Amoxicillin + Clarithromycin + Rabeprazole Sodium Kit

Amoxicillin + Clarithromycin + Rabeprazole Sodium Kit is a combination therapy used to eradicate H. pylori infection and treat peptic ulcer disease. It contains two antibiotics (Amoxicillin and Clarithromycin) and a proton pump inhibitor (Rabeprazole).

Amoxicillin inhibits bacterial cell wall synthesis, Clarithromycin blocks bacterial protein synthesis, and Rabeprazole reduces gastric acid secretion to promote ulcer healing. Together, these three medicines effectively eliminate H. pylori infection.

This kit is usually taken twice daily for 7-14 days. Common side effects include nausea, diarrhea, abdominal pain, headache, metallic taste, and skin rash.

• Eradication of H. pylori infection
• Active chronic gastric ulcer
• Duodenal ulcer
• Peptic ulcer disease

Amoxicillin: Inhibits bacterial cell wall synthesis by binding to one or more penicillin-binding proteins, inhibiting the final transpeptidation step of peptidoglycan synthesis, resulting in bacterial lysis [citation:6].

Clarithromycin: Inhibits protein synthesis by binding to the 50S ribosomal subunit, causing antibacterial activity [citation:6].

Rabeprazole: Proton pump inhibitor that binds to H+/K+-exchanging ATPase (proton pump) in gastric parietal cells, blocking acid secretion [citation:6].

Amoxicillin destroys bacteria by inhibiting cell wall formation. Clarithromycin prevents bacterial protein synthesis, stopping bacterial growth. Rabeprazole reduces stomach acid secretion, helping ulcers heal. Together, these three medicines effectively eliminate H. pylori infection and promote ulcer healing.

Adult Dosage:

• Each strip (Rabeprazole 20 mg + Clarithromycin 500 mg + Amoxicillin 1000 mg) twice daily [citation:2][citation:12]
• Treatment duration: 7-14 days (usually 7 days, 14 days for severe cases) [citation:2][citation:4]
• Dosage and duration as per physician's advice

Hepatic Dose: No dosage adjustment needed with hepatic impairment [citation:7].

Renal Dose: Do not use if CrCl <30 mL/min [citation:7].

Take this medicine on an empty stomach or as advised by your doctor. Swallow each tablet/capsule whole as per strip instructions. Complete the full course of treatment.

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.

>10%:

• Clarithromycin GI effects (13%) [citation:7]

1-10%:

• Headache (6%)
• Abdominal pain (adults 2%, children 3%)
• Abnormal taste (3-7%)
• Diarrhea (3-6%)
• Nausea (3-6%)
• Vomiting (adults 1%, children 6%)
• Dyspepsia (2%)
• Heartburn (2%)
• Rash (children 3%)
• Flatulence (3%)
• Constipation (2%)

<1%:

• QT prolongation, anxiety, dizziness, hallucinations, seizures, psychosis
• Anorexia, glossitis, pancreatitis
• AST increased, bilirubin increased, elevated LFTs, hepatic dysfunction, jaundice
• Hypoglycemia, leukopenia, neutropenia, thrombocytopenia
• Anaphylaxis, C. Diff colitis, Stevens-Johnson syndrome
• Agitation, agranulocytosis, alopecia, anemia, angioedema
• Hypokalemia, hypomagnesemia, hyponatremia
• Osteoporosis related fracture, rhabdomyolysis
• Toxic epidermal necrolysis

Serious Precautions:

• Inform your doctor if allergic to penicillin - serious anaphylactic reactions may occur
• Complete the full course - do not stop even if you feel better
• Stop and inform your doctor immediately if you develop allergic reactions (rash, swelling of face/throat/tongue, breathing difficulties)
• Caution in severe hepatic impairment, gastric malignancy
• May increase risk of GI infections due to acid suppressive effects
• Do not use during pregnancy
• Not recommended during lactation

• Hypersensitivity to any component [citation:2][citation:4]
• Severe hepatic impairment
• Gastric malignancy
• Pregnancy
• CrCl <30 mL/min [citation:7]

• Amoxicillin: May reduce efficacy of oral contraceptives; may increase effect of anticoagulants; increased risk of allergic reactions with allopurinol; increased and prolonged blood levels with probenecid; chloramphenicol, macrolides, sulfonamides and tetracyclines may interfere with bactericidal effect [citation:7]
• Clarithromycin: Serious adverse reactions with CYP3A4 substrates - colchicine toxicity; rhabdomyolysis with simvastatin, lovastatin, atorvastatin; hypotension and acute kidney injury with calcium channel blockers metabolized by CYP3A4 (verapamil, amlodipine, diltiazem, nifedipine) - especially in elderly patients ≥65 years [citation:7]
• Rabeprazole: May decrease serum concentration of ketoconazole, itraconazole and clopidogrel; increased risk of hypomagnesemia with diuretics and digoxin; may increase prothrombin time and INR of warfarin; may increase plasma concentration of saquinavir and methotrexate; decreased serum levels with sucralfate [citation:7]
• Potentially Fatal: May decrease plasma concentrations and pharmacological effects of rilpivirine and atazanavir [citation:7]

Alcohol consumption may cause Disulfiram reaction (flushing, increased heart beat, nausea). Avoid alcohol during treatment.

[CONSULT YOUR DOCTOR] This kit is unsafe during pregnancy. Animal studies have shown harmful effects on the developing baby. Use only if potential benefit justifies potential risk [citation:2][citation:7].

[CAUTION] Amoxicillin is excreted in human milk in very small amounts. Due to potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or discontinue the drug [citation:2][citation:4]. Not recommended during lactation [citation:7].

Safety and effectiveness in pediatric patients have not been established.

Elderly patients may suffer from asymptomatic renal and hepatic dysfunction. Care should be taken when administering to these patients [citation:2][citation:4].

[CAUTION] Do not use if CrCl <30 mL/min [citation:7].

[CAUTION] No dosage adjustment needed with hepatic impairment [citation:7]. However, caution is required in severe hepatic impairment.

Rabeprazole: No experience of overdose [citation:4].

Amoxicillin: In case of overdose, discontinue medication and provide symptomatic supportive treatment [citation:4].

Clarithromycin: Overdose may cause abdominal pain, vomiting, nausea and diarrhea [citation:4].

Store below 30°C, away from light and moisture. Keep out of reach of children [citation:2].