• Lansoprazole, Clarithromycin, and Amoxicillin

    (lan soe' pra zole) (kla rith' roe mye sin) (a mox i sil' in)

    WHY is this medicine prescribed?

    Lansoprazole, clarithromycin, and amoxicillin are used to treat and prevent the return of ulcers (sores in the lining of the stomach or intestine) caused by a certain type of bacteria (H. pylori). Lansoprazole is in a class of medications called proton pump inhibitors. Clarithromycin and amoxicillin are in a class of medications called antibiotics. Lansoprazole works by decreasing the amount of acid made in the stomach. Clarithromycin and amoxicillin work by stopping the growth of the bacteria that may cause ulcers. Antibiotics will not work for colds, flu, or other viral infections.

    HOW should this medicine be used?

    Lansoprazole comes as a delayed-release (long-acting) capsule, clarithromycin comes as a tablet, and amoxicillin comes as a capsule, all to be taken by mouth. These medications are usually taken before a meal twice a day. To help you take the right number of capsules and tablets at each dose, the medication is packaged in dosing cards. Each dosing card contains all of the medication needed for both daily doses. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take the medication exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
    Swallow the tablets and capsules whole; do not split, chew, or crush them.
    Take lansoprazole, clarithromycin, and amoxicillin until you finish the prescription, even if you feel better. If you stop taking antibiotics too soon your infection may not be completely treated and the bacteria may become resistant to antibiotics.
    If your condition does not improve or gets worse, call your doctor.

    Are there OTHER USES for this medicine?

    These medications may be prescribed for other uses. Ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking lansoprazole, clarithromycin, and amoxicillin,
    • tell your doctor and pharmacist if you are allergic to any antibiotics, including amoxicillin, azithromycin (Zithromax), clarithromycin (Biaxin), dirithromycin (Dynabac), erythromycin, and penicillin; lansoprazole (Prevacid); any other medications; or any of the ingredients in amoxicillin tablets, clarithromycin capsules, or lansoprazole capsules. Ask your pharmacist for a list of the ingredients.
    • tell your doctor if you are taking any of the following medications: cisapride (Propulsid) (not available in the U.S.), dihydroergotamine (D.H.E, Migranal), ergotamine (Ergomar, in Cafergot, in Migergot), pimozide (Orap), astemizole (Hismanal)(not available in the U.S.) or terfenadine (Seldane) (not available in the U.S.). Your doctor will probably tell you not to take lansoprazole, clarithromycin, and amoxicillin if you are taking one or more of these medications.
    • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: other antibiotics such as ampicillin (Principen); anticoagulants ('blood thinners') such as warfarin (Coumadin); bromocriptine (Cycloset, Parlodel); carbamazepine (Tegretol); certain cholesterol-lowering medications including lovastatin (Mevacor) and simvastatin (Zocor); cilostazol (Pletal); colchicine (Colcrys, in Col-probenecid); cyclosporine (Gengraf, Neoral, Sandimmune); certain benzodiazepines including alprazolam (Niravam, Xanax), midazolam, and triazolam (Halcion); digoxin (Lanoxin, Lanoxicaps); disopyramide (Norpace); fluconazole (Diflucan); iron supplements; ketoconazole (Nizoral); certain medications for HIV such as atazanavir Reyataz), ritonavir (Norvir, in Kaletra) and zidovudine (Retrovir, in Trizivir, in Combivir); methylprednisolone (Medrol); phenytoin (Dilantin); probenecid (Probalan, in Col-probenecid); quinidine; rifabutin (Mycobutin); sildenafil (Revatio, Viagra); tacrolimus (Prograf); theophylline (Theo-Dur, Slo-Bid, Slo-Phyllin, others) ),and valproate (Depacon). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • if you are taking sucralfate (Carafate), take it 30 minutes after you take lansoprazole, clarithromycin, and amoxicillin.
    • tell your doctor if you have or have ever had asthma, allergies, hives, hay fever, myasthenia gravis (a disease that causes muscle weakness); or kidney or liver disease.
    • tell your doctor if you are pregnant, plan to become pregnant or are breast-feeding. If you become pregnant while taking these medications, call your doctor.
    • if you are having surgery, including dental surgery, tell your doctor or dentist that you are taking lansoprazole, clarithromycin, and amoxicillin.

    What SPECIAL DIETARY instructions should I follow?

    Unless your doctor tells you otherwise, continue your normal diet.

    What should I do IF I FORGET to take a dose?

    Take the missed dose (one lansoprazole capsule, one clarithromycin tablet, and two amoxicillin capsules) as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Lansoprazole, clarithromycin, and amoxicillin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • diarrhea
    • stomach pain or cramps
    • vomiting
    • nausea
    • change in ability to taste food
    • headache
    • dizziness
    Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
    • blistering or peeling skin
    • rash
    • hives`
    • swelling of the face, eyes, lips, tongue, arms, or legs
    • difficulty breathing or swallowing
    • hoarseness
    • sore throat, fever, chills, and other signs of infection
    • watery or bloody diarrhea with or without stomach pain that occurs during your treatment or for up to 2 months afterward
    Lansoprazole, amoxicillin, and clarithromycin may cause other side effects. Call your doctor if you have any unusual problems while you are taking these medications.
    People who take proton pump inhibitors such as lansoprazole may be more likely to fracture their wrists, hips, or spine than people who do not take one of these medications. The risk is highest in people who take high doses of one of these medications or take them for 1 year or longer. The risk may also be higher in people who are 50 years of age or older. Talk to your doctor about the risk of taking lansoprazole.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the daily packets and storage box it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light and excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
    Symptoms of overdose may include:
    • stomach pain
    • nausea
    • vomiting
    • diarrhea
    • decreased urination

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor and the laboratory. Do not let anyone else take your medication. Your prescription is probably not refillable. If you still have symptoms after you finish your prescription, call your doctor.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Prevpac® (as a combination product containing Amoxicillin, Clarithromycin, Lansoprazole)

    Clarithromycin

    (kla rith' roe mye sin)

    WHY is this medicine prescribed?

    Clarithromycin is used to treat certain infections caused by bacteria, such as pneumonia (a lung infection), bronchitis (infection of the tubes leading to the lungs), and infections of the ears, sinuses, skin, and throat. It also is used to treat and prevent disseminated Mycobacterium avium complex (MAC) infection [a type of lung infection that often affects people with human immunodeficiency virus (HIV)]. It is used in combination with other medications to eliminate H. pylori, a bacteria that causes ulcers. Clarithromycin is in a class of medications called macrolide antibiotics. It works by stopping the growth of bacteria. Antibiotics will not work for colds, flu, or other viral infections.

    HOW should this medicine be used?

    Clarithromycin comes as a tablet, an extended-release (long-acting) tablet, and a suspension (liquid) to take by mouth. The regular tablet and liquid are usually taken with or without food every 12 hours (twice a day) for 7-14 days. The long-acting tablet is usually taken with food every 24 hours (once a day) for 7-14 days. Take clarithromycin at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take clarithromycin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
    Shake the liquid well before each use to mix the medication evenly.
    The tablets should be taken with a full glass of water. Swallow the long-acting tablets whole; do not split, chew, or crush them.
    Take clarithromycin until you finish the prescription, even if you feel better. If you stop taking clarithromycin too soon, your infection may not be completely treated and the bacteria may become resistant to antibiotics.

    Are there OTHER USES for this medicine?

    Clarithromycin also is used sometimes to treat other types of infections including Lyme disease (an infection that may develop after a person is bitten by a tick), crypotosporidiosis (an infection that causes diarrhea), cat scratch disease (an infection that may develop after a person is bitten or scratched by a cat), Legionnaires' disease (a type of lung infection), and pertussis (whooping cough; a serious infection that can cause severe coughing). It is also sometimes used to prevent heart infection in patients having dental or other procedures. Talk to your doctor about the possible risks of using this medication for your condition.
    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking clarithromycin,
    • tell your doctor and pharmacist if you are allergic to clarithromycin, azithromycin (Zithromax), dirithromycin (Dynabac) (not available in the U.S.), erythromycin (E.E.S., E-Mycin, Erythrocin), telithromycin (Ketek), or any other medications
    • tell your doctor if you are taking astemizole (Hismanal) (not available in the U.S.), cisapride (Propulsid), dihydroergotamine (DHE 45, Migranal), ergotamine (Ergomar, in Cafergot, in Migergot), pimozide (Orap), or terfenadine (Seldane) (not available in the U.S.). Your doctor may tell you not to take clarithromycin if you are taking one or more of these medications.
    • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin); alfentanil (Alfenta); alprazolam (Xanax); bromocriptine (Parlodel); carbamazepine (Tegretol); cholesterol-lowering medications such as lovastatin (Mevacor) and simvastatin (Zocor); cilostazol (Pletal); colchicine; cyclosporine (Neoral, Sandimmune); darifenacin (Enablex); digoxin (Lanoxin); erlotinib (Tarceva); eszopiclone (Lunesta); fluconazole (Diflucan); certain medications for HIV such as nelfinavir (Viracept), ritonavir (Norvir), and ziodvudine (AZT, Retrovir); certain medications for irregular heartbeat such as disopyramide (Norpace) and quinidine; methylprednisolone (Medrol), midazolam (Versed); omeprazole (Prilosec); phenytoin (Dilantin); ranitidine (Zantac); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); sildenafil (Viagra), tacrolimus (Prograf); theophylline (Theo-Dur); triazolam (Halcion); valproate (Depacon) and valproic acid (Depakote). Many other medications may also interact with clarithromycin, so tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • tell your doctor if you have or have ever had kidney or liver disease .
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking clarithromycin, call your doctor.

    What SPECIAL DIETARY instructions should I follow?

    Unless your doctor tells you otherwise, continue your normal diet.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Clarithromycin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • diarrhea
    • nausea
    • heartburn
    • abnormal taste
    • stomach pain
    • headache
    Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
    • rash
    • hives
    • itching
    • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
    • difficulty breathing or swallowing
    • hoarseness
    • blisters or red splotches on skin
    • fever
    • yellowing of the skin or eyes
    • unusual bruising or bleeding
    • pain in the upper right part of the stomach
    • lack of energy
    • flu-like symptoms
    • fast, pounding, or irregular heartbeat
    Clarithromycin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat and moisture (not in the bathroom). Keep away from light. Throw away any medication that is outdated or no longer needed. Do not refrigerate the oral solution. Keep it at room temperature and away from excess heat and moisture. Throw away any unused oral solution after 14 days. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
    Symptoms of overdose may include:
    • stomach pain
    • nausea
    • vomiting
    • diarrhea

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor.
    The extended-release tablet does not dissolve in the stomach after swallowing. It slowly releases the medicine as it passes through your digestive system. You may notice the tablet coating in the stool. This is normal and does not mean that you did not get the full dose of medication.
    Do not let anyone else take your medication. Your prescription is probably not refillable. If you still have symptoms of infection after you finish the clarithromycin, call your doctor.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Biaxin® Filmtab®
    • Biaxin® Granules
    • Biaxin® XL Filmtab
    • Biaxin® XL Pac
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