Triokit

Introduction
Triokit is a combination medicine used in the treatment of peptic ulcer disease by relieving the symptoms such as heartburn, indigestion, stomach pain, and irritation. It works by killing the ulcer-causing bacteria H. pylori. Triokit is taken without food in a dose and duration as advised by the doctor. The dose you are given will depend on your condition and how you respond to the medicine. You should keep taking this medicine for as long as your doctor recommends. If you stop treatment too early your symptoms may come back and your condition may worsen. Let your healthcare team know about all other medications you are taking as some may affect, or be affected by this medicine. The most common side effects are nausea, diarrhea, stomach pain, flatulence, loss of appetite, tiredness, headache, skin rash, dryness in mouth, and metallic taste. Most of these are temporary and usually resolve with time. Contact your doctor straight away if you are at all concerned about any side effects. This medicine can also cause sleepiness and dizziness, so do not drive or do anything that requires mental focus until you know how this medicine affects you. Avoid drinking alcohol while taking this medicine as it can worsen your sleepiness. Lifestyle modifications like having cold milk and avoiding hot tea, coffee, spicy food or chocolate can help you to get better results. Before taking this medicine, you should tell your doctor if you are pregnant, planning pregnancy or breastfeeding. You should also tell your doctor if you have kidney diseases so that your doctor can prescribe a suitable dose for you.

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Uses of Triokit
Peptic ulcer disease
Side effects of Triokit
Common
Nausea
Diarrhea
Stomach pain
Flatulence
Indigestion
Tiredness
Dizziness
Headache
Skin rash
Metallic taste
Dryness in mouth
How to use Triokit
Take this medicine in the dose and duration as advised by your doctor. Check the label before use. Triokit is to be taken empty stomach.
How Triokit works
Triokit is a combination of 2 antibiotics (Tinidazole and Amoxycillin) and a proton pump inhibitor (PPI-Lansoprazole) which treat peptic ulcers caused by bacteria. Tinidazole reduces the amount of acid in the stomach and allows healing of ulcers. Amoxycillin kills bacteria and other microorganisms that cause infections by damaging their DNA. Lansoprazole works by preventing the formation of the bacterial protective covering that is essential for the survival of bacteria. Together, they treat your infection effectively.
Quick Tips
Triokit is a combination of three medicines which treats stomach/intestinal ulcers by killing the causative bacteria.
Finish the prescribed course of medicine, even if you start to feel better. Stopping it early may make the ulcer come back and harder to treat.
Stop taking Triokit and inform your doctor immediately if you develop an itchy rash, swelling of the face, throat or tongue or breathing difficulties while taking it.
Brief Description
Indication
Oral Eradication of H. pylori to reduce risk of duodenal ulcer recurrence Lansoprazole 30 mg, amoxicillin 1 g, clarithromycin 500 mg administered together PO twice daily (morning and evening) for 10 or 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. Lansoprazole: Increased risk of hypomagnesaemia w/ diuretics and digoxin. May decrease plasma concentration of erlotinib, dasatinib and lapatinib. May decrease the bioavailability of itraconazole and ketoconazole. May increase plasma concentration of cilostazol and methotrexate. Reduced bioavailability w/ antacids and sucralfate. Potentially Fatal: May decrease serum levels and pharmacological effects of rilpivirine and atazanavir.

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Adult Dose
Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients on penicillin therapy, including amoxicillin. Although anaphylaxis is more frequent following parenteral therapy, it has occurred in patients on oral penicillins. These reactions are more likely to occur in individuals with a history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens. Lactation: Not recommended

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Renal Dose
Lamsoprazole: Proton pump inhibitor; binds to H+/K+-exchanging ATPase (proton pump) in gastric parietal cells resulting in blocking acid secretion. 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.

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Mode of Action
Combination therapy (lansoprazole, amoxicillin, clarithromycin) indicated for the treatment of patients with H. pylori infection and duodenal ulcer disease (active or 1-year history of a duodenal ulcer) to eradicate H. pylori To reduce development of drug-resistant bacteria and maintain efficacy of antibacterial drugs, use only to treat or prevent infections proven or strongly suspected to be caused by susceptible bacteria

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Precaution
H. pylori infection, Peptic ulcer disease, Duodenal Ulcer
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%) Lansoprazole Fatigue (< 3%),Headache (2.5-4.7%),Abdominal pain (1.8%),Diarrhea (8%),Nausea (3.7%) <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 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) _ Interaction Contraindicated in patients with known severe hypersensitivity to any component. Clarithromycin is contraindicated in patients with a 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. A history of severe hypersensitivity reactions (e.g., anaphylaxis or Stevens-Johnson syndrome) to amoxicillin or other beta-lactam antibiotics (e.g., penicillins and cephalosporins) is a contraindication. Clarithromycin is contraindicated in patients with a known hypersensitivity to clarithromycin, erythromycin, or any of the macrolide antibiotics. Clarithromycin is contraindicated in patients with a 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. Amoxicillin/clarithromycin/lansoprazole is not recommended in patients with CrCl less than 30 mL/min. _