Triple therapy (w. amoxicillin + clarithromycin) for H. pylori eradication in duodenal ulcer disease. Short-term treatment and maintenance of healing of erosive esophagitis (EE), symptomatic GERD. Short-term treatment of EE due to acid-mediated GERD in infants 1month to <1year. To reduce risk of NSAID-associated gastric ulcer. Long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome).
Take 1 hour before food. Caps: swallow whole or may open caps and sprinkle pellets on 1 tablespoon applesauce and take immediately. May open caps and mix granules in 50mL of water and give via NG tube; flush tube with more water. Susp: mix contents of packet in 15mL of water, leave 2–3 minutes, then drink within 30 minutes. May give via NG or gastric tube (see literature). Triple therapy: esomeprazole 40mg once daily + amoxicillin 1g twice daily + clarithromycin 500mg twice daily; all for 10 days. EE: 20 or 40mg once daily for 4–8 weeks, may continue 4–8 more weeks. Maintenance of healing of EE: 20mg once daily. Symptomatic GERD: 20mg once daily for 4 weeks, may continue 4 more weeks. NSAID-associated ulcer risk reduction: 20mg or 40mg once daily for up to 6 months. Hypersecretory conditions: initially 40mg twice daily, adjust if needed; doses up to 240mg daily have been used. Severe hepatic impairment: max 20mg/day.
EE due to acid-mediated GERD: <1month: not established. 1month–<1yr: 3kg–5kg: 2.5mg. >5kg–7.5kg: 5mg. >7.5kg–12kg: 10mg; for all: give once daily for up to 6 weeks. Healing of EE: <1yr: not established. 1–11yrs: <20kg: 10mg; ≥20kg: 10 or 20mg; 12–17yrs: 20 or 40mg; for all: give once daily for up to 8 weeks. Symptomatic GERD: 1–11yrs: 10mg once daily for up to 8 weeks; 12–17yrs: 20mg once daily for 4 weeks.
Proton pump inhibitor.
Long term and multiple daily dose therapy: increased risk of osteoporosis-related fractures. Monitor magnesium levels with long-term therapy. Pregnancy (Cat.B). Nursing mothers: not recommended.
Concomitant atazanavir, nelfinavir: not recommended. May potentiate saquinavir; monitor and consider reducing saquinavir dose. May alter absorption of gastric pH-dependent drugs (eg, ketoconazole, iron salts, digoxin). Antagonizes clopidogrel; consider alternative anti-platelet therapy. May affect drugs metabolized by CYP2C19. Avoid concomitant with St. John's Wort, rifampin. May potentiate tacrolimus, cilostazol (consider reduced dose), methotrexate (consider temporary withdrawal of PPI). Monitor warfarin. May give antacids concomitantly. May cause false (+) results in diagnostic investigations for neuroendocrine tumors.
Headache, diarrhea, abdominal pain, nausea, flatulence, constipation, dry mouth, inj site reactions; rare: rash, allergic reactions, hypomagnesemia, possible C. difficile associated diarrhea. Children: Also, somnolence, regurgitation, tachypnea, increased ALT.
See Biaxin for more information on clarithromycin. See Amoxil for more information on amoxicillin.
Hepatic (CYP2C19, CYP3A4). 97% protein bound.
Renal (primarily), fecal.
Caps—30, 90, 1000; Susp—30 packets/box; IV soln (single-use vial)—10