Esomeprazole + Amoxicillin + Clarithromycin interactions

Food & lifestyle

• food

  Moderate

  Absorption

  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.

  What to do: 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.

  2 sources

  1. "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals (2001):
  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 66 (2009): 1438-67

• grapefruit juice

  Minor

  Metabolism

  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.

  What to do: Concomitant use of Clarithromycin with grapefruit or grapefruit juice should generally be avoided.

  1 source

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

Conditions

Conditions in which Esomeprazole + Amoxicillin + Clarithromycin needs care, as documented in this source.

• Clostridium Infections

  Major

  Published observational studies suggest that proton pump inhibitor (PPI) use may be associated with an increased risk of Clostridium difficile-associated diarrhea (CDAD), especially in hospitalized patients. This diagnosis should be considered for diarrhea that does not improve. It is recommended that patients should use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated. Close monitoring is recommended in patients with diarrhea and in those taking antibacterial agents as CDAD has been reported with the use of nearly all these agents. Treatment with antibacterial agents alters the normal flora of the colon, leading to overgrowth of C. difficile. C. difficile produces toxins A and B, which contribute to the development of CDAD. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.

  8 sources

  1. "Product Information. PriLOSEC (omeprazole)." Merck & Co., Inc (2022):
  2. "Product Information. Prevacid (lansoprazole)." TAP Pharmaceuticals Inc (2001):
  3. "Product Information. Aciphex (rabeprazole)." Janssen Pharmaceuticals (2001):
  4. "Product Information. Protonix (pantoprazole)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Protonix IV (pantoprazole)." Wyeth-Ayerst Laboratories
  6. "Product Information. Kapidex (dexlansoprazole)." Takeda Pharmaceuticals America (2009):
  7. "Product Information. NexIUM I.V. (esomeprazole)." Astra-Zeneca Pharmaceuticals (2014):
  8. "Product Information. Esomeprazole Strontium (esomeprazole)." Amneal Pharmaceuticals (2014):

• Colitis

  Major

  Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

  31 sources

  1. "Product Information. Omnipen (ampicillin)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Ceftin (cefuroxime)." Glaxo Wellcome (2002):
  3. "Product Information. Zinacef (cefuroxime)." Glaxo Wellcome (2002):
  4. "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn (2002):
  5. "Product Information. Macrobid (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  6. "Product Information. Macrodantin (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  7. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham (2001):
  8. "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals (2001):

  Show all 31 sourcesShow fewer sources

  9. "Product Information. Coly-Mycin M Parenteral (colistimethate)." Parke-Davis (2001):
  10. "Product Information. Lincocin (lincomycin)." Pharmacia and Upjohn (2001):
  11. "Product Information. Cubicin (daptomycin)." Cubist Pharmaceuticals Inc (2003):
  12. "Product Information. Xifaxan (rifaximin)." Salix Pharmaceuticals (2004):
  13. "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical (2007):
  14. "Product Information. Penicillin G Procaine (procaine penicillin)." Monarch Pharmaceuticals Inc (2009):
  15. "Product Information. Vibativ (telavancin)." Theravance Inc (2009):
  16. "Product Information. Teflaro (ceftaroline)." Forest Pharmaceuticals (2010):
  17. "Product Information. Penicillin G Sodium (penicillin G sodium)." Sandoz Inc (2022):
  18. "Product Information. Dalvance (dalbavancin)." Durata Therapeutics, Inc. (2014):
  19. "Product Information. Orbactiv (oritavancin)." The Medicines Company (2014):
  20. "Product Information. Bicillin C-R (benzathine penicillin-procaine penicillin)." A-S Medication Solutions (2017):
  21. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
  22. "Product Information. Polymyxin B Sulfate (polymyxin B sulfate)." AuroMedics Pharma LLC (2022):
  23. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
  24. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
  25. "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc. (2018):
  26. "Product Information. Aemcolo (rifamycin)." Aries Pharmaceuticals, Inc. (2018):
  27. "Product Information. Fetroja (cefiderocol)." Shionogi USA Inc (2019):
  28. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
  29. "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2021):
  30. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):
  31. "Product Information. Priftin (rifapentine)." sanofi-aventis (2020):

• Colitis

  Major

  Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

  31 sources

  1. "Product Information. Omnipen (ampicillin)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Ceftin (cefuroxime)." Glaxo Wellcome (2002):
  3. "Product Information. Zinacef (cefuroxime)." Glaxo Wellcome (2002):
  4. "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn (2002):
  5. "Product Information. Macrobid (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  6. "Product Information. Macrodantin (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  7. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham (2001):
  8. "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals (2001):

  Show all 31 sourcesShow fewer sources

  9. "Product Information. Coly-Mycin M Parenteral (colistimethate)." Parke-Davis (2001):
  10. "Product Information. Lincocin (lincomycin)." Pharmacia and Upjohn (2001):
  11. "Product Information. Cubicin (daptomycin)." Cubist Pharmaceuticals Inc (2003):
  12. "Product Information. Xifaxan (rifaximin)." Salix Pharmaceuticals (2004):
  13. "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical (2007):
  14. "Product Information. Penicillin G Procaine (procaine penicillin)." Monarch Pharmaceuticals Inc (2009):
  15. "Product Information. Vibativ (telavancin)." Theravance Inc (2009):
  16. "Product Information. Teflaro (ceftaroline)." Forest Pharmaceuticals (2010):
  17. "Product Information. Penicillin G Sodium (penicillin G sodium)." Sandoz Inc (2022):
  18. "Product Information. Dalvance (dalbavancin)." Durata Therapeutics, Inc. (2014):
  19. "Product Information. Orbactiv (oritavancin)." The Medicines Company (2014):
  20. "Product Information. Bicillin C-R (benzathine penicillin-procaine penicillin)." A-S Medication Solutions (2017):
  21. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
  22. "Product Information. Polymyxin B Sulfate (polymyxin B sulfate)." AuroMedics Pharma LLC (2022):
  23. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
  24. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
  25. "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc. (2018):
  26. "Product Information. Aemcolo (rifamycin)." Aries Pharmaceuticals, Inc. (2018):
  27. "Product Information. Fetroja (cefiderocol)." Shionogi USA Inc (2019):
  28. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
  29. "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2021):
  30. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):
  31. "Product Information. Priftin (rifapentine)." sanofi-aventis (2020):

• Diabetes Mellitus

  Moderate

  High urine concentrations of ampicillin may result in false-positive reactions when testing for the presence of glucose in urine using Clinitest®, Benedict's Solution or Fehling's Solution. Since this effect may also occur with amoxicillin, it is recommended that glucose tests based on enzymatic glucose oxidase reactions (such as Clinistix®) be used.

  1 source

  1. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham (2001):

• Diseases requiring hemodialysis

  Moderate

  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.

  22 sources

  1. Giron JA, Meyers BR, Hirschman SZ, Srulevitch E "Pharmacokinetics of piperacillin in patients with moderate renal failure and in patients undergoing hemodialysis." Antimicrob Agents Chemother 19 (1981): 279-83
  2. Heim KL "The effect of hemodialysis on piperacillin pharmacokinetics." Drug Intell Clin Pharm 19 (1985): 455
  3. Francke EL, Appel GB, Neu HC "Kinetics of intravenous amoxicillin in patients on long-term dialysis." Clin Pharmacol Ther 26 (1979): 31-5
  4. Slaughter RL, Kohli R, Brass C "Effects of hemodialysis on the pharmacokinetics of amoxicillin/clavulanic acid combination." Ther Drug Monit 6 (1984): 424-7
  5. Janicke DM, Mangione A, Schultz RW, Jusko WJ "Mezlocillin disposition in chronic hemodialysis patients." Antimicrob Agents Chemother 20 (1981): 590-4
  6. Kampf D, Schurig R, Weihermuller K, Forster D "Effects of impaired renal function hemodialysis and peritoneal dialysis on the pharmacokinetics of mezlocillin." Antimicrob Agents Chemother 18 (1980): 81-7
  7. 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
  8. Francke E, Mehta S, Neu HC, Appel GB "Kinetics of intravenous mezlocillin in chronic hemodialysis patients." Clin Pharmacol Ther 26 (1979): 228-31

  Show all 22 sourcesShow fewer sources

  9. Thorsteinsson SB, Steingrimsson O, Asmundsson P, Bergan T "Pharmacokinetics of mezlocillin during haemodialysis." Scand J Infect Dis 29 (1981): 59-63
  10. Wise R, Reeves DS, Parker AS "Administration of ticarcillin, a new antipseudomonal antibiotic, in patients undergoing dialysis." Antimicrob Agents Chemother 5 (1974): 119-20
  11. Brogard JM, Comte F, Spach MO, Lavillaureix J "Pharmacokinetics of mezlocillin in patients with kidney impairment: special reference to hemodialysis and dosage adjustments in relation to renal function." Chemotherapy 28 (1982): 318-26
  12. Oe PL, Simonian S, Verhoef J "Pharmacokinetics of the new penicillins." Chemotherapy 19 (1973): 279-88
  13. 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
  14. Blum RA, Kohli RK, Harrison NJ, Schentag JJ "Pharmacokinetics of ampicillin (2.0 grams) and sulbactam (1.0 gram) coadministered to subjects with normal and abnormal renal function and with end-stage renal disease on hemodialysis." Antimicrob Agents Chemother 33 (1989): 1470-6
  15. Rho JP, Jones A, Wood M, et al. "Single-dose pharmacokinetics of intravenous ampicillin plus sulbactam in healthy elderly and young adult subjects." J Antimicrob Chemother 24 (1989): 573-80
  16. "Product Information. Polycillin-PRB (ampicillin-probenecid)." Apothecon Inc
  17. "Product Information. Spectrobid (bacampicillin)." Roerig Division (2002):
  18. "Product Information. Geocillin (carbenicillin)." Roerig Division (2002):
  19. "Product Information. Mezlin (mezlocillin)." Bayer (2002):
  20. "Product Information. Pfizerpen (penicillin)." Roerig Division (2001):
  21. "Product Information. Pipracil (piperacillin)." Lederle Laboratories (2001):
  22. "Product Information. Ticar (ticarcillin)." SmithKline Beecham (2001):

• Fractures, Bone

  Moderate

  Various published observational studies have reported that PPI therapy may be associated with an increased risk for osteoporosis related fractures of the hip, wrist or spine. The risk was increased in patients who received high doses (multiple daily doses), and long term treatment (a year or longer). Patients should use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated. Caution should be used in patients at risk for osteoporosis related fractures and should be managed according to established treatment guidelines.

  6 sources

  1. "Product Information. Prevacid (lansoprazole)." TAP Pharmaceuticals Inc (2001):
  2. "Product Information. Aciphex (rabeprazole)." Janssen Pharmaceuticals (2001):
  3. "Product Information. Protonix (pantoprazole)." Wyeth-Ayerst Laboratories (2001):
  4. "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals (2001):
  5. "Product Information. Omeprazole (omeprazole)." Mylan Pharmaceuticals Inc (2003):
  6. "Product Information. Kapidex (dexlansoprazole)." Takeda Pharmaceuticals America (2009):

• Hypomagnesemia 1, Intestinal

  Moderate

  Symptomatic and asymptomatic hypomagnesemia has been reported rarely in patients treated with PPIs for at least 3 months, in most cases after a year of therapy. Serious adverse events can include tetany, seizures, and arrhythmias. Caution should be used in patients prone to magnesium imbalances such as patients taking other medications that can cause hypomagnesemia (e.g., diuretics). Regular monitoring is recommended.

  6 sources

  1. "Product Information. Prevacid (lansoprazole)." TAP Pharmaceuticals Inc (2001):
  2. "Product Information. Aciphex (rabeprazole)." Janssen Pharmaceuticals (2001):
  3. "Product Information. Protonix (pantoprazole)." Wyeth-Ayerst Laboratories (2001):
  4. "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals (2001):
  5. "Product Information. Omeprazole (omeprazole)." Mylan Pharmaceuticals Inc (2003):
  6. "Product Information. Kapidex (dexlansoprazole)." Takeda Pharmaceuticals America (2009):

• Infectious Mononucleosis

  Moderate

  Patients with mononucleosis treated with an aminopenicillin antibiotic, may develop a pruritic erythematous maculopapular skin rash. 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. Therapy with aminopenicillin antibiotics should not be administered in patients with mononucleosis.

  3 sources

  1. "Product Information. Polycillin-PRB (ampicillin-probenecid)." Apothecon Inc
  2. "Product Information. Spectrobid (bacampicillin)." Roerig Division (2002):
  3. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham (2001):

• Kidney Diseases

  Moderate

  Clarithromycin is primarily eliminated by the kidney and liver. A decreased dosage or prolonged dosing intervals are recommended 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 drug accumulation could occur in the presence of concomitant liver disease. Monitoring is advised.

  1 source

  1. "Product Information. Biaxin (clarithromycin)." Abbott Pharmaceutical (2002):

• Kidney Diseases

  Moderate

  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.

  67 sources

  1. Bergan T "Pharmacokinetic comparison of oral bacampicillin and parenteral ampicillin." Antimicrob Agents Chemother 13 (1978): 971-4
  2. Ehrnebo M, Nilsson SO, Boreus LO "Pharmacokinetics of ampicillin and its prodrugs bacampicillin and pivampicillin in man." J Pharmacokinet Biopharm 7 (1979): 429-51
  3. Humbert G, Spyker DA, Fillastre JP, Leroy A "Pharmacokinetics of amoxicillin: dosage nomogram for patients with impaired renal function." Antimicrob Agents Chemother 15 (1979): 28-33
  4. Bloch R, Szwed JJ, Sloan RS, Luft FC "Pharmacokinetics of cefaclor in normal subjects and patients with chronic renal failure." Antimicrob Agents Chemother 12 (1977): 730-2
  5. Santoro J, Agarwal BN, Martinelli R, et al. "Pharmacology of cefaclor in normal volunteers and patients with renal failure." Antimicrob Agents Chemother 13 (1978): 951-4
  6. Spyker DA, Thomas BL, Sande MA, Bolton WK "Pharmacokinetics of cefaclor and caphalexin: dosage nomograms for impaired renal function." Antimicrob Agents Chemother 14 (1978): 172-7
  7. Gartenberg G, Meyers BR, Hirschman SZ, Srulevitch E "Pharmacokinetics of cefaclor in patients with stable renal impairment, and patients undergoing haemodialysis." J Antimicrob Chemother 5 (1979): 465-70
  8. Fillastre JP, Leroy A, Humbert G, Godin M "Cefaclor pharmacokinetics and renal impairment." J Antimicrob Chemother 6 (1980): 155-6

  Show all 67 sourcesShow fewer sources

  9. Berman SJ, Boughton WH, Sugihara JG, et al. "Pharmacokinetics of cefaclor in patients with end stage renal disease and during hemodialysis." Antimicrob Agents Chemother 14 (1978): 281-3
  10. Spyker DA, Gober LL, Scheld WM, et al. "Pharmacokinetics of cefaclor in renal failure: effects of multiple doses and hemodialysis." Antimicrob Agents Chemother 21 (1982): 278-81
  11. Pommer W, Krause PH, Berg PA, et al. "Acute interstitial nephritis and non-oliguric renal failure after cefaclor treatment." Klin Wochenschr 64 (1986): 290-3
  12. Guay DR, Meatherall RC, Harding GK, Brown GR "Pharmacokinetics of cefixime (CL 284,635; FK 027) in healthy subjects and patients with renal insufficiency." Antimicrob Agents Chemother 30 (1986): 485-90
  13. Dhib M, Moulin B, Leroy A, et al. "Relationship between renal function and disposition of oral cefixime." Eur J Clin Pharmacol 41 (1991): 579-83
  14. Shyu WC, Pittman KA, Wilber RB, et al. "Pharmacokinetics of cefprozil in healthy subjects and patients with renal impairment." J Clin Pharmacol 31 (1991): 362-71
  15. Humbert G, Leroy A, Fillastre JP, Godin M "Pharmacokinetics of cefadroxil in normal subjects and in patients with renal insufficiency." Chemotherapy 25 (1979): 189-95
  16. Leroy A, Humbert G, Godin M, Fillastre JP "Pharmacokinetics of cefadroxil in patients with impaired renal function." J Antimicrob Chemother 10 (1982): 39-46
  17. Kabins SA, Kelner B, Walton E, Goldstein E "Cephalexin therapy as related to renal function." Am J Med Sci 259 (1970): 133-42
  18. Kunin CM, Finkelberg Z "Oral cephalexin and ampicillin: antimicrobial activity, recovery in urine, and persistence in blood of uremic patients." Ann Intern Med 72 (1970): 349-56
  19. Yamasaku F, Tsuchida R, Usuda Y "A study of the kinetics of cephalosporins in renal impairment." Postgrad Med J Suppl (1970): 57-9
  20. Bailey RR, Gower PE, Dash CH "The effect of impairment of renal function and haemodialysis on serum and urine levels of cephalexin." Postgrad Med J 46 (1970): 60-4
  21. Regamey C, Humair L "Pharmacokinetics of cephalexin in renal insufficiency." Postgrad Med J 47 Supp) (1971): 69-77
  22. Reisberg BE, Mandelbaum JM "Cephalexin: absorption and excretion as related to renal function and hemodialysis." Infect Immun 3 (1971): 540-3
  23. Kirby WM, de Maine JB, Serrill WS "Pharmacokinetics of the cephalosporins in healthy volunteers and uremic patients." Postgrad Med J 47 Suppl (1971): 41-6
  24. Brogard JM, Pinget M, Dorner M, Lavillaureix J "Determination of cefalexin pharmacokinetics and dosage adjustments in relation to renal function." J Clin Pharmacol 15 (1975): 666-73
  25. Chow M, Quintiliani R, Cunha BA, et al. "Pharmacokinetics of high-dose oral cephalosporins." J Clin Pharmacol 19 (1979): 185-94
  26. Finkelstein ER, Quintiliani R, Nightingale CH "Pharmacokinetics of oral cephalosporins." J Pediatr 93 (1978): 902
  27. Andriole VT "Pharmacokinetics of cephalosporins in patients with normal or reduced renal function." J Infect Dis 137 (1978): s88-99
  28. Hori R, Okumura K, Nihira H, et al. "A new dosing regimen in renal insufficiency: application to cephalexin." Clin Pharmacol Ther 38 (1985): 290-5
  29. St Peter JV, Borin MT, Hughes GS, et al. "Disposition of cefpodoxime proxetil in healthy volunteers and patients with impaired renal function." Antimicrob Agents Chemother 36 (1992): 126-31
  30. Gibaldi M, Perrier D "Drug distribution and renal failure." J Clin Pharmacol 12 (1972): 201-4
  31. Hoffman TA, Cestero R, Bullock WE "Pharmacodynamics of carbenicillin in hepatic and renal failure." Ann Intern Med 73 (1970): 173-8
  32. Latos DL, Bryan CS, Stone WJ "Carbenicillin therapy in patients with normal and impaired renal function." Clin Pharmacol Ther 17 (1975): 692-700
  33. Arancibia A, Droguett MT, Fuentes G, et al. "Pharmacokinetics of amoxicillin in subjects with normal and impaired renal function." Int J Clin Pharmacol Ther Toxicol 20 (1982): 447-53
  34. Sjovall J, Westerlund D, Alvan G "Renal excretion of intravenously infused amoxycillin and ampicillin." Br J Clin Pharmacol 19 (1985): 191-201
  35. Jackson EA, McLeod DC "Pharmacokinetics and dosing of antimicrobial agents in renal impairment, part I." Am J Hosp Pharm 31 (1974): 36-52
  36. Bailey RR, Eastwood JB, Vaughan RB "The pharmacokinetics of an oral form of carbenicillin in patients with renal failure." Postgrad Med J 48 (1972): 422-5
  37. Nelson JD, Reimold EW "Carbenicillin pharmacokinetics in an anephric patient." Lancet 1 (1973): 486-7
  38. Nakano H, Sasaki K, Mizoguchi M, Ishibe T, Nihira H "Absorption and excretion of carbenicillin indanyl sodium in patients with reduced kidney function." Chemotherapy 23 (1977): 299-308
  39. Hoffler D, Koeppe P, Corcilius M, Przyklink A "Cefpodoxime proxetil in patients with endstage renal failure on hemodialysis." Infection 18 (1990): 157-62
  40. Yamasaku F, Tsuchida R, Usada Y "A study of the kinetics of cephalosporins in renal impairment." Postgrad Med J Suppl (1970): 57-9
  41. Standiford HC, Jordan MC, Kirby WM "Clinical pharmacology of carbenicillin compared with other penicillins." J Infect Dis 122 (1970): s9-13
  42. Andriole VT "Pharmacokinetics of cephalosporins in patients with normal or reduced renal function." J Infect Dis 137 (1978): s88-97
  43. Schwinghammer TL, Norden CW, Gill E "Pharmacokinetics of cephradine administered intravenously and orally to young and elderly subjects." J Clin Pharmacol 30 (1990): 893-9
  44. Solomon AE, Briggs JD "The administration of cephradine to patients in renal failure." Br J Clin Pharmacol 2 (1975): 443-8
  45. Neu HC "The pharmacokinetics of bacampicillin." Rev Infect Dis 3 (1981): 110-6
  46. Braga PC, Fraschini F, Ceccarelli G, Scaglione F, Scarpazza G "Clinical pharmacokinetic evaluation of bacampicillin." Clin Ther 4 (1981): 32-42
  47. DeSante KA, Zeckel ML "Pharmacokinetic profile of loracarbef." Am J Med 92 (1992): s16-9
  48. "Product Information. Polymox (amoxicillin)." Bristol-Myers Squibb, Princeton, NJ.
  49. "Product Information. Spectrobid (bacampicillin)." Roerig Division (2002):
  50. "Product Information. Geocillin (carbenicillin)." Roerig Division (2002):
  51. "Product Information. Ceclor (cefaclor)." Lilly, Eli and Company (2002):
  52. "Product Information. Duricef (cefadroxil)." Bristol-Myers Squibb (2002):
  53. "Product Information. Suprax (cefixime)." Lupin Pharmaceuticals Inc (2002):
  54. "Product Information. Vantin (cefpodoxime)." Pharmacia and Upjohn (2002):
  55. "Product Information. Cefzil (cefprozil)." Bristol-Myers Squibb (2002):
  56. "Product Information. Keflex (cephalexin)." Dista Products Company (2002):
  57. "Product Information. Velosef (cephradine)." Apothecon Inc (2002):
  58. "Product Information. Lorabid (loracarbef)." Lilly, Eli and Company (2002):
  59. Therasse DG, Farlow DS, Davidson RL, et al. "Effect of renal dysfunction on the pharmacokinetics of loracarbef." Clin Pharmacol Ther 54 (1993): 311-6
  60. Granero L, Gimeno MJ, Torresmolina F, Chesajimenez J, Peris JE "Studies on the renal excretion mechanisms of cefadroxil." Drug Metab Dispos 22 (1994): 447-50
  61. Hyslop DL "Cefaclor safety profile: a ten-year review." Clin Ther 11 Suppl A (1988): 83-94
  62. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham (2001):
  63. "Product Information. Cedax (ceftibuten)." Schering-Plough (2001):
  64. Nix DE, Symonds WT, Hyatt JM, et al. "Comparative pharmacokinetics of oral ceftibuten, cefixime, cefaclor, and cefuroxime axetil in healthy volunteers." Pharmacotherapy 17 (1997): 121-5
  65. "Product Information. Omnicef (cefdinir)." Parke-Davis (2001):
  66. Guay DRP "Ceftibuten: A new expanded-spectrum oral cephalosporin." Ann Pharmacother 31 (1997): 1022-33
  67. "Product Information. Spectracef (cefditoren)." TAP Pharmaceuticals Inc (2001):

• Liver Diseases

  Moderate

  Hepatic dysfunction, including increased liver enzymes, and hepatocellular and/or cholestatic hepatitis, with or without jaundice, has been reported in patients receiving clarithromycin. The hepatic dysfunction may be severe but in most cases is reversible. Fatal outcomes have also been reported and in general have been associated with serious underlying diseases and/or concomitant medications. Caution and monitoring is advised if using this drug in patients with hepatic impairment. Treatment must be discontinued immediately if signs and symptoms of hepatitis occur (e.g., anorexia, jaundice, dark urine, pruritus, or tender abdomen). The use of clarithromycin and combination medications containing this antibiotic are contraindicated in patients with a history of cholestatic jaundice or hepatic impairment associated with the prior use of clarithromycin.

  2 sources

  1. "Product Information. Biaxin (clarithromycin)." Abbott Pharmaceutical (2002):
  2. "Product Information. Voquezna Triple Pak (amoxicillin/clarithromycin/vonoprazan)." Phathom Pharmaceuticals, Inc (2022):

• Liver Diseases

  Moderate

  Esomeprazole is primarily metabolized by the liver. In patients with mild to moderate hepatic impairment (Child Pugh Class A and B), little drug accumulation has been observed following once-daily, multiple-dose administration. No dosage adjustments are necessary in these patients. In severe hepatic impairment (Child Pugh Class C), however, substantial increases in plasma drug concentrations have been demonstrated. The manufacturer recommends a maximum dosage of 20 mg once daily in patients with severe liver disease.

  1 source

  1. "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals (2001):

• Long QT Syndrome

  Moderate

  Macrolides have been associated with prolongation of the QT interval and infrequent cases of arrhythmia. Clarithromycin and erythromycin should be avoided in: patients with known prolongation of the QT interval, ventricular cardiac arrhythmia, including torsades de pointes; patients with proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, or receiving other drugs that prolong the QT interval.

  2 sources

  1. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
  2. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):

• Myasthenia Gravis

  Moderate

  The use of macrolide antibiotics has been reported to exacerbate symptoms of myasthenia gravis and trigger new onset of symptoms of myasthenic syndrome. Therapy with these agents should be administered cautiously in patients with a history of myasthenia gravis.

  4 sources

  1. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
  2. "Product Information. Zithromax IV (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2022):
  3. "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2021):
  4. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):

Therapeutic duplication

Drug classes that overlap with Esomeprazole + Amoxicillin + Clarithromycin, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• acid suppressant agents

  The recommended maximum number of medicines in the 'acid suppressant agents' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'acid suppressant agents' category.

  Example product in the source data (US market): Prevpac

• acid suppressant agents

  The recommended maximum number of medicines in the 'acid suppressant agents' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'acid suppressant agents' category.

  Example product in the source data (US market): Amoxicillin/clarithromycin/omeprazole

• acid suppressant agents

  The recommended maximum number of medicines in the 'acid suppressant agents' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'acid suppressant agents' category.

  Example product in the source data (US market): Voquezna triple pak

• acid suppressant agents

  The recommended maximum number of medicines in the 'acid suppressant agents' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'acid suppressant agents' category.

  Example product in the source data (US market): Aspirin/omeprazole

• macrolide-type antibiotics

  The recommended maximum number of medicines in the 'macrolide-type antibiotics' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'macrolide-type antibiotics' category.

  Example product in the source data (US market): Pediazole