Pylotrip R

Indication
Eradication of H. pylori infection: One strip twice daily for 7-14 days. Hepatic impairment: No dosage adjustment needed with hepatic impairment

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Administration
Amoxicillin: May reduce the efficacy of OC. May increase the effect of anticoagulants. Increased risk of allergic reactions w/ allopurinol. Increased and prolonged blood levels w/ probenecid. Chloramphenicol, macrolides, sulfonamides and tetracyclines may interfere w/ the bactericidal effect of amoxicillin. Clarithromycin: Serious adverse reactions have been reported in patients taking Clarithromycin concomitantly with CYP3A4 substrates. These include colchicine toxicity with colchicine; rhabdomyolysis with simvastatin, lovastatin, and atorvastatin; and hypotension and acute kidney injury with calcium channel blockers metabolized by CYP3A4 (e.g., verapamil, amlodipine, diltiazem, nifedipine). Most reports of acute kidney injury with calcium channel blockers metabolized by CYP3A4 involved elderly patients 65 years of age or older. Rabeprazole: May decrease serum concentration of ketoconazole, itraconazole and clopidogrel. Increased risk of hypomagnesaemia w/ diuretics and digoxin. May increase prothrombin time and INR of warfarin. May increase plasma concentration of saquinavir and methotrexate. Decreased serum levels w/ sucralfate. Potentially Fatal: May decrease plasma concentrations and pharmacological effects of rilpivirine and atazanavir.

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Adult Dose
Severe hepatic impairment, gastric malignancy. May increase the risk of GI infections due to acid suppressive effects. Pregnancy. Lactation: Not recommended

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Renal Dose
Amoxicillin: Inhibits bacterial cell wall synthesis by binding to one or more penicillin binding proteins that in turn inhibit the final transpeptidation step of peptoglycan synthesis in cell wall biosynthesis. Clarithromycin: Inhibits protein synthesis by binding to 50S ribosomal subunit causing antibacterial activity. Rabeprazole: Proton pump inhibitor (PPI); binds to H+/K+-exchanging ATPase (proton pump) in gastric parietal cells, blocking acid secretion.

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Precaution
H. pylori infection, Peptic ulcer disease
Side Effect
CrCl< 30 mL/min: Do not use _ Pregnancy Category Note >10% Clarithromycin GI effects, general (13%) 1-10% Clarithromycin Headache (6%),Rash (children 3%),Abdominal pain (adults 2%, children 3%),Abnormal taste (adults 3-7%),Diarrhea (3-6%),Dyspepsia (2%),Heartburn (adults 2%),GI intolerance (oral-dose related),Nausea (adults 3-6%),Vomiting (adults 1%; children 6%),Decreased WBC, elevated BUN (4%), elevated PT (1%) Rabeprazole Headache (2-10%),Constipation (2%),Diarrhea (2-5%),Flatulence (3%),Pain (3%),Pharyngitis (3%),Abdominal pain (4%) <1% Clarithromycin QT prolongation,Anxiety, dizziness, hallucinations, manic behavior, neuromuscular blockade, psychosis, seizures,Anorexia, glossitis, pancreatitis,AST increased, bilirubin increased, elevated LFTs, hepatic dysfunction, hepatitis, increased alkaline phosphate, jaundice,Hypoglycemia, leukopenia, neutropenia, thrombocytopenia,Increased serum creatinine,Dyspnea,Anaphylaxis, C Diff colitis, Stevens-Johnson syndrome Rabeprazole Agitation,Agranulocytosis,Alopecia,Anemia,Angioedema,Chest pain,Delirium,Erythema,Hypokalemia,Hypomagnesemia,Hyponatremia,Jaundice,Leukocytosis,Leukopenia,Migraine,Osteoporosis related fracture,Rhabdomyolysis,Stevens-Johnson syndrome,Sudden death,Toxic epidermal necrolysis,Abnormal taste Frequency Not Defined Amoxicillin Headache,Rash,Diarrhea, nausea, vomiting,Anemia,AST/ALT elevation,Acute exanthematous pustulosis,Exfoliative dermatitis Seizure,Insomnia,Hemorrhagic colitis,Toxic epidermal necrolysis,Urticaria,Stevens-Johnson syndrome,Anaphylaxis,Candidiasis (mucocutaneous), pseudomembranous colitis, serum sickness Clarithromycin Torsade de pointes (rare),Allergic reactions: urticaria & skin eruptions, leukocytoclastic vasculitis, toxic epidermal necrolysis, pruritus, rash Transient CNS effects: psychosis, anxiety, behavioral changes, confusional states, depersonalization, disorientation, hallucinations, insomnia, nightmares, tinnitus, tremor, and vertigo,Hepatic failure,Stomatitis,Acute renal failure,Reversible hearing loss (hypoacusis) Potentially Fatal: Anaphylaxis, agranulocytosis. _ Interaction Hypersensitivity.