It is indicated for the eradication of H. pylori in active chronic gastric,duodenal and gastric ulcers.
Esomeprazole exerts its stomach acid-suppressing effects by preventing the final step in gastric acid production by covalently binding to sulfhydryl groups of cysteines found on the (H+, K+)-ATPase enzyme at the secretory surface of gastric parietal cells. This effect leads to inhibition of both basal and stimulated gastric acid secretion, irrespective of the stimulus. As the binding of esomeprazole to the (H+, K+)-ATPase enzyme is irreversible and new enzyme needs to be expressed in order to resume acid secretion, esomeprazole's duration of antisecretory effect that persists longer than 24 hours
Amoxicillin is similar to penicillin in its bactericidal action against susceptible bacteria during the stage of active multiplication. It acts through the inhibition of cell wall biosynthesis that leads to the death of the bacteria.
Clarithromycin acts by inhibiting microsomal protein synthesis in susceptible organisms mainly by binding to the donor site on the 50S subunit of the bacterial ribosome and preventing translocation to that site.
twice daily for 7-14 days or as per the physician?s advice
Esomeprazole is metabolized through the cytochrome P450 system, specially through the CYP3A isozymes. Studies have shown that Esomeprazole does not have clinically significant interactions with other drugs metabolized by the cytochrome P450 system, such as warfarin, antipyrine, indomethacin, ibuprofen, phenytoin, propranolol, prednisolone, diazepam, clarithromycin or terfenadine in healthy subject.
Clarithromycin use in patients who are receiving theophylline may be associated with an increase of serum theophylline concentrations.
There have been reports of interactions of clarithromycin with carbamazepine, cyclosporine, tactrolimus, hexobarbital, phenytoin, alfetanil, disopyramide, lovastatin, bromocriptine, valproate, terfenadine, cisapride, pimozide & astemizole.
It is contraindicated in patients with known hypersensitivity to any of its component.
H. pylori eradication therapy is generally well tolerated. Adverse events reported during clinical trials were not unexpected given the component substances. Common adverse reactions included diarrhoea and nausea.
Esomeprazole
The symptoms described in connection with deliberate esomeprazole overdose
(limited experience of doses in excess of 240 mg/day) are transient. Single doses of
80 mg esomeprazole were uneventful. No specific antidote is known.
Esomeprazole is extensively protein bound and is therefore not readily dialyzable.
As in any case of overdose, treatment should be symptomatic and general
supportive measures should be utilised. Clarithromycin
Reports indicate that the ingestion of large amounts of clarithromycin can be
expected to produce pronounced gastrointestinal symptoms. Severe liver toxicity,
including cholestatic jaundice may occur. One patient who had a history of bipolar
disorder ingested eight grams of clarithromycin and showed altered mental status,
paranoid behaviour, hypokalaemia and hypoxemia.
There is no known antidote. Treatment consists of prompt elimination of the
unabsorbed drug and supportive measures. As with other macrolides, clarithromycin
serum levels are not expected to be appreciably affected by haemodialysis or
peritoneal dialysis. Amoxicillin
Gastrointestinal effects such as nausea, vomiting and diarrhoea may be evident and
symptoms of water/electrolyte imbalance should be treated symptomatically. During
the administration of high doses of amoxicillin, adequate fluid intake and urinary
output must be maintained to minimise the possibility of amoxicillin crystalluria.
Amoxicillin can be removed from the circulation by haemodialysis.
Store in a cool (below 30 degree C) and dry place.
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