Esomeprazole Amoxicillin

Triple therapy (esomeprazole, lansoprazole, omeprazole, rabeprazole)- In combination with clarithromycin and amoxicillin. 

Duodenal ulcer caused by Helicobacter pyhri. PO 40 mg (esomeprazole) once a day, with amoxicillin 1000 mg and clarithromycin 500 mg twice a day for 10 days. 

Proton pump inhibitor-based three-drug regimens Omeprazole 20 mg twice daily Clarithromycin 500 mg twice or lansoprazole 30 mg twice daily daily or pantoprazole 40 mg twice daily or esomeprazole 40 mg daily or rabeprazole 20 mg daily Bismuth-based four-drug regimens Amoxicillin 1 g twice daily or metronidazole 500 mg twice daily ... 

In a study in 18 healthy subjects the AUC, maximum serum levels and half-life of esomeprazole 40 mg once daily were increased by 70%, 18% and 35%, respectively, when taken with clarithromycin 500 mg twice daily and amoxicillin 1 g twice daily for 7 days. When the study was repeated in 19 healthy subjects with esomeprazole 20 mg the AUC, maximum serum levels and half-life of esomeprazole were increased by 127%, 39% and 50%, respectively. All subjects were of the CYP2C19 extensive metaboliser phenotype. Similar increases in esomeprazole levels (e g. AUC doubled) were seen in a further 6 subjects who were of the CYP2C19 poor metaboliser phenotype. In these studies, esomeprazole did not alter elarithromyein levels. ... 

Hassan-Alin M, Andersson T, Niazi M, Liljeblad M Persson BA, Rohss K Studies on drug interactions between esomeprazole, amoxicillin and clarithromycin in healthy subjects IntJ Clin Pharmacol Ther (2006) 44,119-27. 

Esomeprazole, lansoprazole and omeprazole do not alter the pharmacokinetics of amoxicillin, and omeprazole does not alter bacampicillin bioavailability. Isolated reports describe glossitis, stomatitis and/or black tongue in a small number of patients when treated with lansoprazole and antibacterials, which included amoxicillin, clarithromycin and metronidazole. 

A study in 12 healthy subjects found no significant changes in the pharmacokinetics of amoxicillin 1 g twice daily when it was given with lansoprazole 30 mg twice daily and clarithromycin 500 mg twice daily for 4 days. Other randomised, crossover studies in a total of 36 healthy subjects also found no changes in the bioavailability or half-life of amoxicillin 1 g twice daily when it was given with clarithromycin 500 mg twice daily and either esomeprazole 20 mg twice daily or 40 mg once daily for 7 days. ... 

The pharmacokinetics of amoxicillin do not appear to be affected by concurrent use of esomeprazole, lansoprazole and omeprazole, and omeprazole was not affected by amoxicillin. 

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