Clarithromycin pills 500mg №10

Indications

Infections caused by microorganisms sensitive to Clarithromycin :

- lower respiratory tract infections (including acute and chronic bronchitis, pneumonia);

- upper respiratory tract infections (including sinusitis and pharyngitis);

- infections of the skin and soft tissues;

- duodenal ulcer for the eradication of Helicobacter pylori (in combination therapy with proton pump inhibitors).

Dosage and administration

Inside Adults: usual dose is 250 mg 2 times / day for 7 days, if necessary, the dose may be increased to 500 mg 2 times / day for a period of up to 14 days for severe infections.

Children over 12 years old: dosing regimen as for adults.

For the treatment of duodenal ulcers caused by N. pylori (for adults):

Triple therapy regimen (1-14 days): clarithromycin 500 mg 2 times / day; lansoprazole 30 mg 2 times / day; Amoxicillin 1000 mg 2 times / day.

Triple therapy regimen (7 days): clarithromycin 500 mg 2 times / day; lansoprazole 30 mg 2 times / day; Metronidazole 400 mg 2 times / day.

Triple therapy regimen (7 days): clarigromycin 500 mg 2 times / day; Omeprazole 40 mg / day; Amoxicillin 1000 mg 2 times / day or metronidazole 400 mg 2 times / day.

Triple therapy regimen (10 days): Clarithromycin 500 mg 2 times / day is prescribed with amoxicillin 100 mg 2 times / day and omeprazole 20 mg / day.

Dual therapy regimen (14 days): clarithromycin 500 mg 3 times / day, omeprazol orally 40 mg 1 time / day.

At renal impairment usually dose adjustment is not required, except for patients with severe kidney damage (CC <30 ml / min), but if necessary, the total daily dose should be reduced by half, i.e. 250 mg 1 time / day or 250 mg 2 times / day for more severe infections.

While taking ritonavir for patients with impaired renal function recommended dose adjustment according to the following scheme: for patients with CC 30-60 ml / min, the dose of clarithromycin should be reduced by 50%. For patients with QA less than 30 ml / min, the dose of clarithromycin should be reduced by 75%. When combined use of clarithromycin and ritonavir, do not use doses of clarithromycin over 1 g / day.

Adverse effects

Clarithromycin is usually well tolerated by patients.

From the digestive tract: nausea, vomiting, dyspepsia, diarrhea, abdominal pain, stomatitis, glossitis, pancreatitis, oral candidiasis, discoloration of the tongue and teeth; rarely - pseudomembranous enterocolitis. Tooth discoloration is reversible and is usually restored with a special treatment in a dental clinic. As with the admission of other antibiotics from the group of macrolides, liver dysfunction is possible, including increased liver enzymes, hepatocellular and / or cholestatic hepatitis with or without jaundice. These abnormal liver functions can be severe, but usually they are reversible. Very rarely, there have been cases of liver failure and death mainly due to severe concomitant diseases and / or concomitant drug therapy.

From the blood system: in exceptional cases, leukopenia and thrombocytopenia; increased serum creatinine level.

From the central and peripheral nervous system: paresthesia, headache, olfactory disorders, changes in taste; dizziness, agitation, insomnia, nightmares, fear, ringing in the ears, confusion, disorientation, hallucinations, psychosis, depersonalization; reversible hearing loss; convulsions.

Cardiovascular: lengthening of the QT interval, ventricular tachycardia, polymorphic ventricular tachyarrhythmia (torsades de pointes), as well as when taking other macrolides.

Musculoskeletal system: arthralgia, myalgia.

Urogenital: isolated cases of increased plasma creatinine, interstitial nephritis, renal failure.

Allergic reactions: urticaria, angioedema, anaphylactic shock, in rare cases - Stevens-Johnson syndrome, toxic elidermalky necrolysis.

Other: rarely, hypoglycemia in patients taking oral hypoglycemic agents or insulin.

Contraindications

- simultaneous appointment with derivatives of ergot;

- co-administration of the following drugs: cisapride, pimozide, terfenadine;

- children's age up to 12 years;

- pregnancy and lactation.

- hypersensitivity to macrolide antibiotics.

WITH caution: patients with impaired liver and kidney function.

Use during pregnancy and lactation

The safety of clarithromycin during pregnancy and lactation has not been studied.

The drug penetrates into breast milk. If necessary, use during lactation should stop breastfeeding.

Application for violations of the liver

WITH caution: patients with impaired liver function.

Application for violations of kidney function

At renal impairment usually dose adjustment is not required, except for patients with severe kidney damage (CC <30 ml / min), but if necessary, the total daily dose should be reduced by half, i.e. 250 mg 1 time / day or 250 mg 2 times / day for more severe infections.

Use in children

Contraindications: children up to 12 years.

Special notes

Taking clarithromycin pills in children younger than 12 years old is not recommended.

With the simultaneous appointment of clarithromycin and Warfarin, prothrombin time should be regularly monitored.

With the simultaneous appointment of clarithromycin and Digoxin should be monitored for the level of concentration of digoxin in serum.

Overdosage

Symptoms: symptoms of the gastrointestinal tract; In one of the patients taking 8 g of clarithromycin, there was a case of mental disorder, paranoid behavior, hypoglycemia, hypoxemia.

Treatment: gastric lavage, maintenance therapy. Hemodialysis or peritoneal dialysis is ineffective, as for other macrolides.

Drug interaction

With simultaneous administration of clarithromycin with cisapride, pimozide and terfenadine, elevated concentrations of these drugs are observed in the blood plasma, which can cause prolongation of the QT interval and heart rhythm disturbances, including ventricular tachycardia, ventricular fibrillation, arrhythmia and torsade de pointes; similar effects are observed while taking astemizole and other macrolides.

Clarithromycin does not interact with oral contraceptives.

As with other macrolide antibiotics, simultaneous administration of clarithromycin and other drugs that are metabolized with the participation of cytochrome P450 (warfarin, ergot alkaloids, triazolam, midazolam, disopyramide, lovastatin, rifabutin, cyclosporin, cyclosporin, cyclosporin, cyclophorin alkaloids, disopyramide, lovastatin, rifabutin, cyclosporin alkaloids, triazolam, disazyramid, lovastatin, rifabutin, cyclosporin, alkaloids blood.

With the simultaneous use of clarithromycin and HMG-KoA reductase inhibitors (lovastatin, simvastatin), the development of rhabdomyolysis is possible.

With the simultaneous appointment of clarithromycin and theophylline, serum concentration of theophylline and its toxicity increase.

The simultaneous appointment of clarithromycin and warfarin or digoxin may be accompanied by an increase in the severity of their effects.

With the simultaneous appointment of clarithromycin and Carbamazepine, the effect of carbamazepine may increase due to a decrease in the rate of excretion of carbamazepine.

With simultaneous administration of clarithromycin and zidovudine (orally) in HIV-infected adult patients, a decrease in the equilibrium concentration of zidovudine is possible; this can be largely avoidedincreasing the interval between doses of clarithromycin and zidovudine to 1-2 hours. For children, this interaction was not observed.

At the same time taking ritonavir and clarithromycin for the latter increases the values ​​of pharmacokinetic parameters: AUC, C_max, C_min. For patients with normal renal function, dose adjustment is usually not required due to the wide therapeutic dose range of clarithromycin.

With simultaneous use of clarithromycin and omeprazole, clarithromycin and lansoprazole, as well as clarithromycin and Ranitidine, an increase in the concentration of drugs in the blood plasma is possible, but usually dose adjustment is not required.

With the simultaneous use of clarithromycin and hypoglycemic agents, including insulin, in rare cases, hypoglycemia may develop.

Terms and conditions of storage

Store at a temperature not exceeding 25 ° C, out of the reach of children.