Adults: The usual dose is mg twice daily although this may be increased to mg twice daily in severe infections. The usual duration of treatment is 6 to 14 . Penicillin VK Tablets mg. Phenoxymethylpenicillin mg Film-Coated Tablets. 2. Qualitative and quantitative composition. Each tablet contains mg . Tetracycline is most commonly used to treat infections of the skin (including acne), Lyme disease, and certain sexually transmitted infections. Tetracycline Cap mg de Pro Doc Limited® is no longer being manufactured for sale in Canada. The recommended adult dose of.
Severe acute infections should not be treated with phenoxymethylpenicillin. Phenoxymethylpenicillin should be given with caution to patients with a history of allergy, especially to other drugs. Phenoxymethylpenicillin should also be given cautiously to cephalosporin-sensitive patients, as there is some evidence of partial cross-allergenicity between the cephalosporins and penicillins.
Patients have had severe reactions including anaphylaxis to both drugs. If the patient experiences an allergic reaction phenoxymethylpenicillin should be discontinued and treatment with the appropriate agents initiated e. Particular caution should be exercised in prescribing phenoxymethylpenicillin to patients with an allergic diathesis or with bronchial asthma.
Oral penicillins are not indicated in patients with severe illness or with a gastrointestinal disease that causes persistent nausea, vomiting gastric dilation, cardiospasm, intestinal hypermotility or diarrhoea because absorption may be reduced.
Occasionally, patients do not absorb therapeutic amounts of orally administered penicillin. Streptococcal infections should be treated for a minimum of 10 days and post-therapy cultures should be performed to confirm the eradication of the organisms.
In patients undergoing long-term phenoxymethylpenicillin treatment the complete and differential blood count, as well as the liver and kidney function, should be monitored.
During long-term treatment attention should also be paid to the potential overgrowth of resistant organisms including Pseudomonas or Candida. If super-infection occurs, appropriate measures should be taken.
High doses should be used with caution in patients receiving potassium-containing drugs or potassium sparing-diuretics. As penicillins like phenoxymethylpenicillin are only active against proliferating microorganisms, phenoxymethylpenicillin should not be combined with bacteriostatic antibiotics such as tetracycline, erythromycin, chloramphenicol and sulphonamides.
Concomitant use of uricosuric drugs e. Phenoxymethylpenicillin may reduce the excretion of methotrexate causing an increased risk of toxicity.
During treatment with phenoxymethylpenicillin non-enzymatic urinary glucose tests may be false-positive. Combined use of phenoxymethylpenicillin and oral anticoagulants e. Coumarin — common experience in anticoagulant clinics is that INR can be altered by a course of broad-spectrum penicillins such as ampicillin, although studies have failed to demonstrate an interaction with coumarins.
Phenindione — common experience in anticoagulant clinics is that INR can be altered by a course of broad-spectrum penicillins such as ampicillin, although studies have failed to demonstrate an interaction with phenindione.
Phenoxymethylpenicillin potassium has been in extensive clinical use and suitability in human pregnancy has been well documented in clinical trials. However, as with other drugs, caution should be exercised when prescribing to pregnant patients.
Breast feeding is not contraindicated with phenoxymethylpenicillin potassium. Trace quantities of phenoxymethylpenicillin potassium can be detected in breast milk. While adverse effects are apparently rare, two potential problems exist for nursing infant:. Potential allergic reactions include urticaria, angioneurotic oedema, erythema multiforme, exfoliative dermatitis, fever, joint pain, serum sickness-like reactions, haemolytic anaemia, interstitial nephritis or anaphylactic shock which could be fatal with collapse and anaphylactoid reactions asthma, purpura, gastrointestinal symptoms.
Although these are less common, and take a milder course, in oral treatment than during parenteral penicillin treatment, it should be remembered that all degrees of hypersensitivity, including fatal anaphylaxis, have been observed with oral penicillin. Phenoxymethylpenicillin potassium is generally well tolerated. Occasionally soft stools occur and they do not require the interruption of the treatment. Sustained severe diarrhoea should prompt suspicion of pseudomembranous colitis.
As this condition may be life-threatening phenoxymethylpenicillin should be withdrawn immediately and treatment guided by bacteriologic studies with appropriate antibiotherapy i. Eosinophilia, haemolytic anaemia, leukopenia, thrombocytopenia and agranulocytosis are extremely rare. Other possible effects on the blood composition include: Central nervous system toxicity, including convulsions, has been reported, especially following high doses or in severe renal impairment.
Paraesthesia has been reported with prolonged use. As with other broad-spectrum antibiotics prolonged use may result in the overgrowth of non-susceptible organisms, e. This may present a vulvo-vaginitis. Reporting of suspected adverse reactions after authorisation of the medicinal product is important.
Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme www. A large overdose may cause nausea, vomiting and diarrhoea. Rarely major motor seizures may occur. There is no known antidote. In cases where beta —lactam antibiotics cannot be used e. Currently, macrolides are only considered to play a role in some skin and soft tissue infections, such as those caused by Corynebacterium minutissimum erythrasma , acne vulgaris, and erysipelas and in situations where penicillin treatment cannot be used.
In the event of severe acute hypersensitivity reactions, such as anaphylaxis, severe cutaneous adverse reactions SCAR e. Acute generalised exanthematous pustulosis AGEP , Stevens-Johnson Syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms DRESS , clarithromycin therapy should be discontinued immediately and appropriate treatment should be urgently initiated.
Clarithromycin should be used with caution when administered concurrently with medications that induce the cytochrome CYP3A4 enzyme see section 4. HMG-CoA reductase inhibitors statins: Concomitant use of clarithromycin with lovastatin or simvastatin is contraindicated see section 4. Caution should be exercised when prescribing clarithromycin with other statins.
Rhabdomyolysis has been reported in patients taking clarithromycin and statins. Patients should be monitored for signs and symptoms of myopathy. In situations where the concomitant use of clarithromycin with statins cannot be avoided, it is recommended to prescribe the lowest registered dose of the statin.
Use of a statin that is not dependent on CYP3A metabolism e. Careful monitoring of glucose is recommended see section 4. There is a risk of serious haemorrhage and significant elevations in International Normalized Ratio INR and prothrombin time when clarithromycin is co-administered with warfarin see section 4. INR and prothrombin times should be frequently monitored while patients are receiving clarithromycin and oral anticoagulants concurrently.
Long-term use may, as with other antibiotics, result in colonisation with increased numbers of non-susceptible bacteria and fungi. If superinfections occur, appropriate therapy should be instituted. Attention should also be paid to the possibility of cross resistance between clarithromycin and other macrolide drugs, as well as lincomycin and clindamycin. The use of the following drugs is strictly contraindicated due to the potential for severe drug interaction effects: Elevated cisapride levels have been reported in patients receiving clarithromycin and cisapride concomitantly.
This may result in QT prolongation and cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation and torsades de pointes.
Similar effects have been observed in patients taking clarithromycin and pimozide concomitantly see section 4. Macrolides have been reported to alter the metabolism of terfenadine resulting in increased levels of terfenadine which has occasionally been associated with cardiac arrhythmias, such as QT prolongation, ventricular tachycardia, ventricular fibrillation and torsades de pointes see section 4.
In one study in 14 healthy volunteers, the concomitant administration of clarithromycin and terfenadine resulted in 2- to 3-fold increase in the serum level of the acid metabolite of terfenadine and in prolongation of the QT interval which did not lead to any clinically detectable effect.
Similar effects have been observed with concomitant administration of astemizole and other macrolides. Post-marketing reports indicate that co-administration of clarithromycin with ergotamine or dihydroergotamine has been associated with acute ergot toxicity characterized by vasospasm, and ischaemia of the extremities and other tissues including the central nervous system.
Concomitant administration of clarithromycin and ergot alkaloids is contraindicated see section 4. When midazolam was coadministered with clarithromycin tablets mg twice daily , midazolam AUC was increased 7fold after oral administration of midazolam. Concomitant administration of oral midazolam and clarithromycin is contraindicated see section 4. Concomitant use of clarithromycin with lovastatin or simvastatin is contraindicated see 4.
Reports of rhabdomyolysis have been received for patients taking clarithromycin concomitantly with these statins. If treatment with clarithromycin cannot be avoided, therapy with lovastatin or simvastatin must be suspended during the course of treatment. Caution should be exercised when prescribing clarithromycin with statins. Drugs that are inducers of CYP3A e. This may result in sub-therapeutic levels of clarithromycin leading to reduced efficacy. Furthermore, it might be necessary to monitor the plasma levels of the CYP3A inducer, which could be increased owing to the inhibition of CYP3A by clarithromycin see also the relevant product information for the CYP3A4 inhibitor administered.
Concomitant administration of rifabutin and clarithromycin resulted in an increase in rifabutin, and decrease in clarithromycin serum levels together with an increased risk of uveitis. The following drugs are known or suspected to affect circulating concentrations of clarithromycin; clarithromycin dosage adjustment or consideration of alternative treatments may be required. Strong inducers of the cytochrome P metabolism system such as efavirenz, nevirapine, rifampicin, rifabutin, and rifapentine may accelerate the metabolism of clarithromycin and thus lower the plasma levels of clarithromycin, while increasing those of OH-clarithromycin, a metabolite that is also microbiologically active.
Since the microbiological activities of clarithromycin and OH-clarithromycin are different for different bacteria, the intended therapeutic effect could be impaired during concomitant administration of clarithromycin and enzyme inducers. Clarithromycin exposure was decreased by etravirine; however, concentrations of the active metabolite, OHclarithromycin, were increased.
Because OH-clarithromycin has reduced activity against Mycobacterium avium complex MAC , overall activity against this pathogen may be altered; therefore alternatives to clarithromycin should be considered for the treatment of MAC. Steady state concentrations of the active metabolite OH-clarithromycin were not significantly affected by concomitant administration of fluconazole.
No clarithromycin dose adjustment is necessary. A pharmacokinetic study demonstrated that the concomitant administration of ritonavir mg every eight hours and clarithromycin mg every 12 hours resulted in a marked inhibition of the metabolism of clarithromycin. An essentially complete inhibition of the formation of OH-clarithromycin was noted.
Because of the large therapeutic window for clarithromycin, no dosage reduction should be necessary in patients with normal renal function. However, for patients with renal impairment, the following dosage adjustments should be considered: Similar dose adjustments should be considered in patients with reduced renal function when ritonavir is used as a pharmacokinetic enhancer with other HIV protease inhibitors including atazanavir and saquinavir see section below, Bi-directional drug interactions.
Co-administration of clarithromycin, known to inhibit CYP3A, and a drug primarily metabolised by CYP3A may be associated with elevations in drug concentrations that could increase or prolong both therapeutic and adverse effects of the concomitant drug.
Clarithromycin should be used with caution in patients receiving treatment with other drugs known to be CYP3A enzyme substrates, especially if the CYP3A substrate has a narrow safety margin e. Dosage adjustments may be considered, and when possible, serum concentrations of drugs primarily metabolised by CYP3A should be monitored closely in patients concurrently receiving clarithromycin.
The following drugs or drug classes are known or suspected to be metabolised by the same CYP3A isozyme: Drugs interacting by similar mechanisms through other isozymes within the cytochrome P system include phenytoin, theophylline and valproate.
There have been post-marketed reports of torsade de points occurring with the concurrent use of clarithromycin and quinidine or disopyramide. Electrocardiograms should be monitored for QTc prolongation during co-administration of clarithromycin with these drugs. Serum levels of quinidine and disopyramide should be monitored during clarithromycin therapy. There have been post marketing reports of hypoglycemia with the concomitant administration of clarithromycin and disopyramide.
Therefore blood glucose levels should be monitored during concomitant administration of clarithromycin and disopyramide. With certain hypoglycemic drugs such as nateglinide, and repaglinide, inhibition of CYP3A enzyme by clarithromycin may be involved and could cause hypolgycemia when used concomitantly. Careful monitoring of glucose is recommended. Clarithromycin mg every 8 hours was given in combination with omeprazole 40 mg daily to healthy adult subjects.
The mean hour gastric pH value was 5. Each of these phosphodiesterase inhibitors is metabolised, at least in part, by CYP3A, and CYP3A may be inhibited by concomitantly administered clarithromycin.
Co-administration of clarithromycin with sildenafil, tadalafil or vardenafil would likely result in increased phosphodiesterase inhibitor exposure.
Reduction of sildenafil, tadalafil and vardenafil dosages should be considered when these drugs are co-administered with clarithromycin. Dose reduction may need to be considered. In this population subset, inhibition of CYP3A results in significantly higher serum concentrations of tolterodine.
A reduction in tolterodine dosage may be necessary in the presence of CYP3A inhibitors, such as clarithromycin in the CYP2D6 poor metaboliser population. When midazolam was co-administered with clarithromycin tablets mg twice daily , midazolam AUC was increased 2. If intravenous midazolam is co-administered with clarithromycin, the patient must be closely monitored to allow dose adjustment.
Drug delivery of midazolam via oromucosal route, which could bypass pre-systemic elimination of the drug, will likely result in a similar interaction to that observed after intravenous midazolam rather than oral administration.
The same precautions should also apply to other benzodiazepines that are metabolised by CYP3A, including triazolam and alprazolam. For benzodiazepines which are not dependent on CYP3A for their elimination temazepam, nitrazepam, lorazepam , a clinically important interaction with clarithromycin is unlikely. There have been post-marketing reports of drug interactions and central nervous system CNS effects e. Monitoring the patient for increased CNS pharmacological effects is suggested.
Digoxin is thought to be a substrate for the efflux transporter, P-glycoprotein Pgp. Clarithromycin is known to inhibit Pgp. When clarithromycin and digoxin are administered together, inhibition of Pgp by clarithromycin may lead to increased exposure to digoxin. Elevated digoxin serum concentrations in patients receiving clarithromycin and digoxin concomitantly have also been reported in post marketing surveillance.
Some patients have shown clinical signs consistent with digoxin toxicity, including potentially fatal arrhythmias. Serum digoxin concentrations should be carefully monitored while patients are receiving digoxin and clarithromycin simultaneously.
Simultaneous oral administration of clarithromycin tablets and zidovudine to HIV-infected adult patients may result in decreased steady-state zidovudine concentrations.
Because clarithromycin appears to interfere with the absorption of simultaneously administered oral zidovudine, this interaction can be largely avoided by staggering the doses of clarithromycin and zidovudine to allow for a 4-hour interval between each medication.
This interaction does not appear to occur in paediatric HIV-infected patients taking clarithromycin suspension with zidovudine or dideoxyinosine. This interaction is unlikely when clarithromycin is administered via intravenous infusion. There have been spontaneous or published reports of interactions of CYP3A inhibitors, including clarithromycin with drugs not thought to be metabolised by CYP3A e.
Serum level determinations are recommended for these drugs when administered concomitantly with clarithromycin. Increased serum levels have been reported. Both clarithromycin and atazanavir are substrates and inhibitors of CYP3A, and there is evidence of a bi-directional drug interaction.
Doses of clarithromycin greater than mg per day should not be co-administered with protease inhibitors. Caution is advised regarding the concomitant administration of clarithromycin and calcium channel blockers metabolized by CYP3A4 e.
Plasma concentrations of clarithromycin as well as calcium channel blockers may increase due to the interaction. Hypotension, bradyarrhythmias and lactic acidosis have been observed in patients taking clarithromycin and verapamil concomitantly. Both clarithromycin and itraconazole are substrates and inhibitors of CYP3A, leading to a bidirectional drug interaction.
Clarithromycin may increase the plasma levels of itraconazole, while itraconazole may increase the plasma levels of clarithromycin. Patients taking itraconazole and clarithromycin concomitantly should be monitored closely for signs or symptoms of increased or prolonged pharmacologic effect.
Both clarithromycin and saquinavir are substrates and inhibitors of CYP3A, and there is evidence of a bi-directional drug interaction. Observations from drug interaction studies using the soft gelatin capsule formulation may not be representative of the effects seen using the saquinavir hard gelatin capsule. When saquinavir is co-administered with ritonavir, consideration should be given to the potential effects of ritonavir on clarithromycin see section 4.
Patients taking oral contraceptives should be warned that if diarrhoea, vomiting or breakthrough bleeding occur there is a possibility of contraceptive failure. The safety of clarithromycin for use during pregnancy has not been established.
Based on variable results obtained from studies in mice, rats, rabbits and monkeys, the possibility of adverse effects on embryofoetal development cannot be excluded. Therefore, use during pregnancy is not advised without carefully weighing the benefits against risk. The safety of clarithromycin for using during breast-feeding of infants has not been established. Clarithromycin is excreted into human breast milk. There are no data on the effect of clarithromycin on the ability to drive or use machines.
The potential for dizziness, vertigo, confusion and disorientation, which may occur with the medication, should be taken into account before patients drive or use machines. The information on this sheet is based on approvals granted by the Japanese regulatory authority.
Approval details may vary by country. Medicines have adverse reactions risks as well as efficacies benefits. It is important to minimize adverse reactions and maximize efficacy. To obtain a better therapeutic response, patients should understand their medication and cooperate with the treatment. It is usually used to treat inflammation of upper respiratory tract, acute bronchitis, bronchial asthma, chronic bronchitis, bronchiectasis, pulmonary tuberculosis expectoration purpose , chronic sinusitis drainage purpose.
Common side effects are reported as below.
Alvedon, munsönderfallande tablett 250 mg 12 st (15-40 kg)
Find patient medical information for Mefenamic Acid Oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Take this medication by mouth with or without food as directed by your doctor, usually 3 or 4 times a ww-2.info dosage is based on your medical condition and. Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children younger than 6 years. Keep this product out of reach of children.