinavir by 177% and 187%, respectively, compared with saquinavir administration alone. separately. The AUC and Cmax values of clarithromycin were approximately 40% higher than with clarithromycin monotherapy. When these two drugs are used together for a limited time at the doses/formulations indicated above, no dose adjustment is required. Results from drug interaction studies using saquinavir soft gelatin capsules may not be consistent with the effects observed with saquinavir hard gelatin capsules. The results of drug interaction studies with saquinavir monotherapy may not be consistent with the effects observed with saquinarine/ritonavir therapy. When taking saquinavir with ritonavir, consider the potential effect of ritonavir on clarithromycin.
Lancid Keith
Before starting therapy, it is necessary to exclude the presence of a malignant process (especially with a stomach ulcer), since treatment, masking symptoms, can delay the correct diagnosis.
Clarithromycin
Long-term use of antibiotics can lead to the formation of colonies with an increased number of insensitive bacteria and fungi. In case of superinfection, appropriate therapy must be prescribed.
Hepatic dysfunction (increased plasma levels of liver enzymes, hepatocellular and/or cholestatic hepatitis with or without jaundice) has been reported with the use of clarithromycin. Liver dysfunction can be severe but is usually reversible. There have been cases of fatal liver failure, mainly associated with the presence of serious concomitant diseases and/or concomitant use of other drugs. If signs and symptoms of hepatitis such as anorexia appear. jaundice, dark urine, abdominal tenderness on palpation, clarithromycin therapy should be stopped immediately.
In the presence of chronic liver diseases, it is necessary to regularly monitor blood plasma enzymes.
When treated with almost all antibacterial agents, including clarithromycin, cases of pseudomembranous colitis have been described, the severity of which can range from mild to life-threatening.
Antibacterial drugs can change the normal intestinal microflora, which can lead to the growth of Clostridium difficile. Pseudomembranous colitis caused by Clostridium difficile should be suspected in all patients who experience diarrhea after using antibacterial agents. After a course of antibiotic therapy, careful medical monitoring of the patient is necessary. Cases of the development of pseudomembranous colitis 2 months after taking antibiotics have been described.
Clarithromycin should be used with caution in patients with coronary heart disease (CHD), severe heart failure, hypomagnesemia, severe bradycardia (less than 50 beats/min), as well as when used simultaneously with class IA (quinidine, procainamide) and class III antiarrhythmic drugs ( dofetilide, amiodarone, sotalol). In these conditions and while taking clarithromycin with these drugs, the electrocardiogram should be regularly monitored for an increase in the QT interval.
It is possible to develop cross-resistance to clarithromycin and other macrolide antibiotics, as well as lincomycin and clindamycin.
If acute hypersensitivity reactions occur, such as anaphylactic reaction, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms (DRESS syndrome), Henoch-Schönlein purpura, you should immediately stop taking clarithromycin and begin appropriate therapy.
Worsening of myasthenia gravis symptoms has been reported in patients taking clarithromycin.
In case of combined use with warfarin or other indirect anticoagulants, it is necessary to monitor MHO and prothrombin time.
Amoxicillin
Before starting amoxicillin, it is necessary to obtain a detailed history regarding previous hypersensitivity reactions to penicillins, cephalosporins or other allergens. Serious and sometimes fatal hypersensitivity reactions (anaphylactic reactions) to penicillins have been described. The risk of such reactions is highest in patients with a history of hypersensitivity reactions to penicillins. If allergic reactions occur, you must stop taking amoxicillin and start therapy with an antibiotic from a different group. In case of serious hypersensitivity reactions, appropriate measures should be taken immediately. Epinephrine, oxygen therapy, intravenous corticosteroids, and airway management, including intubation, may also be required.
It is necessary to refrain from using amoxicillin if infectious mononucleosis is suspected, since amoxicillin can cause a measles-like skin rash in patients with this disease, making diagnosis difficult.
Long-term treatment with amoxicillin sometimes leads to excessive proliferation of insensitive microorganisms.
During the use of amoxicillin, it is recommended to periodically evaluate renal, hepatic and hematopoietic function. Amoxicillin should be used with caution in patients with impaired liver function. Liver function should be monitored on a regular basis. In patients with impaired renal function, the dose of amoxicillin should be reduced according to the degree of impairment.
Amoxicillin can provoke nonspecific binding of immunoglobulins and albumins to the erythrocyte membrane, which can cause a false-positive reaction with the Coombs test.
Crystalluria very rarely occurs in patients with reduced diuresis. Adequate fluid intake and maintaining adequate diuresis are extremely important during amoxicillin therapy.
In patients with cholangitis or cholecystitis, antibiotics can be prescribed only if the disease is mild and in the absence of cholestasis. During therapy with amoxicillin, it is necessary to remember the possible development of superinfection (usually caused by bacteria of the genus Pseudomonas spp. or fungi of the genus Candida). In this case, amoxicillin therapy should be discontinued and/or appropriate treatment should be prescribed.
If severe diarrhea persists, pseudomembranous colitis caused by antibiotics should be suspected, which can pose a threat to the patient's life (watery stool mixed with blood and mucus; dull widespread or colicky abdominal pain; fever, sometimes tenesmus). In such cases, amoxicillin should be immediately discontinued and pathogen-specific treatment, such as vancomycin, should be prescribed. In this case, drugs that reduce gastrointestinal motility are contraindicated.
The excretion of amoxicillin leads to its high content in the urine, which can lead to false-positive results when determining glucose in urine (for example, Benedict's test, Fehling's test). In this case, it is recommended to use the glucose oxidase method for determining the concentration of glucose in urine.
If concomitant use of amoxicillin with anticoagulants is necessary, prothrombin time or INR should be carefully monitored when amoxicillin is prescribed or discontinued.
When using estrogen-containing oral contraceptives and amoxicillin simultaneously, other or additional methods of contraception should be used.
Particular caution is recommended for patients with allergic diathesis or bronchial asthma, or a history of gastrointestinal diseases (in particular, colitis caused by antibiotic treatment).
When taking amoxicillin for a long time, nystatin, levorin or other antifungal drugs should be prescribed simultaneously.
It is not recommended to drink alcohol during treatment.
Lansoprazole
It is recommended to avoid the combined use of proton pump inhibitors and clopidogrel. When used together, the risk of recurrent myocardial infarction, hospitalization for a heart attack or unstable angina, stroke, and repeated revascularization increases. If co-administration is absolutely necessary, patients should be closely monitored.
It is recommended to avoid the concomitant use of proton pump inhibitors and antiretroviral drugs in HIV-infected patients. If combined use with atazanavir/ritonavir is necessary, it is recommended to maintain a 12-hour interval between taking lansoprazole and these drugs, and not to exceed the dose of lansoprazole 30 mg.
When used together with antiretroviral drugs (indinavir, nelfinavir, atazanavir), as well as ketoconazole, itraconazole, posaconazole, cefpodoxime, cefuroxime and ampicillin, monitoring of their effectiveness and the emergence of resistance is necessary.
Concomitant use with imatinib may increase the risk of adverse reactions (potential interaction via CYP3A4), especially in individuals with a history of severe allergic reactions.
Due to the increased risk of myotoxicity, patients taking atorvastatin, lovastatin, or simvastatin should be closely monitored during concomitant use of lansoprazole.
In patients taking warfarin concomitantly, monitoring of prothrombin time and MHO is necessary.
Long-term use of proton pump inhibitors increases the risk of infection (including Salmonella, Campylobacter, Clostridium difficile). The benefit of preventing upper gastrointestinal bleeding must be weighed against the potential risk of developing ventilator-associated pneumonia.
Long-term use of proton pump inhibitors increases the risk of fractures in postmenopausal women.
During the treatment period, you should avoid drinking alcoholic beverages.
Pharmacogenetic factor: the effectiveness of the drug depends on the genetic polymorphism of CYP2C19. In patients classified as 'slow metabolizers' (RM-type), the effectiveness is higher; eradication of Helicobacter pylori is significantly more often achieved compared to 'fast metabolizers' (homEM-type), even against the background of clarithromycin resistance.
'Acid rebound syndrome' is not typical for lansoprazole if the recommendations for duration of use are followed.
Effect on the ability to drive machinery and a car
During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions, since the drugs included in the drug can cause weakness, drowsiness and dizziness.
Amoxicillin
Antacids, glucose, laxatives, food, aminoglycosides
slow down and reduce absorption,
ascorbic acid
increases absorption.
Bactericidal antibiotics (including aminoglycosides, cephalosporins, cycloserine, vancomytium, rifampicin, quinolones)
have a synergistic effect,
bacteriostatic drugs (macrolides, chloramphenicol, lincosamides, tetracyclines, sulfonamides) are
antagonistic (the effectiveness of amoxicillin is reduced).
Increases the effectiveness of indirect anticoagulants
(by suppressing intestinal microflora, reduces the synthesis of vitamin K and the prothrombin index), reduces the effectiveness
of drugs, during the metabolism of which para-aminobenzoic acid is formed, ethinyl estradiol
- the risk of developing “breakthrough” bleeding.
However, the literature describes cases of increased international normalized ratio (INR) in patients receiving maintenance therapy with acenocoumarol
or
warfarin
who are prescribed a course of treatment with amoxicillin. If concomitant use of drugs is necessary, the INR should be carefully monitored when amoxicillin is added or removed. In addition, it may be necessary to adjust the dose of oral anticoagulants.
Diuretics, allopurinol, oxyphenbutazone, phenylbutazone, non-steroidal anti-inflammatory drugs and drugs that block tubular secretion by reducing tubular secretion
, increase the concentration of amoxicillin in the blood plasma.
When used simultaneously with allopurinol
the risk of developing a skin rash increases.
Reduces clearance and increases toxicity of methotrexate
.
Enhances the absorption of digoxin
.
Use of amoxicillin and probenecid
not recommended, because probenecid reduces the renal tubular secretion of amoxicillin, thereby increasing its plasma concentration and lengthening the time it remains in the blood serum.
