Lansoprazole, Amoxicillin, and Clarithromycin

Pronunciation

(lan SOE pra zole, a moks i SIL in, & kla RITH roe mye sin)

U.S. Brand Names

Prevpac®

Synonyms

Amoxicillin, Lansoprazole, and Clarithromycin; Clarithromycin, Lansoprazole, and Amoxicillin

Generic Available

Canadian Brand Names

Hp-PAC®; Prevpac®

Use

Eradication of H. pylori to reduce the risk of recurrent duodenal ulcer

Pregnancy Risk Factor

C (clarithromycin)

Pregnancy Implications

See individual agents.

Lactation

Excretion in breast milk unknown/not recommended

Contraindications

Hypersensitivity to lansoprazole, amoxicillin (or any penicillin), clarithromycin (or erythromycin), or any component of the formulation; concurrent use with pimozide or cisapride

Warnings/Precautions

Based on lansoprazole component: Severe liver dysfunction may require dosage reductions.

Based on amoxicillin component: In patients with renal impairment, doses and/or frequency of administration should be modified in response to the degree of renal impairment; a high percentage of patients with infectious mononucleosis have developed rash during therapy with amoxicillin; a low incidence of cross-allergy with other beta-lactams and cephalosporins exists

Based on clarithromycin component: Dosage adjustment required with severe renal impairment, decreased dosage or prolonged dosing interval may be appropriate; antibiotic-associated colitis has been reported with use of clarithromycin. Macrolides (including clarithromycin) have been associated with rare QT prolongation and ventricular arrhythmias, including torsade de pointes. Safety and efficacy in children <6 months of age have not been established.

Adverse Reactions

Note: Frequencies noted refer to experience with combination therapy for 14 days with all components. Refer to individual monographs for more extensive information on adverse reactions reported with each component.

3% to 10%:

Central nervous system: Headache (6%)

Gastrointestinal: Diarrhea (7%), taste perversion (5%)

<3%: Abdominal pain, candidiasis (oral), confusion, dark stools, dermatologic reactions, dizziness, dry mouth, glossitis, myalgia, nausea, rectal itching, thirst, tongue discoloration, vaginitis, vomiting

Drug Interactions

Lansoprazole: Substrate of CYP2C8/9 (minor), 2C19 (major), 3A4 (major); Inhibits CYP2C8/9 (weak), 2C19 (moderate), 2D6 (weak), 3A4 (weak); Induces CYP1A2 (weak)

Clarithromycin: Substrate of CYP3A4 (major); Inhibits CYP1A2 (weak), 3A4 (strong)

Also see individual agents.

Pharmacodynamics/Kinetics

See individual agents.

Dosage

Oral: Adults: Lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg taken together twice daily for 10 or 14 days

Patient Education

See individual agents. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Do not breast-feed.

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

May cause drowsiness or dizziness; rarely large doses may produce confusion, hallucinations, and depression; penicillins have been reported to cause apprehension, illusions, agitation, insomnia, depersonalization, and encephalopathy; macrolides have been reported to cause nightmares, confusion, anxiety, and mood lability

Mental Health: Effects on Psychiatric Treatment

Disulfiram may increase amoxicillin levels; macrolides are contraindicated with pimozide and increase carbamazepine and triazolam levels; monitor for signs of toxicity

Dosage Forms

Combination package (Prevpac®) [each administration card contains]:

Capsule (Trimox®): Amoxicillin 500 mg (4 capsules/day)

Capsule, delayed release (Prevacid®): Lansoprazole 30 mg (2 capsules/day)

Tablet (Biaxin®): Clarithromycin 500 mg (2 tablets/day)

International Brand Names

Hp-PAC® (CA); Prevpac® (CA)

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process . A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2007 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Home > Medical Reference > Complementary Medicine