Clarithromycin + Metronidazole + Lansoprazole

Clarithromycin + Metronidazole + Lansoprazole is a combination medicine used for the treatment of H. pylori infection and peptic ulcer disease. Clarithromycin is a macrolide antibiotic that binds to the 50S ribosomal subunit of bacteria, inhibiting protein synthesis. Metronidazole is a nitroimidazole antibiotic that damages DNA of anaerobic bacteria and protozoa. Lansoprazole is a proton pump inhibitor (PPI) that blocks the final step of acid secretion by inhibiting H+/K+ ATPase in gastric parietal cells. This triple therapy combination effectively eradicates H. pylori infection and helps heal peptic ulcers.

• H. pylori infection
• Peptic ulcer disease
• Duodenal ulcer

Clarithromycin inhibits protein synthesis by binding to 50s ribosomal subunits of susceptible organisms. Lansoprazole is a substituted benzimidazole, and is also known as PPI due to its property to block the final step of acid secretion by inhibiting H+/K+ ATPase enzyme system in gastric parietal cell. Both basal and stimulated acid are inhibited. Metronidazole is converted to reduction products that interact with DNA to cause destruction of helical DNA structure and strand leading to a protein synthesis inhibition and cell death in susceptible organisms.

Clarithromycin binds to the 50S ribosomal subunit of bacteria, inhibiting protein synthesis. Lansoprazole inhibits gastric acid secretion by blocking H+/K+ ATPase. Metronidazole damages DNA of anaerobic bacteria and protozoa.

Adult Dose: One strip containing lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 500 mg twice daily for 7-14 days.

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. May be taken with or without food.

If you miss a dose of this combination, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Common Side Effects (<3% in clinical trials):

• Nausea
• Vomiting
• Diarrhea
• Dark stool
• Glossitis
• Oral moniliasis
• Stomatitis
• Tongue discoloration
• Myalgia
• Confusion
• Headache
• Dizziness
• Skin reactions
• Vaginitis
• Vaginal moniliasis

• Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients on penicillin therapy. Higher risk in individuals with history of penicillin hypersensitivity and/or sensitivity to multiple allergens.
• Contraindicated in patients with history of cholestatic jaundice/hepatic dysfunction associated with prior use of clarithromycin.
• Clarithromycin should not be given to patients with history of QT prolongation or ventricular cardiac arrhythmia, including torsades de pointes.

• Known severe hypersensitivity to any component
• History of cholestatic jaundice/hepatic dysfunction associated with prior use of clarithromycin
• History of QT prolongation or ventricular cardiac arrhythmia (including torsades de pointes)

Clarithromycin: Reduced efficacy with CYP3A inducers (phenytoin, carbamazepine); strong CYP450 inducers (efavirenz, rifampicin) accelerate metabolism; inhibition of metabolism with ritonavir; torsades de pointes with quinidine or disopyramide; increased phosphodiesterase inhibitor exposure; increased digoxin toxicity; decreased zidovudine concentration; bi-directional interactions with atazanavir, itraconazole or saquinavir; hypotension, bradyarrhythmias, lactic acidosis with verapamil; increased risk of myopathy with HMG-CoA reductase inhibitors; increased hypoglycemia risk with oral hypoglycemics and insulin; increased INR with oral anticoagulants; increased ototoxicity with aminoglycosides; increased sedation with triabenzodiazepines.

Metronidazole: Psychotic reactions with disulfiram; potentiation of oral anticoagulants; increased lithium toxicity; increased 5-fluorouracil toxicity; increased ciclosporin levels; increased busulfan levels; enhanced metabolism with phenobarbital and phenytoin.

Lansoprazole: Increased hypomagnesemia risk with diuretics and digoxin; decreased plasma concentration of erlotinib, dasatinib, lapatinib; decreased bioavailability of itraconazole and ketoconazole; increased plasma concentration of cilostazol and methotrexate; reduced bioavailability with antacids and sucralfate; decreased serum levels and pharmacological effects of rilpivirine and atazanavir.

May be taken with or without food. Avoid alcohol consumption (metronidazole may cause disulfiram-like reaction).

Safety during pregnancy has not been fully established. Use only if clearly needed and on the advice of a physician.

Safety during lactation has not been fully established. Consult your doctor before use.

Limited information is available regarding use in children. Use as advised by a physician.

Limited information is available regarding dose adjustment for elderly patients.

Use with caution in patients with kidney or liver disease. Dose adjustment may be needed in severe renal or hepatic impairment.

Overdose symptoms include severe gastrointestinal symptoms, CNS depression, and seizures. Seek immediate medical attention if overdose is suspected.

Store in a cool and dry place, protected from light & moisture. Keep out of reach of children.

Clarithromycin + Metronidazole + Lansoprazole