Ranitidine Clarithromycin

Clarithromycin/Ranitidine bismuth citrate-500 mg clarithromycin 2 times/day (every 12 hours) or 3 times/day (every 8 hours), and 400 mg ranitidine bismuth citrate given 2 times/day (every 12 hours) for 14 days. An additional 14 days of ranitidine bismuth citrate 2 times/day is recommended for ulcer healing and symptom relief. This combination is not recommended in patients with a creatinine clearance (Ccr) less than 25 mL/min. 

Acute porphyria Do not use clarithromycin in combination with ranitidine bismuth citrate in patients with a history of acute porphyria. 

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)... 

Finally, it is universally accepted at present that Helicobacter pylori infection has a definitive ethiological role in peptic ulcer disease, and that erradication therapy is warranted in these clinical scenarios. The majority of therapeutic trials have included the application of triple therapy with proton pump inhibitors or ranitidine bismuth citrate, clarithromycin and either amoxycillin or metronidazol and is to date the treatment of choice. However, recent studies have reported antibiotic resistance which can be one reason for failure of treatment of Helicobacter pylori infection [101-103], and new treatment strategies are therefore Wellcome. Flavonoids, in addition to their gastroprotective activity previously commented, have been also shown to inhibit Helicobacter pylori growth in vitro. In this way, Beil et al. [50]... 

Proton pump inhibitor or ranitidine bismuth citrate (as Ranitidine Bismutrex) b.d. + clarithromycin 500 mg b.d. + amoxycillin Ig b.d. for 7 days. 

Data from 20 clinical studies in 5000 patients who had taken ranitidine bismuth citrate (200, 400, or 800 mg bd) have been reported (14). The incidence of adverse events was not different from that associated with placebo and was independent of dose. The most common events (>1% of patients) were upper respiratory tract infections, constipation, diarrhea, nausea, vomiting, dizziness, and headache, the last being the only event reported by over 2% of the patients. Adverse events considered by the chnical investigator to be adverse reactions occurred with a similar frequency amongst patients given ranitidine bismuth citrate (8%), ranitidine hydrochloride (6%), and placebo (6%). The incidence of adverse reactions was greater when amoxicillin (11%) or clarithromycin (20%) were co-prescribed. 

Ranitidine 300 mg bd and omeprazole 20 mg bd have been compared as components of triple therapies (combining them with either amoxicillin plus clarithromycin or amoxicillin plus metronidazole) in 320 patients with H. pylori (5). Omeprazole and ranitidine combined with two antibiotics for 1 week were equally effective in eradicating H. pylori. This result questions the role of profound acid suppression in eradication. There was no difference in the reported adverse effects, which included nausea, vomiting, diarrhea, metallic taste, skin rashes, and headache. 

In addition to being available in a variety of dosage forms as the hydrochloride salt, ranitidine is also available us a bismuth citrate salt for use with the macrolide antibiotic clarithromycin in treating patients with an active duodenal ulcer... 

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... 

Bismuth-containing preparations (e.g., those containing colloidal bismuth subcitrate) have effects similar to those of sucralfate, apparently because of their similar physical properties and coating effects. A combination of ranitidine-bismuth citrate is used with clarithromycin for eradication of H. pylori in the treatment and prevention of recurrence of duodenal ulcers. Combinations of bismuth subcitrate with other antibiotics and with H2 antihistamines also are used. Bismuth subsalicylate is used in this way as well. 

Cimetidine doubled the serum levels of erythromycin in one single-dose study, and a single case report describes reversible deafness, which was attributed to this interaction. No clinically significant interaction appears to occur when cimetidine is given with azithromycin or clarithromycin, or when ranitidine is given with clarithromycin, roxithromycin, or telithromycin. 

There is evidence that azithromycin and clarithromycin do not interact, and ranitidine does not interact with clarithromycin, roxithromycin or tel-ithromycin. No interaction would be expected between the macrolides and other non-enzyme inducing H2-receptor antagonists. 

Eradication therapy is mainly carried out as a one-week triple therapy, i.e. a proton pump inhibitor (PPI) combined with amoxicillin and clarithromycin or metronidazole. Bismuth or Ranitidine bismuth citrate triple therapies are also prescribed, as... 

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