Triple therapy (w. amoxicillin + clarithromycin) for H. pylori eradication in duodenal ulcer disease. Short-term treatment of erosive or ulcerative gastroesophageal reflux disease (GERD) or duodenal ulcers. Treatment of symptomatic GERD in patients ≥12 years of age. Maintenance of healing and reduction in relapse rates of heartburn symptoms in erosive or ulcerative GERD. Long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome).
Swallow whole. ≥18yrs: Triple therapy: rabeprazole 20mg + amoxicillin 1g + clarithromycin 500mg, all twice daily (w. AM and PM meals) for 7 days. GERD healing: 20mg once daily for 4–8 weeks; may repeat for 8 more weeks. GERD symptoms: 20mg once daily for 4 weeks; may repeat for 4 more weeks. GERD maintenance: 20mg once daily. Duodenal ulcer healing: 20mg once daily after breakfast for up to 4 weeks. Hypersecretory conditions: initially 60mg once daily; titrate; doses up to 100mg once daily or 60mg twice daily have been used.
<12yrs: not established. ≥12yrs: Short-term treatment of GERD: 20mg once daily for up to 8 weeks.
Proton pump inhibitor.
Gastric malignancy. Increased risk of osteoporosis-related fractures of the hip, wrist or spine with long-term and multiple daily dose PPI therapy. Severe hepatic impairment. Monitor magnesium levels with long-term therapy. Pregnancy (Cat.B). Nursing mothers: not recommended.
May alter absorption of gastric pH-dependent drugs (eg, ketoconazole, digoxin). Concomitant digoxin or drugs that cause may hypomagnesemia (eg, diuretics): consider monitoring magnesium levels. May give antacids concomitantly. May antagonize atazanavir (not recommended). Monitor warfarin, cyclosporine. May potentiate methotrexate (see literature).
Headache, pain, pharyngitis, flatulence, infection, constipation; rare: hypomagnesemia (w. prolonged PPI therapy), possible C. difficile associated diarrhea.
See Amoxil entry for more information on amoxicillin. See Biaxin entry for more information on clarithromycin.