Lansoprazole Clarithromycin

This issue has become increasingly more important, as H. pylori strains with metronidazole resistance vary between 20 and 70% around the world [124]. In the MACH 2 study 27% of strains were indeed found to be metronidazole resistant, but in spite of this 76% of patients with metronidazole-resistant, but in spite of this 76% of patients with metronidazole resistance were cured with the OMC regimen, whereas with OAC no interference was to be expected, and it worked effectively in 94% of metronidazole-resistant strains. That OMC is still effective in 76% of metronidazole-resistant strains, an effect that decreases to 43% with MC and without omeprazole, confirms the special not yet elucidated synergistic effect of omeprazole with the two antibiotics. Similar efficacy in metronidazole-resistant strains was shown with the combination lansoprazole, clarithromycin and metronidazole [126]. 

Dual therapy - In combination with clarithromycin (omeprazole) or amoxicillin (lansoprazole). 

Dual therapy - 30 mg lansoprazole plus 1 g amoxicillin both taken 3 times/day for 14 days for patients intolerant or resistant to clarithromycin. 

Triple therapy- 30 mg lansoprazole plus 500 mg clarithromycin and 1 g amoxicillin all taken twice/day for 10 to 14 days. 

Clarithromycin/Lansoprazole/Amoxicillin- 500 mg clarithromycin, 30 mg lansoprazole, and 1 g amoxicillin every 12 hours for 10 or 14 days. 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

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)... 

H. pylori infection PO 1 g twice a day in combination with clarithromycin and lansoprazole for 14 days. 

The study population consisted of CYP2C19-genotyped patients infected with H. pylori who had completed initial treatment with omeprazole 20 mg or lansoprazole 30 mg twice daily, and clarithromycin 200 mg and amoxicillin 500 mg three times a day for 1 week. Patients in whom the infection was not eradicated after initial treatment were retreated with lansoprazole 30 mg and amoxicillin 500 mg four times a day for 2 weeks. 

In a similar study in 221 patients with peptic ulcer disease associated with H. pylori, rabeprazole has been compared with omeprazole and lansoprazole (combining them with amoxicillin plus clarithromycin for 1 week) (6). Rabeprazole was as effective as omeprazole and lansoprazole in eradicating H. pylori (84-88% each). There were no differences in reported adverse events. Common adverse effects were soft stools, glossitis, taste disturbances, and skin rashes. 

Sucralfate 1 g tds in combination with amoxicillin 500 mg tds and clarithromycin 400 mg bd for 2 weeks was as effective as a combination of lansoprazole 30 mg bd plus amoxicillin 500 mg tds and clarithromycin 400 mg bd for 2 weeks for H. pylori eradication in a randomized, multicenter trial in 150 patients (9). There was no significant difference in adverse effects between the two groups. Diarrhea, abdominal pain, glossitis, and taste disturbance were the adverse effects commonly reported. 

Ducons JA, Santolaria S, Guirao R, Ferrero M, Montoro M, GomoUon F. Impact of clarithromycin resistance on the effectiveness of a regimen for Helicobacter pylori a prospective study of 1-week lansoprazole, amoxycillin and clarithromycin in active peptic ulcer. Aliment Pharmacol Ther 1999 13(6) 775-80. 

Clinically important, potentially hazardous interactions with aluminum, aminophylline, aspirin, chlorambucil, cimetidine, clarithromycin, cyclophosphamide, cyclosporine, dicumarol, diuretics, docetaxel, estrogens, grapefruit juice, indomethacin, influenza vaccines, itraconazole, ketoconazole, lansoprazole, live vaccines, methotrexate, montelukast, omeprazole, oral contraceptives, pancuronium, phenobarbital, phenytoin, ranitidine, rifampicin, rifampin, timolol, tolbutamide, vitamin A... 

Miki I, Aoyama N, Sakai T, Shirasaka D, Wambura CM, Maekawa S, et al. Impact of clarithromycin resistance and CYP2C19 genetic polymorphism on treatment efficacy of Helicobacter pylori infection with lansoprazole- or rabeprazole-based triple therapy in Japan. Eur J Gastroenterol Hepatol 2003 15 27-33. 

Regarding proton pump inhibitors, the effect of CYP2C19 PM status is not limited to pharmacokinetic alterations. The difference in the pharmacokinetics has been shown to influence the outcome of H. Pylori eradication therapy. Furuta et al. showed that in patients with confirmed H. Pylori infection treated with omeprazole or lansoprazole plus clarithromycin and amoxicillin, CYP2C19 PMs had an eradication rate of 97.8% compared with a rate of 72.7% (P < 0.001) for CYP2C19 EMs (51). 

The presence of a defective CYP2C19 allele has been associated with improved Helicobacter pylori cure rates after dual (omeprazole and amoxicillin) or triple therapy (omeprazole, amoxicillin, and clarithromycin) with omeprazole, as weU as with lansoprazole. This difference likely reflects the higher achievable intragastric pH in the PM group. The cure rate achieved with dual therapy was 100% in PMs compared with 60% and 29% in heterozygous and homozygous EMs, respectively. In two studies, EMs had H. pylori... 

Acetaminophen, aldrin, alfentanil, amiodarone, aminopyrine, amitriptyline, amprenavir, androstenedione,antipyrine, astemizole, benzphetamine, budesonide, carbamazepine, celecoxib, chlorpromazine, chlorzoxazone, cisapride, clarithromycin, clozapine, cocaine, codeine, cortisol, cyclophosphamide,cyclosporin, dapsone, delavirdine, dextromethorphan, digitoxin, diltiazem, diazepam, erythromycin, 17j3-estradiol, ethinylestradiol, etoposide, felbamate, fentanyl, flutamide, hydroxyarginine, ifosphamide, imipramine, indinavir, ketoconazole, lansoprazole, loratidine, losartan, lovastatin, (iS)"mephen3d in, methadone, mianserin, miconazole, mifepristone, nelfinavir, nevirapine, nicardipine, nifedipine, odansetron, omeprazole, orphenadrine, proguanil, propafenone, quinidine, quinine, rapamycin, retinoic acid, ritonavir, saquinavir, selegiline, serindole, sufentanil, sulfinpyrazone, tacrolimus, tamoxifen, tamsulosin, taxol, teniposide, terfenadine, tetrahydrocannabinol, theophylline, toremifene, triazolam, trimethadone, trimethoprim, troleandomycin, verapamil, warfarin, zatosetron, Zolpidem, zonisamide... 

In combination with lansoprazole and clarithromycin or lansoprazole alone In combination with other products... 

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... 

The AUC of a single 60-mg dose of lansoprazole was raised 1.55-fold to 1.8-fold by clarithromycin 500 mg twice daily for 6 days in both extensive and poor metabolisers of CYP2C19. In another study in healthy subjects, the AUC of lansoprazole 30 mg twice daily was increased by just 25% by clarithromycin 500 mg twice daily and amoxicillin 1 g twice daily for 4 days. The AUC of the hydroxyl metabolite of clarithromycin was also increased by about 25%. ... 

See also Proton pump inhibitors + Penicillins , below, for information on case reports of glossitis, stomatitis and a black tongue with lansoprazole and antibacterial regimens including clarithromycin. 

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. 

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