Clarithromycin Esomeprazole

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

Amoxycillin 1 g twice daily plus clarithromycin 500 mg twice daily, plus esomeprazole 20 mg twice daily (or lansoprazole 30 mg twice daily or pantoprazole 40 mg twice daily or daily or ranitidine bismuth citrate 400 mg twice daily or rabeprazole 20 mg twice daily)... 

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. 

Rhabdomyolysis was associated with third-degree atrioventricular block in a patient taking atorvastatin with esomeprazole and clarithromycin. 

Sipe BE, Jones RJ, Bokhart GH. Rhabdomyolysis causing AV blockade due to possible atorvastatin, esomeprazole, and clarithromycin interaction. Ann Pharmacother 2003 37 808-11. 

Clinically important, potentially hazardous interactions with chlorpheniramine, clarithromycin, efavirenz, esomeprazole, imatinib, indinavir, ketoconazole, nelfinavir, nilutamide, ritonavir... 

Clinically important, potentially hazardous interactions with alcohol, amprenavir, barbiturates, buprenorphine, chlorpheniramine, clarithromycin, CNS depressants, efavirenz, esomeprazole, eucalyptus, fluoroquinolones, imatinib, indinavir, ivermectin, macrolide antibiotics, MAO inhibitors, methadone, mianserin, nalbuphine, narcotics, nelfinavir, nilutamide, phenothiazines, ritonavir, SSRIs... 

Clinically important, potentially hazardous interactions with alprazolam, amiodarone, amphotericin B, arbutamine, bendroflumethiazide, benzthiazide, bisacodyl, bumetanide, carbimazole, chlorothiazide, chlorthalidone, cholestyramine, clarithromycin, conivaptan, cyclosporine, cyclothiazide, dan-shen, demeclocycline, devil s claw, dexmedetomidine, doxycycline, erythromycin, esomeprazole, ethacrynic acid, flunisolide, furosemide, ginseng, glycopyrrolate, glycopyrronium, hawthorn (fruit, leaf, flower extract), horsetail, hydrochlorothiazide, hydroflumethiazide, indapamide, licorice, lopinavir, mepenzolate, methyclothiazide, metolazone, minocycline, mistletoe, oxprenolol, oxytetracycline, paroxetine, phenylbutazone, polythiazide, propafenone, propantheline, quinethazone, quinidine, rabeprazole, rifampin, roxithromycin, sarsaparilla, senna, Siberian ginseng, squill, St John s wort, telithromycin, teriparatide, tetracycline, thiazide diuretics, tolvaptan, trichlormethiazide, verapamil... 

Clinically important, potentially hazardous interactions with amprenavir, aprepitant, atazanavir, carbamazepine, chlorpheniramine, cimetidine, clarithromycin, clorazepate, CNS depressants, darunavir, delavirdine, dexamethasone, efavirenz, erythromycin, esomeprazole, fluconazole, fluoxetine, fosamprenavir, grapefruit juice, griseofulvin, imatinib, indinavir, itraconazole, ivermectin, ketoconazole, lopinavir, nelfinavir, nevirapine, phenobarbital, phenytoin, primidone, rifabutin, rifampin, ritonavir, roxithromycin, saquinavir, St John s wort, telithromycin, tipranavir... 

Clarithromycin approximately doubles the serum levels of esomeprazole, lansoprazole and omeprazole, but has no effect on panto-prazole. A small rise in the serum levels of clarithromycin might also occur, which may be therapeutically useful. Some very limited evidence indicates that erythromycin raises serum omeprazole... 

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. ... 

The pharmacokinetic interactions between clarithromycin and omeprazole, esomeprazole and lansoprazole are established. However, none of the changes reported represents an adverse interaction, but they may help to explain why concurrent use is valuable in the eradication of Helicobacter pylori. Erythromycin is likely to interact similarly, whereas roxithromycin does not. Pantoprazole is not affected by macrolides. 

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. 

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