Archive for March, 2016

Can you take Hydrocodone and Meloxicam together

Mar 30 2016 Published by under Drug Interactions

What is Hydrocodone

Hydrocodone is a Generic name for an opioid drug which is synthesized from codeine, an opioid alkaloid that can be found in the opium poppy.

This drug is narcotic analgesic which is used orally for relieving the moderate to severe pain, but it is also commonly used in liquid form as an antitussive agent for symptomatic relief of nonproductive cough, alone or together with other cough suppressants or expectorants.

This drug works by changing the way the brain and nervous system respond to pain. As an analgesic, hydrocodone is usually combined with ibuprofen, acetaminophen or aspirin for pain treatment.

The analgesic action of hydrocodone starts in 20–30 minutes and lasts for about 4–8 hours. However, hydrocodone is only used for the treatment of patients who are expected to need painkiller for severe pain for a long time, and who cannot be treated with other medicines or treatments.

Hydrocodone is predominantly prescribed in the US. According to the the International Narcotics Control Board, 99% of the worldwide hydrocone supply in 2007 was consumed in the US.

Other Brand names on the market containing hydrocodone are: Hysingla ER, Zohydro ER, Norco, Vicodin and Robidone.

What is Hydrocodone

What is Meloxicam

Meloxicam is a Generic name for a nonsteroidal anti-inflammatory drug (NSAID) that is used to relieve the symptoms of pain and inflammation for conditions such as: osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, primary dysmenorrhea and fever.

This drug works by reducing hormones that that are responsible for causing inflammation and pain in the body. It is available in tablet form in following strengths: 7.5 mg and 15 mg. Meloxicam begins to relieve pain about 30–60 minutes after oral administration.

Other common Brand names for this drug on the market are: Movalis, Recoxa, Melox, Mobic and Tenaron.

What is Meloxicam

How does Hydrocodone and Meloxicam work in the body

Hydrocodone is an opioid agonist of opioid receptors within the CNS. This morphinans structure substance blocks pain perception in the cerebral cortex of the brain.

Hydrocodone decreases synaptic chemical transmission in the CNS, which in turn inhibits pain sensation into the higher centers of the brain. Agonist activities at the μ and kappa receptors can cause analgesia, miosis, and decreased body temperature.

Agonist activity at the μ receptor can also cause the suppression of opiate withdrawal, while antagonist activity can result in precipitation of withdrawal.

Hydrocodone acts at several locations within the CNS by involving several systems of neurotransmitters to produce analgesia, but the precise mechanism of action has not been fully understood.

Opiate agonists don’t change the threshold or responsiveness of afferent nerve endings to noxious stimuli nor the conduction of impulses along peripheral nerves.

Instead, they alter the perception of pain at the spinal cord and higher concentrations in the CNS and the person’s emotional response to pain.

Hydrocodone can produce inhibition at the chemoreceptors through μ-opioid receptors and in the medulla through μ and δ receptors which can lead to dose-related respiratory depression.

Meloxicam works by blocking the enzyme effects of cyclooxygenase (COX), which is responsible for transforming arachidonic acid into prostaglandins, mediators of inflammation.

At low therapeutic doses, meloxicam has been shown selectively to inhibit COX-2 over COX-1. In synovial fluid Meloxicam reaches concentrations range from 40% to 50%.

The free fraction of meloxicam in synovial fluid is 2.5 times greater compared to plasma concentrations. This is because of the lower albumin amount in synovial fluid compared to those in plasma. This is why meloxicam is recommended for the treatment of joint disorders.

Can patients take Hydrocodone and Meloxicam together

Since there are no significant interactions between these two drugs they can be taken together for the treatment of chronic pain. Both drugs work well together to alleviate pain but in different ways.

However, patients should always ask their pharmacist or doctor first before taking these medications together, as they can cause serious side effects if they are overdosed.

The table below shows side effects after Hydrocodone and Meloxicam administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.

Very common side effects >10% Constipation (8-11%)
Common side effects 1-10% Nausea (7-10%), Upper respiratory infection (≤8.3%), Headache (4%), Vomiting (3-5%), Somnolence (1-5%), Dry mouth (3%), Abdominal pain (1.9-4.7%), Nausea (2.4-7.2%), Pruritus (3%), Tremor (3%), Fatigue (1-4%), Back pain (1-4%), Dizziness (2-3%), Peripheral edema (1-3%), Decreased platelet aggregation (<2%), Muscle spasms (1-3%), Decreased appetite (2%), Tinnitus (2%), Insomnia (3%), Influenza (3%), Gastrointestinal hemorrhage (<2%), Indigestion (3.8-9.5%), Diarrhea (1.9-7.8%), Anemia (≤4.1%), Constipation (0.8-2.6%), Congestive heart failure (<2%), Angina (<2%), Hepatitis (<2%), Hypertension (<2%), GI perforation, GI ulcer (<2%), Myocardial infarction (<2%), Inflammatory disorder of digestive tract (<2%)
Rare side effects <1% Angioedema, Anaphylactoid reaction, Asthma, bronchospasm, Erythema multiforme, Interstitial nephritis, renal failure, Stevens-Johnson syndrome, Cerebrovascular accident, Jaundice, liver failure

Special precautions and warnings during Hydrocodone and Meloxicam administration:

  • Patients should tell their doctor and pharmacist if they are allergic to hydrocodone or meloxicam or any other medicines, or any of the ingredients that are used in the production of hydrocodone extended-release capsules or extended-release tablets.
  • Patients should tell their doctors or pharmacists what prescription and nonprescription medicines, vitamins or nutritional supplements they are taking or plan to take.
  • Patients using hydrocodone should also tell their doctors if they are taking any of the following medications: antihistamines; dronedarone (Multaq); medications for irritable bowel disease, Parkinson’s disease, ulcers, haloperidol (Haldol); azithromycin (Zithromax, Zmax); amiodarone (Cordarone, Pacerone, Nexterone); butorphanol; chlorpromazine; citalopram (Celexa); laxatives such as lactulose (Cholac, Constulose, Enulose, others); nalbuphine; or pentazocine (Talwin), levofloxacin (Levaquin). They should also tell their doctors if they are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid (Marplan), selegiline (Eldepryl, Emsam, Zelapar), phenelzine (Nardil), rasagiline (Azilect), or tranylcypromine (Parnate). Doctor may need to change the doses of medicines or monitor carefully for side effects.
  • Patients using meloxicam should tell their doctor if they are taking some of the following drugs: ACEI drugs such as benazepril, captopril, enalapril, fosinopril, lisinopril, and quinapril (Accupril); cholestyramine, diuretics, lithium and methotrexate
  • Hydrocodone shouldn’t be used if patient has blockage of stomach or intestines, or paralytic ileus.
  • Patients should tell their doctor if they have or have ever had hypotension, difficulties with urinating, seizure attacks, or any of the thyroid, liver, kidney, gall bladder or pancreas disease.
  • Patients should tell their doctor if they are breastfeeding.
  • If patients are having surgery, including dental surgery, they should tell their doctor or dentist that they are taking hydrocodone or meloxicam.
  • Hydrocodone may make patients drowsy. Patients should not drive a car or operate machinery.
  • Hydrocodone dizziness, fainting and lightheadedness, if patient get up too quickly from a lying position. This is more common when initial dose of hydrocodone is taken. To avoid this problem, patients should slowly get out of bed, resting their feet on the floor for a few minutes before standing up.
  • Hydrocodone can cause constipation. Patients should talk with their doctor about changing diet and using other medications to treat or prevent constipation.
  • tell your doctor if you have or have ever had asthma, especially if you have frequent stuffed or runny nose or nasal polyps (swelling of the lining of the nose); swelling of the hands, feet, ankles, or lower legs; or kidney or liver disease.
  • Patients using meloxicam should tell their doctor if they are pregnant, especially if they are in the last three months of pregnancy or if they plan to become pregnant, or if they are breast-feeding. If women become pregnant while taking meloxicam, she should call her doctor.

Can you take Hydrocodone and Oxycodone together
Aspirin mechanism of action

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Can you take Hydrocodone and Oxycodone together

Mar 29 2016 Published by under Drug Interactions

What is Hydrocodone

Hydrocodone is a Generic name for an opioid drug which is synthesized from codeine, an opioid alkaloid that can be found in the opium poppy.

This drug is narcotic analgesic which is used orally for relieving the moderate to severe pain, but it is also commonly used in liquid form as an antitussive agent for symptomatic relief of nonproductive cough, alone or together with other cough suppressants or expectorants.

This drug works by changing the way the brain and nervous system respond to pain. As an analgesic, hydrocodone is usually combined with ibuprofen, acetaminophen or aspirin for pain treatment.

The analgesic action of hydrocodone starts in 20–30 minutes and lasts for about 4–8 hours. However, hydrocodone is only used for the treatment of patients who are expected to need painkiller for severe pain for a long time, and who cannot be treated with other medicines or treatments.

Hydrocodone is predominantly prescribed in the US. According to the the International Narcotics Control Board, 99% of the worldwide hydrocodone supply in 2007 was consumed in the US.

Other Brand names on the market containing hydrocodone are: Hysingla ER, Zohydro ER, Norco, Vicodin and Robidone.

What is Hydrocodone

What is Oxycodone

Oxycodone is a Generic name for an opioid narcotic drug containing same name active ingredient that is used for moderate to severe pain relief. As a narcotic analgesic, oxycodone is more potent and addicting than its related compound codeine.

Oxycodone is available in the form of tablet (extended or immediate release), capsule and solution in following strengths: 5, 10, 15, 20, 30, 40 and 80 mg. The extended-release form of this drug is for around-the-clock therapy of pain.

This form of oxycodone is not for use on an as-needed basis for pain. Oxycodone dose should be adjusted individually, according to the pain severity and the patient response.

The dose can be exceeded in patients who have more severe pain or in those who become tolerant to the opioids analgesic effects.

Other products on the market containing oxycodone are: OxyCONTIN, Oxecta, Oxyfast, OxyIR, M-Oxy, Roxicodone, ETH-Oxydose, Percolone, Endocodone, Dazidox, Roxicodone Intensol, Oxaydo.

What is Oxycodone

How does Hydrocodone and Oxycodone work in the body

Hydrocodone is an opioid agonist of opioid receptors within the CNS. This morphinans structure substance blocks pain perception in the cerebral cortex of the brain.

Hydrocodone decreases synaptic chemical transmission in the CNS, which in turn inhibits pain sensation into the higher centers of the brain. Agonist activities at the μ and kappa receptors can cause analgesia, miosis, and decreased body temperature.

Agonist activity at the μ receptor can also cause the suppression of opiate withdrawal, while antagonist activity can result in precipitation of withdrawal.

Hydrocodone acts at several locations within the CNS by involving several systems of neurotransmitters to produce analgesia, but the precise mechanism of action has not been fully understood.

Opiate agonists don’t change the threshold or responsiveness of afferent nerve endings to noxious stimuli nor the conduction of impulses along peripheral nerves.

Instead, they alter the perception of pain at the spinal cord and higher concentrations in the CNS and the person’s emotional response to pain.

Hydrocodone can produce inhibition at the chemoreceptors through μ-opioid receptors and in the medulla through μ and δ receptors which can lead to dose-related respiratory depression.

Oxycodone is a weak agonist of μ – mu, κ – kappa, and δ – delta opioid receptors within the CNS. Oxycodone predominantly affects μ opioid receptors, which are binded with G-protein receptors complex and acts as modulators, both negative and positive, of synaptic transmission through G-proteins that trigger effector proteins.

Oxycodone decrease intracellular levels of cAMP by inhibiting enzyme called adenylate cyclase and release of nociceptive neurotransmitters such as GABA, dopamine, substance P, acetylcholine, and noradrenaline.

Oxycodone can also inhibit hormone release of somatostatin, insulin, vasopressin, and glucagon. As κ -receptor agonist oxycodone closes N-type voltage-operated calcium channels, while as μ and δ receptor agonist, oxycodone opens calcium-dependent potassium channels. The results are hyperpolarization and reduced neuronal excitability.

Can patients take Hydrocodone and Oxycodone together

Patients should never take hydrocodone and oxycodone together at the same time. These drugs belong to the same pharmacological class and have very similar effects in the body.

Taking them together patients may increase the risk of side effects to happen. The most serious side effect that can happen during administration of these drugs combination is slowing or stopping of breathing (respiratory depression) which could cause death.

Patients could also experience higher level of drowsiness, dizziness, nausea and sedation. The best option for patient is to stick with one medicine and adjust the dose to achieve pain relief as directed by physician.

The table below shows side effects after Hydrocodone and Oxycodone administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.

Very common side effects >10% Constipation (8-11%)
Common side effects 1-10% Nausea (7-10%), Headache (4%), Vomiting (3-5%), Somnolence (1-5%), UTI (1-5%), Dry mouth (3%), Pruritus (3%), Tremor (3%), Fatigue (1-4%), Back pain (1-4%), Dizziness (2-3%), Peripheral edema (1-3%), URI infection (1-3%) and Muscle spasms (1-3%), Decreased appetite (2%), Tinnitus (2%), Insomnia (3%), Influenza (3%)

Special precautions and warnings during Hydrocodone and Oxycodone administration:

  • Patients should tell their doctor and pharmacist if they are allergic to hydrocodone or oxycodone or any other medicines, or any of the ingredients that are used in the production of hydrocodone extended-release capsules or extended-release tablets.
  • Patients should tell their doctors or pharmacists what prescription and nonprescription medicines, vitamins or nutritional supplements they are taking or plan to take.
  • Patients should also tell their doctors if they are using any of the following medications: antihistamines; dronedarone (Multaq); medications for irritable bowel disease, Parkinson’s disease, ulcers, haloperidol (Haldol); azithromycin (Zithromax, Zmax); amiodarone (Cordarone, Pacerone, Nexterone); butorphanol;chlorpromazine; citalopram (Celexa); laxatives such as lactulose (Cholac, Constulose, Enulose, others); nalbuphine; or pentazocine (Talwin), levofloxacin (Levaquin).
  • They should also tell their doctors if they are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid (Marplan), selegiline (Eldepryl, Emsam, Zelapar), phenelzine (Nardil), rasagiline (Azilect), or tranylcypromine (Parnate). Doctor may need to change the doses of medicines or monitor carefully for side effects.
  • These drugs shouldn’t be used if patient has blockage of stomach or intestines, or paralytic ileus.
  • Patients should tell their doctor if they have or have ever had hypotension, difficulties with urinating, seizure attacks, or any of the thyroid, liver, kidney, gall bladder or pancreas disease.
  • If patients are taking the extended-release tablets, they should tell their doctor if they have or have ever had difficulties with swallowing, colon cancer, esophageal cancer, heart failure or heart rhythm problems such long QT syndrome.
  • Patients should tell their doctor if they are breastfeeding.
  • If patients are having surgery, including dental surgery, they should tell their doctor or dentist that they are taking hydrocodone or oxycodone.
  • Hydrocodone and Oxycodone may make patients drowsy. Patients should not drive a car or operate machinery.
  • Hydrocodone and Oxycodone may cause dizziness, fainting and lightheadedness, if patient get up too quickly from a lying position. This is more common when initial dose of hydrocodone is taken. To avoid this problem, patients should slowly get out of bed, resting their feet on the floor for a few minutes before standing up.
  • Hydrocodone and Oxycodone can cause constipation. Patients should talk with their doctor about changing diet and using other medications to treat or prevent constipation.
  1. What are the most common side effects of aspirin?
  2. Can you take Hydrocodone and Naproxen together?
  3. Can you take Hydrocodone and Ibuprofen together?

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Aspirin

Mar 29 2016 Published by under Medicines

What is Aspirin

  • Aspirin is a prototypical analgesic, fibrinolytic and anti-inflammatory drug which is used for the treatment of fever, inflammation and mild to moderate pain.

Aspirin generic and brands name

  • The drug is available under generic name Acetylsalicylic acid (ASA) and brand name
  • Active component of aspirin i.e. salicylic acid was initially isolated by Edward Stone from the bark of willow tree in 1763.
  • Aspirin was first synthesised by Felix Hoffmann at Bayer in
  • Aspirin is manufactured and marketed by pharmaceutical company Bayer Health Care.
  • Aspirin is also manufactured by Merck Pharmaceuticals under brand name Acetophen.
Aspirin: Structure and chemical information.

                                                                          Aspirin: Structure and chemical information.

What is the source of the drug (natural or synthetic)

  • Aspirin is a synthetic (man-made) pharmaceutical non-steroidal anti-inflammatory

What is the use of aspirin

  • Aspirin plays a key role in the treatment of inflammatory diseases such as rheumatoid arthritis (a progressive autoimmune disease primarily causes inflammation in joints) and osteoarthritis (a disease of joint caused by breakdown of joint cartilage).
  • Usually, Aspirin is used in the treatment of Fever and mild to moderate Pain due to headache, arthritis, menstrual periods and muscle aches.
  • It is also used in the treatment of Systemic lupus erythematosus (autoimmune disease of connective tissues) and other rheumatologic conditions.
  • Aspirin is also prescribed for patients of heart attack to reduce the risk of heart attack and deaths caused by heart attack.
  • Aspirin is usually recommended for the patients of ischemic stroke (blockage of blood flow to brain due to blood clot) or mini stroke (blockage of blood flow to brain for short time).
  • This drug is also used to treat the angina (sensation of chest pain occur when heart muscle does not get enough oxygen).
  • However, Aspirin does not used to prevent the hemorrhagic strokes (leakage of blood around the brain due to the rupture of blood vessel).

Pharmacophore structure: Information about the chemical structure of the drug

Aspirin chemically belongs to the class of organic compounds which are known as phenol esters characterized by benzene ring substituted by a hydroxyl group and an ester group. The detailed chemical classification of Aspirin is described below:

Kingdom Organic compounds
Super Class Benzenoids
Class Benzene and substituted derivatives
Sub Class Phenol esters
Direct Parent Phenol esters

Chemical information of the drug

  • Aspirin is available as acetylsalicylic acid and acts by inhibiting the synthesis and release of prostaglandins.
  • It is a synthetic pharmaceutical Aromatic homomonocyclic compounds with a molecular formula C9H8O4.
  • The molecular weight of the Aspirin is 157 g/mol.
  • Chemically, Aspirin is known as 2-(acetyloxy) benzoic acid.
  • Aspirin is odourless, white, granular or needle-like crystalline powder and has water solubility of 46 mg/mL.
  • Aspirin is freely soluble in alcohol, sparingly soluble in absolute ether, soluble in chloroform and ether and slightly soluble in water. Aspirin is highly lipid soluble.
  • The melting point of Aspirin is 135°C while the boiling point of Aspirin is 140°

Aspirin available strength

  • Aspirin is available in the form of regular strength tablets and caplets, extra strength tablet, delayed-release tablet and quick chewable tablets for oral administration with food or without food.
    • ASPIRIN regular strength tablets are available in strength of 325 mg.
      • It is round in shape and white in color crossed with BAYER on both side.
      • Aspirin regular strength tablets contain acetylsalicylic as active component and powdered cellulose, corn starch, hypromellose and triacetin as inactive constituent.
    • ASPIRIN regular strength caplets are available in strength of 325 mg.
      • It is capsule shaped, white in color scored on one side and crossed with BAYER on other side.
      • Aspirin regular strength caplets contain acetylsalicylic as active component and powdered cellulose, corn starch, hypromellose and triacetin as inactive constituent.
    • ASPIRIN extra strength tablets are available in strength of 500 mg.
      • It is round in shape, white in color crossed with BAYER on one side in red ink.
      • Aspirin extra strength tablets contain acetylsalicylic as active component and powdered cellulose, corn starch, hypromellose carnauba wax, shellac, propylene glycol, titanium dioxide, triacetin, D&C Red No. 7, FD&C Blue No. 2 and FD&C Red No. 40 as inactive constituent.
    • ASPIRIN delayed release tablets are available in strength of 81 mg.
      • It is pale blue in color, enteric coated and marked with 81 on one side.
      • Aspirin delayed release tablets contain acetylsalicylic as active component and powdered cellulose, corn starch, hypromellose carnauba wax, croscarmellose sodium, lactose monohydrate, methacrylic acid polymer, microcrystalline cellulose, polysorbate 80, sodium lauryl sulphate, starch, shellac, propylene glycol, titanium dioxide, triacetin, FD&C Blue No. 1 and FD&C Blue No. 2 as inactive constituent.
    • ASPIRIN quick chew tablets are available in strength of 81 mg.
      • It is peach colored with pleasant orange taste and crossed with BAYER on one side.
      • Aspirin quick chew tablets contain acetylsalicylic as active component and dextrose, corn starch, sodium cyclamate, orange juice flavour and FD&C Yellow No. 6 as inactive constituent.

Aspirin mechanism of action

How the medicine works (mode of action)?

  • Aspirin is a non-steroidal anti-inflammatory drug that inhibits cyclooxygenase (COX) enzyme therefore known as COX inhibitor agent.
  • Cyclioxygenase enzyme (namely COX1 and COX 2) known as prostaglandin-endoperoxide synthase (PTGS), that coverts arachidonic acid in to prostanoids, including thromboxane (mediators of vasoconstriction) and prostaglandins (mediators of inflammatory and anaphylactic reactions).
  • The action of both acetyl and salicylate component of the acetylsalicylic acid (ASA or Aspirin) and its active metabolite salicylate are liable for the anti-inflammatory and analgesic properties through inhibition of cyclooxygenases.
  • ASA inhibits the COX (both COX-1 and COX-2) activity by binding to it irreversibly.
  • Inhibition of COX results in reduced formation of precursors of prostaglandins and thromboxane from arachidonic acid.
  • Anti-rheumatic or non-steroidal anti-inflammatory effect is caused by the analgesic and anti-inflammatory mechanisms of ASA not by the pituitary-adrenal stimulation.
  • Antipyretic effect of ASA is resulted from the intervention in production of Prostaglandin E1 which is a potent pyretic agent.
  • ASA also inhibit the aggregation of platelets. This inhibitory effect of ASA is resulted from the intervention in production of Thromboxane A2 which is accountable for the platelets aggregation.
  • Acetylsalicylic acid acts as acetyl donor to COX. This acetylation of COX is irreversible and causes the inactivation of the COX. This inactivation results in the prevention of formation of the Thromboxane A2.
Aspirin: Mode of action.

                                                         Aspirin: Mode of action.

Recommended doses of Aspirin

The prescribed dose of Aspirin varies depending upon the age and diseased state of the patient.

  • Adult dose:
    • Angina Pectoris and Angina Pectoris Prophylaxis: 75 mg to 325 mg in a day orally in single dose.
    • Ankylosing Spondylitis: 3 gm in a day in 3 to 4 divided doses orally.
    • Fever: 325 mg to 650 mg at interval of 4 hours (maximum 4 gm in a day) orally or by rectal route.
    • Ischemic Stroke: 50 mg to 325 mg in a day orally in single dose.
    • Myocardial Infarction: 160-162.5 mg in a day orally in single dose.
    • Osteoarthritis: 3 gm in a day in 3 to 4 divided doses orally.
    • Pain: 325 mg to 650 mg at interval of 4 hours (maximum 4 gm in a day) orally or by rectal route.
    • Prophylaxis of Ischemic Stroke: 75 mg to 325 mg in a day orally in single dose.
    • Prophylaxis of Myocardial Infarction: 75 mg to 325 mg in a day orally in single dose.
    • Prophylaxis of Thromboembolic Stroke: 75 mg to 325 mg in a day orally in single dose.
    • Prophylaxis of Revascularization Procedures
    • Coronary Artery Bypass Graft: After procedure: 325 mg after 6 hour from beginning the procedure. 325 mg once by oral route daily for a year or until your doctor does not say to stop.
    • Percutaneous Transluminal Coronary Angiography
      • Before procedure: 325 mg 2 hours prior to procedure.
      • After procedure: 160 to 325 mg once by oral route daily until your doctor does not say to stop.
    • Carotid Endarterectomy
      • Before procedure: 80 mg once a day or may be up to 650 mg twice in a day orally prior to beginning surgery.
      • After procedure: 80 mg once a day or may be up to 650 mg twice in a day orally until your doctor does not say to stop.
    • Rheumatoid Arthritis: 3 gm in a day in 3 to 4 divided doses orally.
    • Rheumatic Fever: 80 mg/kg in a day in 4 divided doses orally (maximum 6.5 gm in a day) for initial 7-14 days and then decrease to 60-70 mg/kg in a day.
    • Systemic Lupus Erythematosus: 3 gm in a day in 3 to 4 divided doses orally.
  • Paediatric dose:
    • Fever: 2 to 11 years: 10 to 15 mg/kg at interval of 4-6 hours orally.
      • >11 years: 325 to 650 mg/kg at interval of 4 hours orally.
    • Juvenile Rheumatoid Arthritis
      • 2 to 11 years (or ≤ 25 kg)
      • Initial dose: 60-90 mg/kg in a day in divided doses orally.
      • Maintenance dose: 80-100 mg/kg in a day in divided doses orally.
      • >11 years (or ≥ 25 kg)
      • Initial dose: 2.4-3.6 gm in a day in divided doses orally.
      • Maintenance dose: 3.6-5.4 gm in a day in divided doses orally.
    • Kawasaki Disease
      • Initial dose: 90-130 mg/kg in a day in divided doses orally at interval of 4 to 6 hours for 14 days.
      • Maintenance dose: 3-5 mg/kg in a day orally.
    • Pain
      • 2 to 11 years: 10 to 15 mg/kg at interval of 4-6 hours orally.
      • >11 years: 325 to 650 mg/kg at interval of 4 hours orally.
    • Rheumatic Fever
      • 90-130 mg/kg in a day in divided doses orally at interval of 4 to 6 hours.
      • In case of hepatic and renal impairment, the dosing recommendations are as follows:
    • Dose in hepatic impairment: The use of Aspirin is case of hepatic impairment is not recommended.
    • Dose in renal impairment: In case of chronic renal impairment, caution should be exercised. Not recommended for severe renal impairment.

When should I discontinue, withhold or modify the dose of Aspirin

  • The usual dosing of the drug may vary depending upon the efficiency and side effects of the drug in a particular individual.
  • Do not use the medicine if you are hypersensitive or allergic to any of the ingredients of Aspirin or other analgesic, anti-rheumatic, anti-inflammatory and non-steroidal anti-inflammatory drugs.
  • Aspirin is withheld in case of acute gastrointestinal ulcers, severe congestive heart failure, hemorrhagic diathesis and asthma.
  • Aspirin is not used for those patients who have coagulation abnormalities such as deficiency of vitamin K and haemophilia.
  • Aspirin is also not used in case of deficiency of gluose-6-phosphate dehydrogenase.
  • Aspirin is withdrawn in case of hepatic impairment and severe cases of renal impairment.
  • However, aspirin is used with carefulness in case of mild to moderate renal impairments.
  • Aspirin is contraindicated with the use of other non-steroidal anti-inflammatory drugs such as naproxen (Aleve and Naprosyn), valporic acid (Depakene, Depakote) and phenytoin (Dilantin).
  • Use of diclofenac, flurbiprofen, ketoprofen, naproxen and tolmetin with Aspirin is also contraindicated because these drugs can increase the clearance of total drug and decrease the plasma concentration by protein binding displacement.
  • Some drugs or chemicals such as benzoic acid, salicylamide, cimetidine and zomepirac may alter or inhibit the metabolism of Aspirin.
  • Use of Aspirin with ibuprofen is contraindicated because it may interfere with anti-platelet effect of ASA. Ibuprofen should be taken at least 11 hour after and/or 1 hour previous to the ASA dose.

What are the pharmacokinetic properties of the drug

  • Pharmacokinetic studies suggested that after oral administration, Aspirin is absorbed rapidly and completely and has a bio-availability of approximately 80-100%.
  • Following absorption the majority (90-99.5%) of the drug is bound to plasma proteins primarily with
  • It has been observed that following a 1200 mg dose of maximum (or peak) plasma concentration (17-40mg/l) is achieved in 20-30 minutes in the fasted state.
  • The drug is largely metabolized in liver primarily by enzyme
  • Acetylsalicylic acid (ASA) largely metabolised into salicyluric acid, ether or gentisic acid and ester or acyl glucuronide.
  • The average median half-life of Aspirin is dose dependent. 3.1-3.2 hours for 300-650 mg dose, 5 hours for 1 gm dose and about 9 hours for 2 gm dose.
  • Metabolites of Aspirin i.e. salicyluric acid, gentisic acid and acyl glucuronide are mainly excreted in the urine (80-100%). Little amount of metabolites are also excreted through feces and sweat.
  • The average steady state volume of distribution of the Aspirin is approximately 5L.

Which pregnancy category (A; B; C; D; X) has been assigned to Aspirin

  • The Aspirin is classified by US FDA pregnancy category: N (not classified by FDA).
  • Although, aspirin is considered in pregnancy category D.
  • There are positive evidences of human fetal risk based on adverse reaction data from investigational and marketing experience or studies in human.
  • Aspirin in pregnant women is contraindicated and recommended only when benefit justifies the risk.
  • Aspirin may cause increased maternal bleeding during delivery and also affect the cardiovascular system of the foetus.
  • Studies support that the aspirin excrete into animal milk as well as in human milk in little quantity. Therefore, breast-feeding is not recommended.
  • Despite these facts caution should be exercised when taking Aspirin.

How to take aspirin safely

  • Aspirin is available in extended-release tablets and chewable form for oral administration.
  • Aspirin tablet is taken by mouth with or without food but in case of gastric upset, it must be taken with food.
  • Aspirin extended-release tablets do not chew, split or crush. Whole tablet should be swallowed.
  • Chewable tablet should be chewed before swallowing.
  • Aspirin tablets must be taken with a glass of water.
  • Aspirin tablets should be taken 2 or more times in a day at the intervals of 4 to 6 hours.
  • It is also recommended to take drug at almost the same time every day.
  • Follow the instructions carefully as directed on prescription leaflet and take Aspirin exactly as directed.
  • Do not change the dose of the drug as prescribed by your doctor. Since, the dosage is based on patient medical condition, treatment responses and usage with other drugs.

How to store the drug

  • Aspirin is stored at 25°C (77°F) and excursion permitted to 15-30°C (59-86°F).
  • Store the medicine away from light and moisture.
  • Medicine should not be stored in the bathroom.
  • The drug should be kept away from children and pets.

How to properly dispose of expired aspirin

  • Throw away unused and opened, outdated or no longer used container.
  • Also dispose the old medicine after the expiration date.
  • Aspirin should not be dispose in the household garbage, sink or in wastewater.
  • Consult your pharmacist or local waste disposal company for proper disposal.

Does Aspirin has approval from government / FDA /or any other related agencies

  • Aspirin receive its official approval from U.S. Food and Drug Administration (FDA) in June, 1965.
  • Aspirin was approved to treat medical complications such as Fever, Pain, Rheumatic Fever, Myocardial Infarction and Ischemic Strokes.

Other uses of the drug                                                           

  • Aspirin may also be used to treat the rheumatic fever (an inflammatory disease that may cause swelling of the heart valves) and Kawasaki disease (a rare autoimmune disease in children).
  • Aspirin may also be used in patients with artificial heart valves to lower the possibility of blood clot.
  • Aspirin may also be used for other uses not listed here. It is advisable to ask your doctor or pharmacist for more information.

What special dietary precautions should I follow

  • Consult your doctor regarding the use of grapefruit products with your doctor or pharmacist.
  • Alcohol consumption can also enhance some side effects of the drug.

What special precautions should I follow/ what should I avoid while using Aspirin

  • Before taking Aspirin, tell your doctor about your medical history preferentially if you have any kind of bleeding problems such as haemophilia, liver disease or kidney disease.
  • Take advice to your medical health provider if you have ulcers, anaemia, nasal polypus (swelling of nasal lining inside the nasal passage) and asthma.
  • Consult with your doctor and pharmacist if you are taking any prescription and non-prescription medications or herbal products.
  • Aspirin extended-release tablets should not be used in fever or during pain.
  • Alcoholic and alcoholic beverages should be avoided because alcohol increases the level of acetylsalicylic acid about to 50-100% in serum.
  • Avoid skipping the dose and do not suddenly stop the medication of Aspirin.
  • Stopping the Aspirin medication may enhance the possibility of-
  • Blood clots
  • Heart attacks
  • Strokes and other cardiovascular problems
  • Consult your doctor in case of any query.

Aspirin side effects

In addition to the associated benefits, Aspirin also is accompanied with the side effects some of which are common whereas some are more serious. It is always recommended to consult a doctor if you encounter any of the side effects.

Common side effects caused by Aspirin requiring medical attention are as follows:

  • Burning in heart
  • Nausea
  • Stomach pain
  • Vomiting

Aspirin may also cause some serious side effects which require immediate medical attention. These include:

  • Blood in vomiting
  • Bright red blood in stools
  • Cold, clammy skin
  • Difficulty in breathing
  • Fast heartbeat
  • Hearing loss
  • Hives
  • Increased and fast breathing
  • Rashes
  • Ringing in the ears
  • Swelling of the eyes, face, lips, tongue, or throat
  • Wheezing

Besides these, Aspirin may also be associated with some other side effects. These include:

  • Cardiovascular effects: Hypotension, ventricular ectopy, conduction abnormalities and variant angina.
  • Dermatologic effects: Papuloerythroderma, wrinkling in palms and stevens-johnson syndrome.
  • Endocrinal effects: Hyperglycaemia and hypoglycaemia in childrens.
  • Gastrointestinal effects: Peptic ulcers, esophageal ulceration, hemorrhage, epigastric distress, abdominal pain, gastric mucosal lesions, nausea and vomiting.
  • Haematological effects: Megaloblastic anaemia, aplastic anemia, thrombocyturia, thrombocytopenia, hypoprothrombinemia, pancytopenia, eosinophilia and increased blood fibrinolytic activity.
  • Hepatic effect: Cholestatic hepatitis and hepatotoxicity.
  • Hypersensitivity: Anaphylaxis, rhinitis, urticaria, conjunctivitis, bronchospasm and angioedema.
  • Musculoskeletal effects: Rhabdomyolysis.
  • Nervous system effects: Confusion, agitation, dizziness, confusion, coma, cerebral edema, cranial hemorrhage, headache, seizures and sometimes hearing loss may occur.
  • Ocular effects: Localized periorbital edema.
  • Renal effects: Interstitial nephritis, papillary necrosis, renal failure, hematuria, proteinuria, elevation in blood urea nitrogen and creatinine and reduction in glomerular filteration rate particularly in patients with cirrhosis or advanced heart failure.
  • Respiratory effects: Pulmonary edema, hyperpnea and tachypnea.

Aspirin overdose

What should I do in case of overdose? If you overdose the drug contact with your doctor or pharmacist for symptomatic and supportive measures. Symptoms of Aspirin overdose may include:

  • Cardiovascular failure
  • Cerebral edema
  • Coma
  • Decreased urination
  • Dizziness
  • Double vision
  • Haemorrhage
  • Hypotension
  • Mental confusion
  • Nausea
  • Renal failure
  • Respiratory alkalosis or failure
  • Seizures
  • Sweating
  • Vomiting

What should I do in case of missed a dose

  • Take a missed dose as soon as possible.
  • To make up the missed dose, do not take extra medicine.
  • Avoid taking the missed dose if it is about time for your next dose.

Aspirin drug interactions

Does Aspirin have any interaction with other drugs? Aspirin may interact with one of the following drugs. Care should be taken when you are taking these medications together.

  • Angiogtensin converting enzyme (ACE) inhibitors such as captopril (Capoten), benazepril (Lotensin), perindopril, (Aceon), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Zestril and Prinivil), moexipril (Univasc), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik). Parallel administration of Aspirin is able to minimize the hypotensive and hyponatremic effect of ACE inhibitors.
  • Anticonvulsant drugs such as valpronate or valproic acid (Depakene and Depakote). Concomitant use of Aspirin may cause increase serum level of valpronate.
  • Anti-inflammatory drugs such as ibuprofen (Advil, Motrin, Nuprin) and naproxen (Aleve, Naprosyn). Ibuprofen hinder with fibrinolytic effect of Aspirin.
  • Anti-inflammatory steroidal hormones such as glucocorticoids which included prednisone, cortisol and betamethasone. Corticosteroides decreases the level of salicylate in the blood through increased salicylate elimination.
  • Beta blockers propranolol (Inderal), metoprolol (Lopressor and Toprol XL),nadolol (Corgard), labetalol (Normodyne) and atenolol (Tenormin). Simultaneous administration of aspirin with beta blocker may weaken the hypotensive effect of beta blockers which may result in salt and fluid retention and decline in blood flow.
  • Diuretic drugs or water pills such as thiazides (Esidrix and Zaroxolyn), furosemide (Lasix) and bumetanide (Bumex). Use of Aspirin in the company of diuretic drugs decreases the glomerular filtration by means of reduction in prostaglandin synthesis which results in decline sodium excretion.
  • Drugs that inhibits the selective serotonin re-uptake (SSRIs) such as citalopram (Celexa and Cipramil), paroxetine (Paxil) and fluoxetine (Prozac and Sarafem). Synergistic effect of SSRIs and Aspirin increased the bleeding in upper gastrointestinal tract.
  • Drugs that used as anticoagulant or blood thinners such as heparin and warfarin (Coumadin and Jantoven). Aspirin enhance the anti-coagulant activity of heparin and displace warfarin from binding sites of proteins which increases the possibility of bleeding.
  • Inhibitors of carbonic anhydrase enzyme such as acetazolamide (Diamox). Aspirin may increase the serum concentration of acetazolamide.
  • Oral hypoglycaemic drugs for example insulin (Humulin and Novolin) and sulfonylurea agents such as chlorpropamide (Diabinese). Aspirin enhance the effect of oral hypoglycaemic drugs which possibly lead to hypoglycaemia.
  • Other non-steroidal anti-inflammatory drugs (NSAIDs) such as phenytoin (Dilantin), naproxen (Aleve and Naprosyn). Use of Aspirin with these drugs may decrease renal function and increases bleeding.
  • Uricosuric agents such as methotrexate(Trexall), Sulfinpyrazone (Anturane) and probenecid. Aspirin antagonise the action of uricosuric acid.

This list of drugs interacting with Aspirin is not complete and other drugs may also interact with it. Always consult your doctor about the medications you use.

Does Aspirin have any interaction with diseases

It has been observed that following medical conditions (disease) may also interact with Aspirin:

  • Coagulation: Aspirin is usually not recommended in patients suffering from bleeding or hemorrhagic disorders including Von Willebrand’s disease, Haemophilia, or Telangiectasia. The drug inhibits platelet aggregation, prolongs bleeding time and hence interferes with coagulation. Administration of Aspirin should be done with extreme caution in patients with vitamin K deficiency, severe hepatic impairment, thrombocytopenia, thrombotic thrombocytopenic purpura, hypoprothrombinemia, or anticoagulant use.
  • Anemia: Aspirin usually causes asymptomatic Gastrointestinal (GI) blood loss via its local effect on the GI mucosal membrane which may lead to iron deficiency anemia. Aspirin therapy for an extended period should be done cautiously in patients who are more liable to anemia or suffering from anemia. Periodic monitoring of hematocrit is recommended in such cases.
  • Renal Dysfunction: Severe renal impairment demands careful administration of Salicylate drugs including Aspirin and its metabolites as these are eliminated almost entirely by the kidney. Dosage adjustment is required to avoid drug accumulation. Prolonged use may cause renal toxicities (including elevations in serum creatinine, renal papillary necrosis, and acute tubular necrosis) and sometimes renal failure. Aspirin may cause reversible and occasionally a marked decrease in renal blood flow and glomerular filtration rate in patients of renal dysfunction.
  • Asthma: Asthamatic patients may develop Aspirin-sensitive asthma which is characterized by pansinusitis, eosinophilia, nasal polyposis, and precipitation of asthma and rhinitis attacks after administration of Aspirin. These patients are more prone to severe bronchospasm and fatal anaphylactoid reactions. Cross reactivity between Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) limits therapy with any NSAID in asthmatic patients with a history of aspirin or other NSAID sensitivity, and careful administration in all patients with preexisting asthma. Aspirin desensitization is also attempted in some cases.
  • Dialysis: Salicylates (including Aspirin) and their metabolites can be removed from the body by hemodialysis and also peritoneal dialysis. Dosage adjustment is required in case a patient undergoes dialysis.
  • Hepatotoxicity: Aspirin (a salicylate) use may result in acute, reversible hepatotoxicity characterized by elevated levels of alkaline phosphatase, serum transaminases, sometimes bilirubin and also hepatic injury which may occasionally lead to encephalopathy or death. Salicylate therapy including Aspirin should be administered cautiously in patients suffering with rheumatic fever, active systemic lupus erythematosus, juvenile arthritis, or preexisting hepatic impairment. Dosage adjustments is required in case of development of liver function abnormalities and elevated levels of serum salicylate concentration (exceeding 25 mg/dL).
  • Glucose-6-Phosphate Dehydrogenase (G-6-PD) Deficiency: Aspirin (Salicylate) may result in the development of or intensify hemolysis in patients having deficiency of enzymes namely, pyruvate kinase or glucose-6-phosphate dehydrogenase (G-6-PD). It is therefore recommended to administer Aspirin in such patients with high caution.
  • Reye’s Syndrome (sudden brain damage and liver function problems): The use of salicylate drugs, including Aspirin lead to an increased risk of Reye’s syndrome in children with influenza-like illnesses or varicella infections. It is therefore not advisable to administer salicylates in children who are suffering from or are prone to varicella or influenza infections and also during presumed outbreaks of influenza.
  • Gastrointestinal (GI) Toxicity: Aspirin is most often associated with gastrointestinal bleeding and mucosal damage. Therapy with Aspirin may result in iron deficiency anemia and reactivation of latent ulcers, development of peptic ulcers, and ulcer perforation. However, patients who have active peptic ulcers or associated with recent GI bleeding predominantly show increased cases of major upper GI bleeding. Aspirin or other salicylates should be administered cautiously in patients (more particular in elder patients) with a history of GI disease or alcoholism and necessitate close monitoring for toxicity. Co-administration of anti-ulcer agents is generally recommended in patients with active peptic ulceration or GI bleeding treated with Aspirin or other salicylates.
Aspirin diseases interaction

                                                               Aspirin diseases interaction.

Where can I get more information

Your pharmacist or health care provider can provide more information about Aspirin.

Clinical research and current scenario of the drug

  • Studies indicate a decrease in cardiovascular events in case of patients with acute coronary syndrome or who are more prone to cardiovascular diseases when Aspirin is given concomitantly with clopidogrel.
  • A large number of clinical trials are being undertaken to investigate the role of Aspirin in the prevention of stroke or heart attack.
  • Co-administration of aspirin and platelet P2Y12receptor inhibitors plays a crucial role in the antithrombotic treatment in patients suffering with acute coronary syndrome.
  • Clinical studies indicate the use of Aspirin in lowering the risk of in situ breast tumors or hormone receptor-positive tumors and reducing the risk of breast cancer in postmenopausal women.
  • Studies involving Salicylates (including Aspirin) in humans and animals nullify them as the sole factor in the generation of permanent threshold shift of auditory sensitivity.
  • Clinical studies indicate the use of Aspirin in the primary treatment of venous thromboembolism in patients undergoing surgery and even in non-surgical situations.
  • Research indicate that regular administration of Aspirin may contribute to the risk of stroke even in case of healthy people.
  • Study shows that regular consumption of Aspirin brings about a reduction in the risk of bowel cancer as well as other hereditary cancers.
  • Clinical studies also advocate the role of Aspirin in reducing breast cancer risk by up to 20%.

References from chemical, biological and toxicological databases

  • DrugBank: Acetylsalicylic acid (DB00945). http://www.drugbank.ca/drugs/db00945
  • Aspirin | C9H8O4 – PubChem. https://pubchem.ncbi.nlm.nih.gov/compound/aspirin
  • Aspirin | C9H8O4 | ChemSpider. chemspider.com/Chemical-Structure.2157.html
  • Aspirin: MedlinePlus Drug Information. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682878.html
  • Aspirin and recurrent venous thromboembolism. http://www.ncbi.nlm.nih.gov/pubmed/23482543
  • Aspirin Use and Risk of Breast Cancer: Systematic Review and Meta-analysis of Observational Studies. http://www.ncbi.nlm.nih.gov/pubmed/26315555
  • Pubmed health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0000168/
  • Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews. http://www.ncbi.nlm.nih.gov/pubmed/24074752
  • Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a meta-analysis of randomized trials. http://www.ncbi.nlm.nih.gov/pubmed/21742097
  • Low-dose aspirin in patients with stable cardiovascular disease: a meta-analysis. http://www.ncbi.nlm.nih.gov/pubmed/18187072
  • Aspirin: old drug, new uses and challenges. http://www.ncbi.nlm.nih.gov/pubmed/21062358
  • The Discovery of Aspirin’s Antithrombotic Effects. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894700/
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Can you take Hydrocodone and Naproxen together

Mar 29 2016 Published by under Drug Interactions

What is Hydrocodone

Hydrocodone is a Generic name for an opioid drug which is synthesized from codeine, an opioid alkaloid that can be found in the opium poppy.

This drug is narcotic analgesic which is used orally for relieving the moderate to severe pain, but it is also commonly used in liquid form as an antitussive agent for symptomatic relief of nonproductive cough, alone or together with other cough suppressants or expectorants.

This drug works by changing the way the brain and nervous system respond to pain. As an analgesic, hydrocodone is usually combined with ibuprofen, acetaminophen or aspirin for pain treatment.

The analgesic action of hydrocodone starts in 20–30 minutes and lasts for about 4–8 hours. However, hydrocodone is only used for the treatment of patients who are expected to need painkiller for severe pain for a long time, and who cannot be treated with other medicines or treatments.

Hydrocodone is predominantly prescribed in the US. According to the the International Narcotics Control Board, 99% of the worldwide hydrocone supply in 2007 was consumed in the US.

Other Brand names on the market containing hydrocodone are: Hysingla ER, Zohydro ER, Norco, Vicodin and Robidone.

What is Hydrocodone

What are Naproxen and Aleve

Aleve is a Brand name for a drug containing naproxen sodium as an active ingredient while Naproxen is a Generic name for the drug containing the same active ingredient.

They are nonsteroidal anti-inflammatory drug (NSAID) which are used as a pain relievers for various conditions such as: headaches, dental pain, muscle pain, tendinitis (inflammation or irritation of a tendon, a thick cord that attaches bone to muscle), menstrual cramps, and for the treatment of pain, swelling and joint stiffness caused by arthritis, osteoarthritis, juvenile arthritis, bursitis, ankylosing spondylitis and gout.

They can also be used to temporarily reduce fever and for the treatment of common cold. These drugs are available in the form of capsule and tablets in dose of 220mg of naproxen-sodium.

Aleve products on the market are: Aleve caplets, Aleve tablets, Aleve gelcaps, Aleve liquid gels, Aleve PM (contains naproxen-sodium 220 mg + diphenhydramine hydrochloride 25 mg), and Aleve-D (contains naproxen-sodium 220 mg + pseudoephedrine HCl 120 mg, extended-release).

Naproxen products on the market are: Naproxen capsule, Naproxen tablet, Naproxen All Day Relief for Pain, Naproxen Liquid Gels, Naproxen Caplets All Day Relief for Pain, Naproxen Menstrual Pain Relief and Naproxen Sodium (nsaid) Fever Reducer / Pain Reliever.

Other Brand names for medications containing naproxen are: Anaprox, EC-Naprosyn, Flanax Pain Reliever, Leader Naproxen Sodium, Midol Extended Relief, Naprelan 375, Naprosyn.

Hydrocodone and Naproxen together

How does Hydrocodone and Naproxen work in the body

Hydrocodone is an opioid agonist of opioid receptors within the CNS. This morphinans structure substance blocks pain perception in the cerebral cortex of the brain.

Hydrocodone decreases synaptic chemical transmission in the CNS, which in turn inhibits pain sensation into the higher centers of the brain. Agonist activities at the μ and kappa receptors can cause analgesia, miosis, and decreased body temperature.

Agonist activity at the μ receptor can also cause the suppression of opiate withdrawal, while antagonist activity can result in precipitation of withdrawal.

Hydrocodone acts at several locations within the CNS by involving several systems of neurotransmitters to produce analgesia, but the precise mechanism of action has not been fully understood.

Opiate agonists don’t change the threshold or responsiveness of afferent nerve endings to noxious stimuli nor the conduction of impulses along peripheral nerves.

Instead, they alter the perception of pain at the spinal cord and higher concentrations in the CNS and the person’s emotional response to pain.

Hydrocodone can produce inhibition at the chemoreceptors through μ-opioid receptors and in the medulla through μ and δ receptors which can lead to dose-related respiratory depression.

Naproxen inhibits synthesis of prostaglandins (substances in the body that play a key role in pain and inflammation processes in body tissues) by inhibiting at least 2 cyclooxygenase (COX) isoenzymes, COX-1 and COX-2.

Inhibition of COX-2 leads to the anti-inflammatory, analgesic and antipyretic effects while the inhibition of COX-1 may cause gastrointestinal bleeding and ulcers.

COX-1-dependent prostaglandins play a crucial homeostatic role in physiological functions (gastrointestinal cytoprotection, aggregation of platelets and modulation of vascular muscle tone) while COX-2-dependent prostaglandins play dominant roles in pathophysiologic processes (inflammation and cancer, or physiological processes such as endothelial vasoprotection).

If NSAID drug less inhibits the COX-1, less side effect would be caused. Studies showed that naproxen has a lowest risk of provoking heart attack compared to all other NSAIDs.

This drug may also inhibit chemotaxis, decrease proinflammatory cytokine activity, alter lymphocyte activity, and inhibit neutrophil aggregation – these effects may also contribute to anti-inflammatory activity.

Can patients take Hydrocodone and Naproxen or Aleve together

From a pharmacology standpoint, there is no harm if Naproxen or Aleve is taken together with Hydrocodone. So if hydrocodone isn’t controlling the pain well, patients can use Naproxen or Aleve and Hydrocodone but only with physician instructions.

Naproxen is a blood thinner and may cause bleeding in predisposed patients, so if patient is already taking Hydrocodone for the treatment of post-surgical pain, in that case, these drugs shouldn’t be used together.

There are also many other factors that can exclude the usage of Naproxen and Hydrocodone combination such as: age, past medical history, pregnancy and breast-feeding, and possible interactions with other medications, food or alcohol.

However, Naproxen is the safest NSAID for the patients with coronary disease. It has the lowest risk of provoking heart attack.

Patients should avoid Aleve products containing antihistamines such as Aleve PM in combination with Hydrocodone. Antihistamines and Hydrocodone used together can increase the risk of side effects such as drowsiness and difficulties with concentration.

The table below shows side effects after Hydrocodone and Naproxen or Advil administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.

Very common side effects 10 – 40% Constipation
Common and rare side effects 1-10% Abdominal pain, Heartburn, Nausea, Vomiting, Edema, Dizziness, Drowsiness,  Vertigo, Nausea, Headache, Somnolence Vomiting, Agitation, Emotional lability, Anxiety, Hallucinations, Euphoria, Nervousness, Asthenia, Pruritus, Dyspepsia, Spasticity, Diarrhea, Sweating, Dry mouth, Hypertonia, Malaise, Rash, Menopausal symptoms, Urinary frequency, Urinary retention, Visual disturbance, Vasodilation, Gastrointestinal bleeding, Perforation, and Ulcers, Dyspnea

Special precautions and warnings during Hydrocodone and Naproxen or Aleve administration:

  • Patients should tell their doctor and pharmacist if they are allergic to hydrocodone or naproxen, or any other medicines, or any of the ingredients that are used in Hydrocodone or Aleve or Naproxen products.
  • Patients should tell their doctors or pharmacists what prescription and nonprescription medicines, vitamins or nutritional supplements they are taking or plan to take.
  • Patients should also tell their doctors if they are using any of the following medications: antihistamines; dronedarone, medications for irritable bowel disease, Parkinson’s disease and ulcers, haloperidol, azithromycin, amiodarone, butorphanol;chlorpromazine; citalopram, laxatives such as lactulose, nalbuphine; or pentazocine, levofloxacin.
  • They should also tell their doctors if they are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid (Marplan), selegiline (Eldepryl, Emsam, Zelapar), phenelzine (Nardil), rasagiline (Azilect), or tranylcypromine (Parnate). Doctor may need to change the doses of medicines or monitor carefully for side effects.
  • Hydrocodone shouldn’t be used if patient has blockage of stomach or intestines, or paralytic ileus.
  • Patients should tell their doctor if they have or have ever had hypotension, difficulties with urinating, seizure attacks, or any of the thyroid, liver, kidney, gall bladder or pancreas disease.
  • If patients are taking hydrocodone extended-release tablets, they should tell their doctor if they have or have ever had difficulties with swallowing, colon cancer, esophageal cancer, heart failure or heart rhythm problems such long QT syndrome.
  • Patients should tell their doctor if they are breastfeeding.
  • If patients are having surgery, including dental surgery, they should tell their doctor or dentist that they are taking hydrocodone.
  • Hydrocodone may make patients drowsy. Patients taking hydrocodone should not drive a car or operate machinery.
  • Hydrocodone may cause dizziness, fainting and lightheadedness, if patient get up too quickly from a lying position. This is more common when initial dose of hydrocodone is taken. To avoid this problem, patients should slowly get out of bed, resting their feet on the floor for a few minutes before standing up.
  • Hydrocodone can cause constipation. Patients should talk with their doctor about changing diet and using other medications to treat or prevent constipation.
  • There aren’t also appropriate studies on the relationship of geriatric-specific problems with the effects of naproxen and hydrocodone combination. However, elderly patients are more likely to develop kidney or stomach problems which are age-related. Hydrocodone is more likely to cause breathing problems in older patients who are severely ill, malnourished, or if they have other risk factors
  • Pregnant patients should never use these medicines; because their babies could become drug dependent, so life-threatening withdrawal symptoms can be caused after baby is born. Those babies may need medical treatment for several weeks. Patients should tell doctor if they are pregnant or plan to become pregnant
  • If patient should have surgery, including dental surgery, he/she should tell the doctor or dentist that he/she is taking naproxen
  1. Can you take Hydrocodone and Ibuprofen together
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Azithromycin

Mar 29 2016 Published by under Medicines

What is Azithromycin

Azithromycin is an antibiotic that is used for the treatment of variety of bacterial infections such as skin, ear, respiratory infections and sexually transmitted diseases (STDs).

Azithromycin generic and brand name

  • The drug is available under generic name Azithromycin and marketed under the various brand names such as Zithromax, Azithrocin and
  • Azithromycin was originally developed by Croatian pharmaceutical company Pliva in 1980.
  • Initially Pfizer was accountable for the manufacturing and marketing of Azithromycin under the licence of Pliva.
  • Azithromycin is also manufactured by Pliva and marketed by Teva pharmaceuticals.
  • Furthermore, Azithromycin is marketed as an ophthalmic solution under the brand name AzaSite by Inspire Pharmaceuticals (a subsidiary of Merck & Co.).
Azithromycin: Structure and chemical information.

                                                  Azithromycin: Structure and chemical information.

What is the source of the drug (natural or synthetic)

  • Azithromycin is a semi-synthetic, relatively broad spectrum, macrolide

What is azithromycin used for

  • Azithromycin plays a key role in the treatment of complication related to the bacterial infections such bronchitis, pneumonia, skin infections and infections of ear and throat.
  • It is also recommended to treat the sexually transmitted diseases and Urinary tract infections.
  • It is also used to prevent or treat the disseminated Mycobacterium avium complex (MAC) infection.
  • Azithromycin (in form of ophthalmic solution) is used to treat bacterial conjunctivitis (a bacterial eye infection).
  • However, this drug does not provide any protection against flu, cold and other viral infections.
  • Azithromycin is also prescribed for the treatment of acute bacterial sinusitis caused by influenza, M. catarrhalis or S. pneumonia.
  • Sometimes it is also used to treat the infection of pylori and Legionnaires’ disease (inflammatory lung infection caused by Legionella).
  • It is also prescribed for the treatment of Whooping cough.

Pharmacophore structure: Information about the chemical structure of the drug

Azithromycin chemically belongs to the class of organic compounds which are known as Macrolides and analogues characterized by lactone ring of at least twelve members. The detailed chemical classification of Azithromycin is described below:

Kingdom Organic compounds
Super Class Phenylpropanoids and polyketides
Class Macrolides and analogues
Sub Class Not available
Direct Parent Macrolides and analogues

Chemical information of the drug

  • Azithromycin is a derivative of erythromycin and available as a dihydrate salt.
  • It is a semi-synthetic aliphatic heteromonocyclic antimicrobial agent with a molecular formula C38H72N2O12.
  • The molecular weight of the compound is 984 g/mol.
  • Azithromycin is a dihydrate salt of (2R,3S,4R,5R,8R,10R,11R,12S,13S,14R)-11-{[(2S,3R,4S,6R)-4-(dimethylamino)-3-hydroxy-6-methyloxan-2-yl]oxy}-2-ethyl-3,4,10-trihydroxy-13-{[(2R,4R,5S,6S)-5-hydroxy-4-methoxy-4,6-dimethyloxan-2-yl]oxy}-3,5,6,8,10,12,14-heptamethyl-1-oxa-6-azacyclopentadecan-15-one.
  • Azithromycin is white crystalline powder and has a water solubility of 514 mg/mL.
  • Azithromycin is freely soluble in methanol, methylene chloride, ethanol, and chloroform.
  • The melting point of Azithromycin is 114°C.

Azithromycin available strength

  • Azithromycin is available in tablet and oral suspension form for oral administration as well as in the form of ophthalmic solution.
  • Azithromycin tablets are available in two different dosages of 250 mg and 500 mg.
  • Azithromycin tablets of 250 and 500 mg are pink in color, capsule shaped, engraved, and film-coated.
  • 250 mg tablets are engraved with “Pfizer” on one side and “306” on another side.
  • 500 mg tablets are engraved with “Pfizer” on one side and “ZTM500” on another side.
  • Azithromycin tablets contains azithromycin dihydrate as active ingredient and pregelatinized starch, lactose, dibasic calcium phosphate anhydrous, hypromellose, sodium croscarmellose, magnesium stearate, sodium lauryl sulfate, titanium dioxide, triacetin and D&C Red No. 30 Aluminum Lake as inactive ingredients.
  • Azithromycin oral suspensions are available in two different dosages of 100 mg/5ml and 200 mg/5ml.
  • Azithromycin oral suspension contains azithromycin dihydrate as active ingredient and sucrose, sodium phosphate, tribasic, anhydrous; hydroxypropyl cellulose, xanthan gum, spray dried artificial cherry, vanilla or banana flavours and FD&C Red No. 40 as inactive ingredients.
  • Azithromycin ophthalmic solution (AzaSite®) is available as 1% sterile solution which is an off-white viscous liquid.
  • It contains citric acid, sodium citrate, poloxamer 407, polycarbophil, mannitol, sodium chloride, edentate disodium and water as inactive ingredients. Furthermore, it also contains 0.003% benzalkonium chloride as preservative agent and sodium hydroxide to adjust pH (6.3).

How does azithromycin work (mode of action)

  • Azithromycin is effective against gram positive bacteria such as Staphylococcus aureus, S. agalactiae, S. Pneumonia and pyogenes, gram-negative bacteria such as Haemophilus ducreyi, H. influenza, Moraxella catarrhalis and Neisseria gonorrhoeae and some other bacteria like Chlamydophila pneumonia, Chlamydia trachomatis and Mycoplasma pneumonia.
  • Azithromycin is a macrolides antibiotic (such as Erythromycin and Carbomycin) which acts by inhibiting the bacterial protein synthesis, quorum-sensing and formation of bacterial biofilm.
  • Macrolides primarily act through enhancing the dissociation of peptidyl-tRNA from ribosome, thus inhibiting transpeptidation and translocation step of protein synthesis (an intermediate steps of protein synthesis).
  • It has been observed that Azithromycin binds with the 50S subunit of ribosome and interferes with polypeptide synthesis. Therefore, it is predicted that stimulated dissociation of peptidyl-tRNA from ribosome is the major mechanism of action of Azithromycin.
  • Azithromycin competes for [14C] erythromycin ribosome binding site, suggesting that it binds to the same receptor as erythromycin. However, it does not affect the synthesis of nucleic acid.
  • The Azithromycin accumulates at very higher concentration in cells, predominantly in phagocytes and therefore delivered effectively in high concentrations to sites of infection.
Azithromycine: Mode of action.

                                   Azithromycin: Mode of action.

What are the recommended doses of Azithromycin

The dose of Azithromycin varies depending upon the age and diseased state of the patient.

Adult dose

  • Acute pelvic inflammatory disease
  • Initial dose: 500 mg once intravenously for 1 or 2 days.
  • Maintenance day: 250 mg once in a day orally for 7 days.
  • Babesiosis
  • Initial dose: 500 mg once orally for a day.
  • Maintenance day: 250 mg once in a day in combination with Atovaquone orally for 7-10 days.
  • Bacterial endocarditis: 500 mg as a single dose orally 1 hour previous to process.
  • Bacterial sinusitis: 500 mg once in a day orally for 3 days.
  • Bronchitis
  • Initial dose: 500 mg once orally for a day.
  • Maintenance day: 250 mg once in a day orally for 4 days.
  • Cervicitis: 1000 mg as a single dose orally.
  • Chlamydia infection: 1000 mg as a single dose orally.
  • Chronic obstructive pulmonary disease: 500 mg once orally for 3 days.
  • Community acquired pneumonia
  • Initial dose: 500 mg once orally for a day.
  • Maintenance day: 250 mg once in a day orally for 4 days.
  • Erythema chronicum migrans: 500 mg once in a day orally for 7-10 days.
  • Genital ulcer disease (Chancroid): 1000 mg as a single dose orally.
  • Granuloma inguinale: 1000 mg orally once weekly for 3 weeks or more.
  • Mycobacterium avium complex infection
  • Prophylaxis: 1200 mg once in a week orally.
  • Treatment: 600 mg once in a day orally with Ethambutol.
  • Nongonococcal urethritis: 1000 mg as a single dose orally.
  • Otitis media
  • Initial dose: 500 mg once orally for a day.
  • Maintenance day: 250 mg once in a day orally for 4 days.
  • Pertussis
  • Initial dose: 500 mg once orally for a day.
  • Maintenance day: 250 mg once in a day orally for 4 days.
  • Skin infections
  • Initial dose: 500 mg once orally for a day.
  • Maintenance day: 250 mg once in a day orally for 4 days.
  • STD prophylaxis: 1000 mg as a single dose orally.
  • Tonsillitis/Pharyngitis
  • Initial dose: 500 mg once orally for a day.
  • Maintenance day: 250 mg once in a day orally for 4 days.
  • Toxoplasmosis: 900-1200 mg once a day orally for 6 weeks or more.
  • Typhoid fever: 1000 mg once in a day orally for 5 days.
  • Uncomplicated Gonococcal infection: 2000 mg as a single dose for Gonococcal urethritis and cervicitis orally.
  • Upper respiratory tract infection
  • Initial dose: 500 mg once orally for a day.
  • Maintenance day: 250 mg once in a day orally for 4 days.

Paediatric dose

  • Acute bacterial sinusitis
  • ≥ 6 months: 10 mg/kg daily for 3 days orally.
  • ≥ 16 months: 500 mg daily for 3 days orally.
  • Bacterial endocarditis prophylaxis: 15 mg/kg as a single dose orally 1 hour previous to process.
  • Chlamydia trachomatis infection
  • ≥ 16 months: single dose of 1000 mg orally.
  • Chronic obstructive pulmonary disease
  • ≥ 16 months: 500 mg orally for initial day and then 250 mg once daily for 4 days orally or 500 mg daily for 3 days orally.
  • Community acquired pneumonia
  • ≥ 6 months: 10 mg/kg orally for initial day and then 5 mg/kg once daily for 4 days orally.
  • ≥ 16 months: 500 mg orally for initial day and then 250 mg once daily for 4 days orally.
  • Cystic fibrosis
  • ≥ 16 months
  • 25 – <40 kg: 250 mg thrice in a week at regular interval (one dose in 48 hours).
  • ≥ 40 kg: 500 mg thrice in a week at regular interval (one dose in 48 hours).
  • Erythema chronicum migrans: 10 mg/kg daily for 7-10 days orally.
  • Gonococcal infection
  • ≥ 16 months: single dose of 2000 mg orally.
  • Mycobacterium aviam complex infection
  • Prophylaxis:
  • ≥ 16 months: 1200 mg once in a week orally.
  • Treatment
  • ≥ 16 months: 600 mg once in a day orally with Ethambutol.
  • Nongonococcal infection
  • ≥ 16 months: single dose of 1000 mg orally.
  • Otitis media
  • ≥ 6 months: 30 mg/kg as a single oral dose or 10 mg/mg once a day orally for 3 days.
  • Pelvic inflammatory disease
  • ≥ 16 months: 500 mg intravenously daily for 1-2 days and then 250 mg in a day for 7 days orally.
  • Pertussis
  • <5 months: 10 mg/kg daily for 5 days orally.
  • 1-5 months: 10 mg/kg daily for 5 days orally.
  • ≥ 6 months: 10 mg/kg orally for initial day (not more than 500 mg) and then 5 mg/kg once daily (not more than 250 mg) for 4 days orally.
  • Skin infection
  • ≥ 16 months: 500 mg orally for initial day and then 250 mg once daily for 4 days orally.
  • Tonsillitis/Pharyngitis
  • ≥ 2 months: 12 mg/kg daily for 5 days orally.
  • ≥ 16 months: 500 mg orally for initial day and then 250 mg once daily for 4 days orally.
  • Typhoid fever
  • ≥ 3 months: 20 mg/kg daily for 5-7 days orally.
  • Upper respiratory tract infection
  • ≥ 6 months: 10 mg/kg orally for initial day and then 5 mg/kg once daily for 4 days orally.
  • Renal dose adjustments: Caution should be exercised in patients with GFR <10 ml/min.
  • Hepatic dose adjustments: Caution should be exercised in patients with liver dysfunction.

When should I discontinue, withhold or modify the dose of Azithromycin

  • The usual dosing of the drug may vary depending upon the efficiency and side effects of the drug in a particular individual.
  • Do not use the medicine if you are hypersensitive or allergic to Azithromycin or any other antibiotic such as Clarithromycin, Dirithromycin and Erythromycin.
  • No dosage adjustment is required in case of renal impairment and patient with hepatic impairment.
  • Use of ergot derivatives with Azithromycin should be contraindicated because ergot derivatives may be precipitated by Azithromycin.
  • Caution should be exercised with the use of Azithromycin oral solution in diabetic patients because it contains sucrose.
  • Azithromycin should not be used along with antacids that contain aluminium or magnesium hydroxide because antacids bind to the Azithromycin and prevent the absorption in intestine. Consult to your pharmacist for the use of antacids with Azithromycin.
  • Azithromycin is not recommended for those patients who have Niemann-Pick or Tay-Sachs disease.

What are the pharmacokinetic properties of the drug

  • Pharmacokinetic studies suggest that after oral administration Azithromycin is rapidly absorbed and has a bio-availability of approximately 37%.
  • Following absorption approximately 51% (at 02mcg/ml concentration) to 7% (at 2mcg/ml concentration) of the drug is bound to serum proteins.
  • It has been observed that following a 500 mg dose of maximum (or peak) plasma concentration (35 to 0.45mg/L) is achieved in 120 minutes.
  • The drug is metabolized in liver.
  • The average median half-life of Azithromycin is 68
  • Azithromycin is primarily eliminated in feces as uncharged drug via biliary excretion and approximately 6% of dose is excreted in urine as an uncharged drug.
  • The average steady state volume of distribution of the drug is 1 L/kg.

Which pregnancy category (A; B; C; D; X) has been assigned to Azithromycin

  • The Azithromycin is classified by US FDA pregnancy category: B
  • Due to lack of adequate and well-controlled studies the use of Azithromycin in pregnant women is contraindicated and recommended only when benefit justifies the risk.
  • Laboratory animal studies have shown no adverse effect on the fetus.
  • Studies support the excretion of the Azithromycin into human milk. Even though, breast-feeding may be permissible with caution.
  • Despite these facts caution should be exercised when taking Azithromycin.

How to use azithromycin

  • Azithromycin oral suspension and tablets are generally for oral administration with or without food.
  • Azithromycin tablets should not be chewed, split or crushed. Whole tablet/capsules should be swallowed.
  • Azithromycin oral liquid should be shaken well before every use.
  • Azithromycin oral liquid should be measured with measuring spoon that comes along with medication.
  • Normally one drop of Azithromycin ophthalmic solution is used in a day at any time.
  • It is also recommended to take drug at almost the same time every day.
  • Follow the instructions carefully as directed on prescription leaflet and take Azithromycin exactly as directed.
  • Do not change the dose of the drug as prescribed by your doctor since the dosage is based on patient medical condition, treatment responses and usage with other drugs.

How to store the drug

  • Azithromycin is stored at 25°C (77°F) and excursion permitted to 15-30°C (59-86°F).
  • Store the medicine away from light and moisture.
  • Azithromycin oral solution may be stored in refrigerator but should not be frozen.
  • Ophthalmic solution should be stored at 2 to 8°C (36°F to 46°F).
  • The drug should be kept away from children and pets.
  • Medicine should not be stored in the bathroom.

How to dispose the medicine

  • Throw away unused and opened, outdated or no longer used container.
  • Also dispose the old medicine after the expiration date.
  • Consult your pharmacist or local waste disposal company for proper disposal.

Does Azithromycin has approval from government / FDA /or any other related agencies

  • Azithromycin was approved fromS. Food and Drug Administration (FDA) in November 1991 to treat variety of bacterial infections such asskin, ear, respiratory infections and sexually transmitted diseases.
  • Azithromycin oral suspension was first approved in September 1994 by U.S. FDA.
  • Azithromycin ophthalmic solution was approved in April 2007 by U.S. FDA.

Other uses of the drug

  • Azithromycin is also used for the travelers’ diarrhoea and other gastrointestinal infections and babesiosis (tick-borne malaria like illness caused by species of the intra-erythrocytic protozoanBabesi).
  • Azithromycin may also be used for other uses not listed here. It is advisable to ask your doctor or pharmacist for more information.

What special dietary precautions should I follow

  • Take diet as prescribed by your doctor otherwise follow usual diet.

What special precautions should I follow/ What should I avoid while using Azithromycin

  • Before taking Azithromycin, tell your doctor about your medical history if you have liver or kidney problem, blood infection and myasthenia gravis.
  • Consult with your doctor if you have cystic fibrosis, irregular heartbeats, heart failure, infection of HIV and prolonged Qt intervals.
  • Do not stop taking Azithromycin until you do not finish the prescription. If you do not follow the prescription or stop taking Azithromycin too early, it may lead to the development of antibiotic resistance in bacteria.
  • Consult with your doctor and pharmacist if you are taking any prescription and non-prescription medications, nutritional supplements, vitamins or herbal products.
  • Avoid touching the Azithromycin ophthalmic solution bottle tip with your finger, eye or other objects.
  • Also avoid the use of contact lenses during the treatment of bacterial conjunctivitis.
  • Consult your doctor in case of any query.

Azithromycin side effects

In addition to the associated benefits, Azithromycin also is accompanied with the side effects some of which are more common, others less common whereas some that fade away with time while you take the drug. It is always recommended to consult a doctor if you encounter any of the side effects.

Some of the commonly occurring side effects which require medical attention are outlined as:

  • Diarrhoea
  • Headache
  • Nausea
  • Pain in stomach
  • Vomiting

Sometime, it may cause serious side effects. On appearance of these symptoms stop taking the medicine and immediately talk to your doctor:

  • Blisters or peeling of the skin
  • Dark-colored urine
  • Dizziness
  • Extreme tiredness
  • Fainting
  • Flu-like symptoms
  • Hives
  • Hoarseness
  • Irregular or fast heart beat
  • Itching
  • Lack of energy
  • Loss of appetite
  • Mouth sores
  • Rash
  • Severe diarrhoea with or without fever and stomach cramps
  • Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • Unusual bleeding or bruising
  • Unusual muscle weakness
  • Wheezing or difficulty breathing or swallowing

Azithromycin ophthalmic solution may cause some side effects in eye. These include:

  • Blurred vision
  • Changes to the surface of your eye
  • Discharge coming from your eye
  • Eye burning, stinging and irritation when the drop hits your eye
  • Eye dryness
  • Irritation on your eyelid and the skin around your eye
  • Pain and itching in eye
  • Stuffy nose and sinus infection
  • Swelling around your eye or of your face

Besides these, Azithromycin may also be associated with some other side effects. These include:

  • Cardiovascular effects: hypotension, palpitations, arrhythmias and prolongation of the QT intervels.
  • Dermatologic effects: rashes, urticaria, pruritus and photosensitivity.
  • Gastrointestinal effects: nausea, abdominal pain, vomiting, diarrhoea, pseudomembranous colitis, mucositis, oral moniliasis, flatulence, constipation and gastritis.
  • Genitourinary effects: vaginitis and moniliasis.
  • Hematologic effect: leukopenia, neutropenia, decreased lymphocyte, increased eosinophils and thrombocytopenia.
  • Hepatic effect: elevated bilirubin, hepatic and cholestatic jaundice, hepatic necrosis and failure.
  • Hypersensitivity effect: anaphylaxis, angioedema and Stevens-Johnson syndrome.
  • Nervous system effects: dizziness, headache, somnolence, vertigo, hearing disturbance, paresthesia, convulsion, hyperactivity, nervousness and syncope.
  • Renal effect: interstitial nephritis, acute renal failure and elevation in serum creatinine and blood urea nitrogen.

What should I do in case of overdose

  • If you overdose the drug contact with your doctor or pharmacist for symptomatic and supportive measures.
  • Overdose of Azithromycin may cause gastrointestinal effects such as abdominal pain, vomiting, diarrhoea and constipation.

What should I do in case of missed a dose

  • Take a missed dose as soon as possible.
  • To make up the missed dose, do not take extra medicine.
  • Avoid taking the missed dose if it is about time for your next dose.

Azithromycin drug interactions

A number of drugs are known to interact with Azithromycin that can suppress or elicit the effective of the drug and poses the risk for serious side effects. It is always advisable to discuss about all the prescription, non-prescription drugs, vitamins and herbal supplements you are taking before you go on Azithromycin medication therapy. Also inform your doctor if you are undergoing any type of allergy skin testing or allergy treatments. Azithromycin may interact with one of the following drugs. Care should be taken when you are taking these medications together. Lists of few medications that interact with Azithromycin include:

  • Drugs for the treatment of irregular heartbeats such as sotalol (Betapace, Sorine), quinidine, procainamide (Procanbid), dofetilide (Tikosyn) and amiodarone (Cordarone, Pacerone).
  • Antacids which contain aluminium or magnesium such as Maalox, Mylanta and Tums.
  • Anticoagulant medicines such as digoxin (Lanoxin), dihydroergotamine (D.H.E 45 and Migranal), ergotamine (Ergomar) and warfarin (Coumadin and Jantoven).
  • Immunosuppressant drugs such as cyclosporins (Neoral and Sandimmune), midazolam (Dormicum, Hypnovel, Versed).
  • Antiepileptic medications such as phenytoin (Dilantin,Dilantin) and carbamazepine (Carbatrol, Equetro, Epitol, Tegretol, Teril).
  • Bronchodilator agents such as theophyllines (such as Norphyl, Phyllocontin, Theochorn).
  • Drugs for treating pulmonary hypertension such as sildenafil.
  • HMG-CoA reductase inhibitors such as atorvastatin, lovastatin, pravastatin, simvastatin, rosuvastatin, fluvastatin, pitavastatins.
  • Drugs for the treatment of allergy such as antihistamine (Terfenadine).
  • P-glycoprotein inhibitors such as colchicines, ritonavir, amiodarone, captopril, clarithromycin, reserpine, tariquidar, verapamil.
  • Dihydrofolate reductase inhibitors such as trimethoprim (Proloprim, Monotrim, triprim).
  • Drugs for HIV/AIDS including such as zidovudine (Retrovir), nelfinavir (Viracept), indinavir (Crixivan), efavirenz (Sustiva, Efavir, Stocrin), didanosine (Videx).
  • Antibacterial agents such as rifabutin (Mycobutin), fluconazole (Monicure, Canesten, Alfumet or Dofil), sulfamethoxazole (Gantanol).

This list of drugs interacting with Azithromycin is not complete and other drugs may also interact with it. Always consult your doctor about the medications you use.

Azithromycine: Drug interaction.

                                                     Azithromycin : Drug interaction.

Does Azithromycin have any interaction with diseases

Before you begin to take Azithromycin, it is necessary to discuss any medical condition or allergies you have or any other significant medical fact. Chemically, Azithromycin is macrolides antibiotic and may interact with one or more than one of the following disease conditions.

  • Antibiotics induced colitis: Antibiotic therapy usually associated with significant reduction in gut microbial flora, that permits overgrowth of some of the harmful bacteria over normal gut flora.Clostridium difficile is one of such bacterial species that flourish well under antibiotic therapy. Its toxin is supposed to be a primary cause of antibiotic-associated colitis. The most common antibiotics that cause colitis is Azithromycin, Lincomycin, Amoxicillin, Ampicillin (Aminopenicillins), Clindamycin, and Cephalosporins. Besides Clostridium, Pseudomembranous colitis has also been reported with broad spectrum antibacterial agents. Colitis is a medical condition caused by inflammation of large intestine and associated with growth of unusal harmful bacteria (microbial infection) and range in severity from mild to life-threatening. The disease is associated with severe, persistent diarrhea, abdominal cramps, and passage of blood and mucus. It has been observed that colitis is occasionally caused by taking antibiotics and thus named as antibiotic associated colitis. Thus, antibiotic therapy with Azithromycin and other broad-spectrum antibiotics agents should be managed cautiously in patients with a history of gastrointestinal diseases, particularly colitis. In such patients, antibiotic therapy should be discontinued immediately if significant diarrhea occurs and stool assay and large bowel endoscopy recommended to establish a definitive diagnosis.
  • Liver Disease: Azithromycin and other broad spectrum, macrolide antibiotics are primarily eliminated from the body by the hepatobiliary system. Although clinical trials and studies have shown that Azithromycin is well-tolerated and less associated with adverse/negative side effects. However, it is recommended that Azithromycin therapy should be administered cautiously in patients with liver and/or biliary impairment.
  • Myasthenia Gravis: Myasthenia gravis is a neuromuscular disease which is characterized by fluctuating muscle weakness and fatigue. It has been observed that administration of macrolide antibiotics such as Azithromycin can exacerbate symptoms of myasthenia gravis. Besides this, it has also been observed that Azithromycin treatment also initiate the onset of symptoms of myasthenic syndrome. The underlying cause of this is supposed to be due to presynaptic suppression of acetylcholine release from neurotransmitter. Therefore, Amoxiciliin therapy should  be administered cautiously most important in patients which have a previous history of myasthenia gravis

Where can I get more information

  • Your pharmacist or health care provider can provide more information about Azithromycin.

Clinical research and current scenario of the drug

  • No studies have been performed either In vitro or In vivo for assessing the metabolism of Azithromycin.
  • Studies indicate similar pharmacokinetic parameters of Azithromycin in elderly subjects (aged 65 to 85 years) and young adults.
  • Long-term studies involving Azithromycin have not been performed in animals for evaluating carcinogenic potential.
  • Safety and effectiveness of Azithromycin in the treatment of pediatric patients with otitis media, acute bacterial sinusitis and community-acquired pneumonia under 6 months of age have not been established.
  • Clinical studies have not established the safety and effectiveness of Azithromycin in the treatment of pediatric patients with pharyngitis/tonsillitis below 2 years of age.
  • Clinical trials indicated non-discontinuation of Azithromycin therapy due to any treatment-related laboratory abnormalities.
  • Study indicates a 40% reduction in genital trachomatis infection after treatment with Azithromycin MDA (Mass Drug Administration) for the elimination of trachoma.
  • Studies indicate the concomitant use of Ceftriaxone/Azithromycin for the treatment of pharyngeal gonorrhea in HIV-negative man.
  • Cefazolin and Azithromycin are significantly more effective in the prevention of postcesarean endometritis.

 References from chemical, biological and toxicological databases

  • DrugBank: Erythromycin. www.drugbank.ca/drugs/DB00199
  • Azithromycin | C38H72N2O12 | ChemSpider. http://www.chemspider.com/Chemical-Structure.10482163.html
  • Azithromycin – National Library of Medicine – PubMed Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0000192/
  • Azithromycin: MedlinePlus Drug Information. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a697037.html
  • Azithromycin – Wikipedia. https://en.wikipedia.org/wiki/Azithromycin
  • A review of its antimicrobial activity, pharmacokinetic properties and clinical efficacy. http://www.ncbi.nlm.nih.gov/pubmed/1280567
  • Effect of amoxicillin use on oral microbiota in young children. http://www.ncbi.nlm.nih.gov/pubmed/15273096
  • Treatment of streptococcal pharyngitis with once-daily compared with twice-daily amoxicillin: a noninferiority trial. http://www.ncbi.nlm.nih.gov/pubmed/16940830
  • Common harms from amoxicillin: a systematic review and meta-analysis of randomized placebo-controlled trials for any indication. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284189/
  • Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis of potential high-risk groups. http://www.ncbi.nlm.nih.gov/pubmed/24567620
  • In vivo activities of amoxicillin and amoxicillin-clavulanate against Streptococcus pneumoniae: application to breakpoint determinations. http://www.ncbi.nlm.nih.gov/pubmed/9736566
  • Amoxicillin/clavulanic acid: a review of its use in the management of paediatric patients with acute otitis media. http://www.ncbi.nlm.nih.gov/pubmed/12534334
  • Association of amoxicillin use during early childhood with developmental tooth enamel defects. http://www.ncbi.nlm.nih.gov/pubmed/16203939
  • Amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination. http://www.ncbi.nlm.nih.gov/pubmed/6391783
  • Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial. http://www.ncbi.nlm.nih.gov/pubmed/3520469
  • A case of persistent and possibly treatment resistant pharyngeal gonorrhea. http://www.ncbi.nlm.nih.gov/pubmed/26967304
  • Mass drug administration of azithromycin for trachoma reduces the prevalence of genital Chlamydia trachomatis infection in the Solomon Islands.http://www.ncbi.nlm.nih.gov/pubmed/26888658
  • A comparison of 3 antibiotic regimens for prevention of postcesarean endometritis: an historical cohort study. http://www.ncbi.nlm.nih.gov/pubmed/26901276
  • Common harms from amoxicillin: a systematic review and meta-analysis of randomized placebo-controlled trials for any indication. http://www.ncbi.nlm.nih.gov/pubmed/25404399
  • Augmentin (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infection: a review of the continuing development of an innovative antimicrobial agent. http://www.ncbi.nlm.nih.gov/pubmed/14726431
  • Amoxicillin or myringotomy or both for acute otitis media: results of a randomized clinical trial. http://www.ncbi.nlm.nih.gov/pubmed/2011422
  1. Amoxicillin drug class, uses, strength, side effects, mechanism of action
  2. Can you take Hydrocodone and Tramadol together

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Can you take Hydrocodone and Ibuprofen together

Mar 29 2016 Published by under Drug Interactions

What is Hydrocodone

Hydrocodone is a Generic name for an opioid drug which is synthesized from codeine, an opioid alkaloid that can be found in the opium poppy.

This drug is narcotic analgesic which is used orally for relieving the moderate to severe pain, but it is also commonly used in liquid form as an antitussive agent for symptomatic relief of nonproductive cough, alone or together with other cough suppressants or expectorants.

This drug works by changing the way the brain and nervous system respond to pain. As an analgesic, hydrocodone is usually combined with ibuprofen, acetaminophen or aspirin for pain treatment.

The analgesic action of hydrocodone starts in 20–30 minutes and lasts for about 4–8 hours. However, hydrocodone is only used for the treatment of patients who are expected to need painkiller for severe pain for a long time, and who cannot be treated with other medicines or treatments.

Hydrocodone is predominantly prescribed in the US. According to the the International Narcotics Control Board, 99% of the worldwide hydrocone supply in 2007 was consumed in the US.

Other Brand names on the market containing hydrocodone are: Hysingla ER, Zohydro ER, Norco, Vicodin and Robidone.

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What is Ibuprofen

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). Ibuprofen is a Generic name for a drug containing the same name active ingredient.

It is used as a pain reliever for various conditions such as: headaches, dental pain, muscle pain, tendinitis (inflammation or irritation of a tendon, a thick cord that attaches bone to muscle), menstrual cramps, and for the treatment of pain, swelling and joint stiffness caused by arthritis, osteoarthritis, juvenile arthritis, bursitis, ankylosing spondylitis, psoriatic arthritis and gout.

It can also be used to temporarily reduce fever and for the treatment of common cold symptoms. Ibuprofen may be used intravascular with opiates for relieving moderate to severe pain. Ibuprofen lysine may be also used intravscular as a therapy for premature neonates with ductus arteriosus.

Ibuprofen is available in following dosage forms and strengths: capsule, capsule liquid filled, capsule coated (200, 220 and 400 mg), injection (100mg/ml), oral liquid (100 mg/5mL and 50 mg/1.25mL), solution (100 mg, 100 mg/5mL), suspension (100 mg, 200 mg/10mL, 100 mg/5mL) and tablet (200, 300, 400, 600 and 800 mg).

Common Brand names for ibuprofen are: Advil, Motrin, Brufen, Calprofen, Genpril, Ibu, Midol, Nuprin, Cuprofen, Nurofen, Ibuprofen 800 and PediaCare Children’s Pain Reliever/Fever Reducer IB.

467px-Bottle_of_Ibuprofen_tablets_with_cap_removed_and_tablets_in_front (1)

How does Hydrocodone and Ibuprofen work in the body

Hydrocodone is an opioid agonist of opioid receptors within the CNS. This morphinans structure substance blocks pain perception in the cerebral cortex of the brain.

Hydrocodone decreases synaptic chemical transmission in the CNS, which in turn inhibits pain sensation into the higher centers of the brain. Agonist activities at the μ and kappa receptors can cause analgesia, miosis, and decreased body temperature.

Agonist activity at the μ receptor can also cause the suppression of opiate withdrawal, while antagonist activity can result in precipitation of withdrawal.

Hydrocodone acts at several locations within the CNS by involving several systems of neurotransmitters to produce analgesia, but the precise mechanism of action has not been fully understood.

Opiate agonists don’t change the threshold or responsiveness of afferent nerve endings to noxious stimuli nor the conduction of impulses along peripheral nerves.

Instead, they alter the perception of pain at the spinal cord and higher concentrations in the CNS and the person’s emotional response to pain. Hydrocodone can produce inhibition at the chemoreceptors through μ-opioid receptors and in the medulla through μ and δ receptors which can lead to dose-related respiratory depression.

Ibuprofen inhibits synthesis of prostaglandins (substances in the body that play a key role in pain and inflammation processes in body tissues) by inhibiting at least 2 cyclooxygenase (COX) isoenzymes, COX-1 and COX-2.

Inhibition of COX-2 leads to the anti-inflammatory, analgesic and antipyretic effects while the inhibition of COX-1 may cause gastrointestinal bleeding and ulcers.

Ibuprofen has the lowest risk of causing gastrointestinal bleeding of all NSAID, producing balanced inhibitory effects on both COX-1 and COX-2 isoenzymes. But, this advantage is lost at high doses.

This drug may also inhibit chemotaxis, decrease proinflammatory cytokine activity, alter lymphocyte activity, and inhibit neutrophil aggregation – these effects may also contribute to anti-inflammatory activity.

Can patients take Hydrocodone and Ibuprofen together

From a pharmacology standpoint, there is no harm if ibuprofen is taken together with hydrocodone. So if hydrocodone isn’t controlling the pain well, patients can use Ibuprofen and Hydrocodone but only with physician instructions.

Ibuprofen is a blood thinner and may cause bleeding in predisposed patients, so if patient is already taking Hydrocodone for the treatment of post-surgical pain, in that case, these drugs shouldn’t be used together.

There are also many other factors that can exclude the usage of Ibuprofen and Hydrocodone combination such as: age, past medical history, pregnancy and breast-feeding, and possible interactions with other medications, food or alcohol.

The table below shows side effects after Hydrocodone and Ibuprofen administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.

Very common side effects 10 – 40% Upset stomach, Heartburn, Nausea, Vomiting, Edema, Constipation, Dizziness, Vertigo, Nausea, Headache, Somnolence Vomiting, Agitation, Emotional lability, Anxiety, Hallucinations, Euphoria, Nervousness, Asthenia, Pruritus, Dyspepsia, Spasticity
Common side effects 1-10% Diarrhea, Sweating, Dry mouth, Hypertonia, Malaise, Rash, Menopausal symptoms, Urinary frequency, Urinary retention, Visual disturbance, Vasodilation, Gastrointestinal bleeding, Perforation, and Ulcers, Dyspnea
Rare side effects < 1% Metabolic acidosis, hyperkalaemia Abnormal gait, Amnesia, Depression, Difficulty in concentration, Aplastic anemia, Erythematous macular rashes Cognitive dysfunction, Fatigue, Menstrual disorder, Motor system weakness, Hemolytic anemia, Thrombocytopenia, Neutropenia, Dysphoria, Dysuria, Orthostatic hypotension, Tremor, Tachycardia, Agranulocytosis, Erythema multiforme, Exfoliative dermatitis

Special precautions and warnings during Hydrocodone and Ibuprofen administration:

  • Patients should tell their doctor and pharmacist if they are allergic to hydrocodone or ibuprofen, or any other medicines, or any of the ingredients that are used in Hydrocodone or |Ibuprofen products.
  • Patients should tell their doctors or pharmacists what prescription and nonprescription medicines, vitamins or nutritional supplements they are taking or plan to take.
  • Patients should also tell their doctors if they are using any of the following medications: antihistamines; dronedarone, medications for irritable bowel disease, Parkinson’s disease and ulcers, haloperidol, azithromycin, amiodarone, butorphanol;chlorpromazine; citalopram, laxatives such as lactulose, nalbuphine; or pentazocine, levofloxacin.
  • They should also tell their doctors if they are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid (Marplan), selegiline (Eldepryl, Emsam, Zelapar), phenelzine (Nardil), rasagiline (Azilect), or tranylcypromine (Parnate). Doctor may need to change the doses of medicines or monitor carefully for side effects.
  • Hydrocodone shouldn’t be used if patient has blockage of stomach or intestines, or paralytic ileus.
  • Patients should tell their doctor if they have or have ever had hypotension, difficulties with urinating, seizure attacks, or any of the thyroid, liver, kidney, gall bladder or pancreas disease.
  • If patients are taking hydrocodone extended-release tablets, they should tell their doctor if they have or have ever had difficulties with swallowing, colon cancer, esophageal cancer, heart failure or heart rhythm problems such long QT syndrome.
  • Patients should tell their doctor if they are breastfeeding.
  • If patients are having surgery, including dental surgery, they should tell their doctor or dentist that they are taking hydrocodone.
  • Hydrocodone may make patients drowsy. Patients taking hydrocodone should not drive a car or operate machinery.
  • Hydrocodone may cause dizziness, fainting and lightheadedness, if patient get up too quickly from a lying position. This is more common when initial dose of hydrocodone is taken. To avoid this problem, patients should slowly get out of bed, resting their feet on the floor for a few minutes before standing up.
  • Hydrocodone can cause constipation. Patients should talk with their doctor about changing diet and using other medications to treat or prevent constipation.
  • There aren’t appropriate studies on the relationship of age to the effects of ibuprofen and hydrocodone combination in children and teenagers below 16 years of age.
  • There aren’t also appropriate studies on the relationship of geriatric-specific problems with the effects of ibuprofen and hydrocodone combination. However, elderly patients are more likely to develop kidney or stomach problems which are age-related. Hydrocodone is more likely to cause breathing problems in older patients who are severely ill, malnourished, or if they have other risk factors
  • Pregnant patients should never use these medicines; because their babies could become drug dependent, so life-threatening withdrawal symptoms can be caused after baby is born. Those babies may need medical treatment for several weeks. Patients should tell doctor if they are pregnant or plan to become pregnant
  • If patient should have surgery, including dental surgery, he/she should tell the doctor or dentist that he/she is taking ibuprofen.
  1. Can you take Hydrocodone and Tramadol together
    Can you take Tylenol and Ibuprofen at the same time?

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Can you take Hydrocodone and Tramadol together

Mar 29 2016 Published by under Drug Interactions

What is Hydrocodone

Hydrocodone is a Generic name for an opioid drug which is synthesized from codeine, an opioid alkaloid that can be found in the opium poppy.

This drug is narcotic analgesic which is used orally for relieving the moderate to severe pain, but it is also commonly used in liquid form as an antitussive agent for symptomatic relief of nonproductive cough, alone or together with other cough suppressants or expectorants.

drug works by changing the way the brain and nervous system respond to pain. As an analgesic, hydrocodone is usually combined with ibuprofen, acetaminophen or aspirin for pain treatment.

The analgesic action of hydrocodone starts in 20–30 minutes and lasts for about 4–8 hours. However, hydrocodone is only used for the treatment of patients who are expected to need painkiller for severe pain for a long time, and who cannot be treated with other medicines or treatments.

Hydrocodone is predominantly prescribed in the US. According to the the International Narcotics Control Board, 99% of the worldwide hydrocone supply in 2007 was consumed in the US.

Other Brand names on the market containing hydrocodone are: Hysingla ER, Zohydro ER, Norco, Vicodin and Robidone.

What is Hydrocodone

What is Tramadol

Tramadol is a Generic name for an opioid narcotic-like pain reliever that is used for relieving moderate to moderately severe acute and chronic pain.

According to European League Against Rheumatism, it is recommended for the treatment of chronic pain caused by medical condition called fibromyalgia.

Tramadol tablets are available in 50 mg and 100 mg and they are usually taken several times a day. Extended release tablets are available in doses of 100 mg, 150 mg, 200 mg, and 300 mg.

Common Brand names for medications containing tramadol are: Ultram, Ultram ER, ConZip, Rybix ODT and Ryzolt. Tramadol is available in the following dosage forms: tablet, tablet extended release, suspension, capsule extended release and disintegrating tablet.

What is Tramadol

How does Hydrocodone and Tramadol work in the body

Hydrocodone is an opioid agonist of opioid receptors within the CNS. This morphinans structure substance blocks pain perception in the cerebral cortex of the brain.

Hydrocodone decreases synaptic chemical transmission in the CNS, which in turn inhibits pain sensation into the higher centers of the brain. Agonist activities at the μ and kappa receptors can cause analgesia, miosis, and decreased body temperature.

Agonist activity at the μ receptor can also cause the suppression of opiate withdrawal, while antagonist activity can result in precipitation of withdrawal.

Hydrocodone acts at several locations within the CNS by involving several systems of neurotransmitters to produce analgesia, but the precise mechanism of action has not been fully understood.

Opiate agonists don’t change the threshold or responsiveness of afferent nerve endings to noxious stimuli nor the conduction of impulses along peripheral nerves.

Instead, they alter the perception of pain at the spinal cord and higher concentrations in the CNS and the person’s emotional response to pain. Hydrocodone can produce inhibition at the chemoreceptors through μ-opioid receptors and in the medulla through μ and δ receptors which can lead to dose-related respiratory depression.

Tramadol has 2 different mechanisms of action. First, tramadol can bind with parent and M1 metabolite to μ-opioid receptors causing inhibition of ascending pain pathways in CNS, and secondly, tramadol can inhibit reuptake of norepinephrine and serotonin.

Tramadol’s inhibitory effects on the serotonins 5-HT2C receptors may cause the reduction of the seizure threshold. However, the seizure threshold reduction could be also attributed to tramadol’s inhibition of GABA receptors in CNS at high doses.

In addition, tramadol’s major active metabolite called O-desmethyltramadol, has a high affinity to the δ-opioid receptors in the brain, and interaction with these receptors can be involved in tramadol’s capability to provoke seizures in some individuals, because δ-opioid receptor agonists are well known seizure inducers.

Can patients take Hydrocodone and Tramadol together

Taking Hydrocodone and Tramadol together would be generally unnecessary, because the usage and effects of these two drugs are quite similar, and there is a high risk of serious side effects such as seizures, respiratory depression to happen after using this combination.

In currently or previously patients addicted to opiates, alcohol or other drugs, tramadol and Hydrocodone individually or together are not advised in most cases. However, reduced doses of tramadol can sometimes be suggested by doctors if the drug is being taken in conjunction with Hydrocodone

Hydrocodone can interrupt breathing and high doses may lead to fatal respiratory depression, while tramadol can cause seizure attacks, so taking tramadol with hydrocodone together can make both of these serious effects more likely to happen, so this is the main reason why this combination shouldn’t be advised from medical professionals.

If hydrocodone or tramadol are used for a long period of time, they may become habit-forming, causing physical or mental dependence. Mental dependence – addiction will not occur when these drugs are used for their purpose.

If treatment is stopped suddenly physical dependence may lead to withdrawal side effects such as: tingling, numbness, paresthesia, and tinnitus. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.

The table below shows side effects after Hydrocodone and Tramadol administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.

Very common side effects >10% Constipation, Dizziness, Vertigo, Nausea, Headache, Somnolence Vomiting, Agitation, Emotional lability, Anxiety, Hallucinations, Euphoria, Nervousness, Asthenia, Pruritus, Dyspepsia, Spasticity
Common side effects 1-10% Diarrhea, Sweating, Dry mouth, Hypertonia, Malaise, Rash, Menopausal symptoms, Urinary frequency, Urinary retention, Visual disturbance, Vasodilation
Less common and rare side effects < 1% Abnormal gait, Amnesia, Depression, Difficulty in concentration, Cognitive dysfunction, Fatigue, Menstrual disorder, Motor system weakness, Dysphoria, Dysuria, Orthostatic hypotension, Tremor, Tachycardia

Special precautions and warnings during Hydrocodone and Tramadol administration:

  • Patient who have severe asthma or breathing problems, stomach or intestines blockage, or patients who have recently use alcohol, sedatives, tranquilizers, or narcotic medications should not use tramadol and hydrocodone.
  • Tramadol and Hydrocodone are more likely to cause breathing problems in older patients who are severely ill, malnourished, or if they have other risk factors.
  • Seizures can occur in some people taking tramadol. Patients who have epilepsy or other seizure disorder, a history of head injury, history of drug or alcohol addiction or metabolic disorder should talk with their doctors about seizure risk. They should also tell them if they are using certain medications to treat migraine headaches, depression, muscle spasms, mental illness, nausea and vomiting. These medications can increase the risk of seizures if they are used with tramadol at the same time.
  • These medicines should never be shared with another person, especially with someone who has a history of drug abuse or addiction.
  • Pregnant patients should never use these medicines; because their babies could become drug dependent, so life-threatening withdrawal symptoms can be caused after baby is born. Those babies may need medical treatment for several weeks. Patients should tell doctor if they are pregnant or plan to become pregnant.
  • Tramadol can pass into breast milk and harm a nursing baby. Patients should not breast-feed after administration of this medicine.
  • Hydrocodone should not be used together with Monoamine oxidase (MAO) inhibitor drugs such as: linezolid, isocarboxazid, selegiline, tranylcypromine, phenelzine, and rasagiline, and also with selective serotonin reuptake inhibitors (SSRIs) such as: fluoxetine, paroxetine and duloxetine, because dangerous drug interaction could occur.
  • Patients should tell their doctors or pharmacists what prescription and nonprescription medicines, vitamins or nutritional supplements they are taking or plan to take.
  • Patients using hydrocodone should also tell their doctors if they are using any of the following medications: antihistamines; dronedarone, medications for irritable bowel disease, Parkinson’s disease, ulcers, haloperidol, azithromycin, amiodarone, butorphanol;chlorpromazine; citalopram, laxatives such as lactulose; nalbuphine; or pentazocine and levofloxacin.
  • Patients using hydrocodone should tell their doctor if they have or have ever had hypotension, difficulties with urinating, seizure attacks, or any of the thyroid, liver, kidney, gall bladder or pancreas disease.
  • If patients are taking hydrocodone extended-release tablets, they should tell their doctor if they have or have ever had difficulties with swallowing, colon cancer, esophageal cancer, heart failure or heart rhythm problems such long QT syndrome.
  1. What is Amoxicillin prescribed for?
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Amoxicillin

Mar 29 2016 Published by under Medicines

What is Amoxicillin

Amoxicillin is an antibiotic that is used for the treatment of a variety of bacterial infections, skin and urinary tract infections, pneumonia, and strep throat.

Amoxicillin : Diseases interaction

                                                                             Amoxicillin : Structure and chemical information.

Amoxicillin generic and brand name

  • The drug is available under generic name Amoxicillin and commonly marketed under the brand name Amoxil.
  • The drug Amoxicillin was developed by Beecham and initially manufactured and marketed by SmithKline Beecham.
  • The drug became available in 1972 and was listed on the World Health Organization’s List of Essential Medicines.
  • After the expiration of patent in 1998, many pharmaceutical companies started the manufacturing of Amoxicillin such as GlaxoSmithKline, Ranbaxy, Teva, and MiddleBrook Pharmas under various generic and trade names that include Amoxicilin, Amocla, Tycil, Trimox, Actimoxi, Trimox, Moxatag, Larotid and Alphamox.

What is the source of the drug (natural or synthetic)?

  • Amoxicillin is a semi-synthetic, moderate spectrum, β-lactam class of

What is Amoxicillin prescribed for

  • Amoxicillin plays a key role in the treatment of complications related to the bacterial infections such as bronchitis, pneumonia, gonorrhoea etc.
  • The drug is also prescribed for treatments of skin infections, genitourinary tract infections, urinary tract infections and infections of ears, nose and throat .
  • It is also recommended to treat the infections of Salmonella and Chlamydia, Lyme disease, Streptococcal pharyngitis and Tonsillitis.
  • The drug is only indicated in the treatment of susceptible isolates of Streptococcus pneumoniae,Streptococcus species, Staphylococcus , and Haemophilus influenzae. However, this drug does not provide any protection against flu, cold and other viral infections.
  • Amoxicillin is also used in combination with Clarithromycin (Biaxin) to treat stomach ulcers caused by the infection of Helicobactor pylori.
  • Amoxicillin is used as dual therapy in combination with Lansoprazole as delayed-release capsules in treatment of patients with pylori infection and duodenal ulcer disease in patients who are allergic or intolerant to Clarithromycin or in whom resistance to Clarithromycin is known or suspected.
  • Amoxicillin is also used as triple therapy forHelicobacter pylori infection and duodenal ulcer disease in combination with Clarithromycin and Lansoprazole.

Pharmacophore structure: Information about the chemical structure of the drug

Amoxicillin chemically belongs to the class of organic compounds which are known as Penicillins containing penicillin core structure. Penicillin is characterized by penam ring bearing two methyl groups at position 2 and an amide group at position 6. The detailed chemical classification of Amoxicillin is described below:

Kingdom Organic compounds
Super Class Organoheterocyclic compounds
Class Lactams
Sub Class Beta lactams
Direct Parent Penicillins

Chemical information of the drug

  • Amoxicillin is a derivatives of 6-aminopenicillanic acid (6-APA) and available as a trihydrate salt.
  • It is a semi-synthetic aromatic heteropolycyclic antimicrobial agent with a molecular formula C16H19N3O5S.
  • The molecular weight of the compound is 404 g/mol.
  • Amoxicillin is available as a trihydrate salt and chemically known as (2S,5R,6R)-6-[(2R)-2-amino-2-(4-hydroxyphenyl)acetamido]-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylic acid.
  • Amoxicillin is white powder with sulphurous odour and has a water solubility of 958 mg/mL while Amoxicillin trihydrate is crystalline and off-white in color.
  • Amoxicillin trihydrate is slightly soluble in water, very slightly soluble in ethanol and practically insoluble in fatty oils.
  • The melting point of Amoxicillin is 194°C.

Amoxicillin available strength and forms

  • Amoxicillin is available in capsule, tablet, chew able tablet and oral reconstituted suspension form for oral administration.
  • Amoxicillin capsules are available in two different dosages of 250 mg and 500 mg.
  • Body of capsule is pink in color while cap is royal blue in color.
  • The capsule of 250 and 500 mg are imprinted with product name “AMOXIL” and “250” and “500” corresponding to different dosages of the drug respectively.
  • Capsule contains Amoxicillin trihydrate as an active ingredient and gelatine, magnesium stearate, titanium dioxide, D&C Red no. 28, FD&C Blue No.1 and FD&C Red No. 40 as inactive ingredients.
  • Amoxicillin tablets are available in two different dosages of 500 mg and 875 mg.
  • Amoxicillin tablets are capsule shaped, pink in color, film coated debossed with “AMOXIL” centred over “500” and “875” corresponding to different dosages of the drug respectively.
  • Amoxicillin tablets contain Amoxicillin trihydrate as an active ingredient and colloidal silicon dioxide, crospovidone, hypromellose, microcrystalline cellulose, polyethylene glycol, sodium starch glycolate, magnesium stearate, titanium dioxide and FD&C Red no. 30 as inactive ingredients.
  • Amoxicillin reconstituted suspensions are available in strength of 125, 200, 150 and 400 mg/ 5mL that contain 2.51mg, 3.39mg, 3.36mg and 4.33 mg sodium respectively.
  • Amoxicillin reconstituted suspensions contains Amoxicillin trihydrate as an active ingredient and sodium citrate, sucrose, sodium benzoate, xanthan gum, silica gel, flavourings and FD&C Red No. 3 as inactive ingredients.
  • Amoxicillin is also available in chewable tablet form in different strength of 125mg, 200mg, 250mg and 400 mg.
  • 125 mg chewable tablet is round, mottled yellow in color, lemon-lime flavoured; biconvex that contains 125mg Amoxicillin and 31.25mg clavulanic acid.
  • 200 mg chewable tablet is round, mottled pink in color, cherry-banana flavoured; biconvex that contains 200mg Amoxicillin and 28.50mg clavulanic acid.
  • 250 mg chewable tablet is round, mottled yellow in color, lemon-lime flavoured; biconvex that contains 250 mg Amoxicillin and 62.50 mg clavulanic acid.
  • 400 mg chewable tablet is round, mottled pink in color, cherry-banana flavoured; biconvex that contains 400 mg Amoxicillin and 57.0 mg clavulanic acid.

How does Amoxicillin work (mode of action)

  • Amoxicillin is bacteriolytic antibiotic (antibiotic that acts by dissolution or destruction of bacteria) that works against susceptible gram-positive and gram-negative bacteria.
  • Amoxicillin acts by inhibiting the biosynthesis of cell wall mucopeptide (protein polysaccharide component of bacterial cell wall) during bacterial cell multiplication.
  • This results in inhibition of bacterial cell wall synthesis and ultimately death due to lysis of bacteria. In this view, amoxicillin is useful only for actively growing and cell wall synthesizing bacteria.
  • In bacteria, Amoxicillin interacts and binds with penicillin-binding protein 1A (PBP-1A), which is positioned inside the bacterial cell wall.
  • After binding Amoxicillin acylates (process of adding an acyl group) the penicillin sensitive transpeptidase C-terminal domain of PBP-1A by opening the lactam ring.
  • Inactivation of PBP-1A enzyme prevents the development of a crosslink of two linear peptidoglycan strands.
  • Cross-link formation is the third and last stage of bacterial cell wall synthesis which is necessary for the cell shape and cell division.
  • Besides this, studies also suggest that Amoxicillin may interfere with autolysin inhibitors. Autolysin is bacterial cell wall autolytic enzyme that causes the lysis of bacterial cell.
  • Amoxicillin is more effective against gram positive bacteria than gram negative bacteria.
Amoxicillin: Mode of action.

                                                                                      Amoxicillin: Mode of action.

Recommended doses of Amoxicillin

The recommended dose of the drug for adult is usually 500 mg thrice a day or 875 mg twice a day.Beside these, the dose of Amoxicillin varies depending upon the age and diseased state of the patient.

  • Adult dose

    • Actinomycosis
      • 500 mg thrice or 875 mg twice a day orally for six months.
    • Anthrax prophylaxis
      • 500 mg thrice a day orally.
    • Bacterial endocarditis prophylaxis
      • 2000 mg one hour prior to procedure orally.
    • Bronchitis
      • 250-500 mg thrice a day orally for 7-10 days or 500-875 mg twice a day orally.
    • Chlamydial infection
      • 500 mg thrice a day orally for 7 days.
    • Cutaneous Bacillus anthracis
      • 500 mg thrice or 875 mg twice a day orally.
    • Cystitis
      • 250-500 mg thrice a day orally for 3 to 7 days or 500-875 mg twice a day.
    • Helicobactor pylori infection
      • 1000 mg twice or thrice a day orally.
    • Lymph disease
      • Arthritis: 500 mg trice a day orally for 14-30 days.
      • Carditis: 500 mg trice a day orally for 14-30 days.
      • Erythema chronicum migrans: 500 mg trice a day orally for 14-30 days.
      • Neurological: 500 mg trice a day orally for 14-30 days.
    • Otitis media
      • 250-500 mg thrice a day orally for 10-14 days.
    • Pneumonia
      • 500 mg thrice a day or 875 mg twice a day orally for 7-10 days.
    • Sinusitis
      • 250-500 mg thrice a day orally for 10-14 days or 500-875 mg twice a day orally.
    • Skin infection
      • 250-500 mg thrice a day orally for 7-10 days or 500-875 mg twice a day orally.
    • Tonsillitis
      • 250-500 mg thrice a day orally for 7-10 days or 500-875 mg twice a day orally.
    • Upper respiratory tract infection
      • 250-500 mg thrice a day orally for 7-10 days or 500-875 mg twice a day orally.
    • Urinary tract infection
      • 250-500 mg thrice a day orally for 3 to 7 days or 500-875 mg twice a day.
  • Paediatric dose

    • Anthrax prophylaxis
      • 80 mg/kg in divided dose orally in a day at every 8 hours.
    • Bacterial endocarditis prophylaxis
      • 50 mg/kg one hour prior to procedure.
    • Cutaneous Bacillus anthracis
      • 80 mg/kg in divided dose orally in a day at every 8 hours for only confirmed cases of cutaneous Bacillus anthracis.
    • Otitis media
      • 4 weeks to 3 months: 20-30 mg/kg in divided doses orally in a day (twice in every 12 hour).
      • 4 months to 12 years: 20-50 mg/kg in divided doses orally in a day (twice or thrice in every 12 or 8 hour respectively).
    • Pneumonia
      • 40-50 mg/kg in a day in divided doses orally (thrice daily in every 8 hour).
    • Skin infection
      • 4 weeks to 3 months: 20-30 mg/kg in divided doses orally in a day (twice in every 12 hour).
      • 4 months to 12 years: 20-50 mg/kg in divided doses orally in a day (twice or thrice in every 12 or 8 hour respectively).
    • Tonsillitis
      • 4 weeks to 3 months: 20-30 mg/kg in divided doses orally in a day (twice in every 12 hour).
      • 4 months to 12 years: 20-50 mg/kg in divided doses orally in a day (twice or thrice in every 12 or 8 hour respectively).
      • 12 years or older: 250-500 mg thrice a day orally for 7-10 days.
    • Urinary tract infection
      • 4 weeks to 3 months: 20-30 mg/kg in divided doses orally in a day (twice in every 12 hour).
      • 4 months to 12 years: 20-50 mg/kg in divided doses orally in a day (twice or thrice in every 12 or 8 hour respectively).
  • Doses in patients with renal impairment
    • CrCl 10-30 mL/min: 250-500 mg twice a day orally.
    • CrCl >10 mL/min: 250-500 mg once a day orally

When should I discontinue, withhold or modify the dose of Amoxicillin

  • The usual dosing of the drug may vary depending upon the efficiency and side effects of the drug in a particular individual.
  • Do not use the medicine if you are hypersensitive or allergic (e.g., anaphylaxis or Stevens-Johnson syndrome) to Amoxicillin or any other penicillin antibiotic such as Ampicillin, Dicloxacillin and Oxacillin.
  • Amoxicillin is contraindicated with Chloramphenicol or other antibiotics and Probenecid (Benemid).
  • Amoxicillin is also contraindicated with the use of birth control pills because Amoxicillin make birth control pills less effective.
  • Consult to your doctor if you are allergic to the Cephalosporins such as Cefzil, Ceftin, Keflex and Omnicef.
  • In case of patients with renal impairment specific recommendations and  dosing of Amoxicillin should be adjusted accordingly, since the drug is primarily eliminated through  the kidney
  • Consult with your doctor and pharmacist if you are taking any prescription and non-prescription medications or herbal products.
  • In paediatric population (neonates and young infants) dosing of Amoxicillin should be modified.
  • Clinical studies with Amoxicillin were unable to identify any significant differences in responses between the elderly and younger patients. However, higher sensitivity to Amoxicilline cannot be ruled out in older individuals.

What are the pharmacokinetic properties of the drug

  • Pharmacokinetic studies suggested that after oral administration, Amoxicillin is rapidly absorbed in gastro-intestinal tract and has a bio-availability of approximately 95%.
  • Following absorption, approximately 20% of the drug is bound to plasma proteins.
  • It has been observed that following a 500 mg dose of the drug, maximum (or peak) plasma concentration (approximately 6 mg/L) is achieved with in 1-2 hours.
  • The drug is metabolized in liver. Approximately 20-30% of the drug is metabolised into the penicilloic
  • The average median half-life of Amoxicillin is 3 minutes.
  • Approximately 80% of dose of Amoxicillin is mainly excreted in the urine of which 50-70% is uncharged (of administered dose) drug.
  • The average steady state volume of distribution of the drug is 26-0.31 L/kg.

Which pregnancy category (A; B; C; D; X) has been assigned to Amoxicillin

  • The Amoxicillin is classified by US FDA pregnancy category: B
  • Due to lack of adequate and well-controlled studies the use of Amoxicillin in pregnant women is contraindicated and recommended only when benefit justifies the risk.
  • Laboratory animal studies have revealed that the penicillin class antibiotics can penetrate through placenta but there is no evidence of adverse effect to fetus due to Amoxicillin.
  • Following Amoxicillin administration in pregnant women, a temporary decrease in plasma concentration of total estriol-glucuronide, conjugated estriol, conjugated estrone, and estradiol has been noted.
  • Studies support the excretion of the Amoxicillin into animal milk as well as in human milk. Therefore, breast-feeding is not recommended. It may lead to sensitization of infants.
  • Despite these facts caution should be exercised when taking Amoxicillin.

How to use Amoxicillin

  • Amoxicillin is available in capsule, tablets, chewable tablets and oral solution form for oral administration.
  • Amoxicillin is also available in the paediatric drop form for oral use.
  • The time duration between the drug uses should be 12 hours (twice daily use) to 8 hours (thrice daily use).
  • Liquid and paediatric dose should be shaken well before every use.
  • Amoxicillin tablets/capsules should not be chewed, split or crushed. Whole tablet/capsules should be swallowed.
  • Chewable tablets must be crushed or chewed prior to swallowing.
  • It is also recommended to take drug at almost the same time every day.
  • Follow the instructions carefully as directed on prescription leaflet and take Amoxicillin exactly as directed.
  • Do not change the dose of the drug as prescribed by your doctor since the dosage is based on patient medical condition, treatment responses and usage with other drugs.
  • Do not take more or less amount of the drug or during shorter or longer time then prescribed. Stopping Amoxicillin before time or too early may cause bacteria to become resistant to antibiotics
  • Some of the brands of Amoxicillin may be taken with or without food. Care should be taken and check your medicine leaflet for proper instruction.
  • During the course of drug, blood tests are always prescribed in order to check the kidney and liver function.
  • If you have any queries about the drug immediately consult to your doctor to get information regarding any part you do not understand.
  • It is advisable to inform your doctor if you are taking Amoxicillin. Amoxicillin sometimes may cause some unusual changes in certain medical tests.
  • Do not share Amoxicillin with any other person, even if they have the same symptoms as you have.

How to store the drug

  • Amoxicillin is stored at 25°C (77°F) and excursion permitted to 15-30°C (59-86°F).
  • Amoxicillin oral solution may be stored in refrigerator but should not be freezed.
  • The drug should be kept away from children and pets.
  • Medicine should not be stored in the bathroom.
  • Store the medicine at room temperature away from moisture, heat, and light.

How to dispose the out of date Amoxicillin medicine

  • Throw away unused and opened, outdated or no longer used container.
  • Also dispose the old medicine after the expiration date.
  • Parental drug products containing visible particulates should not be used and it is for single-use only, therefore, discard the unused portion.

Does Amoxicillin has approval from government / FDA /or any other related agencies

  • The drug Amoxicillin was approval from US Food and Drug Administration (FDA) in December 1974 to treat many types of bacterial infections such as pneumonia bronchitis, gonorrhoea and infections of ears, nose, throat, skin and urinary tract.
  • In January 2008, FDA approved Moxatag – Amoxicillin PULSYS – for treatment of Pharyngitis/Tonsillitis in young people and adults.

Other uses of the drug

  • Amoxicillin is also used for the prevention of Anthrax after exposure and treatment of Anthrax infection of the skin.
  • Amoxicillin may also be used for other uses not listed here. It is advisable to ask your doctor or pharmacist for more information.

What special dietary precautions should I follow

  • Take diet as prescribed by your doctor otherwise follow usual diet.

What special precautions should I follow/ What should I avoid while using Amoxicillin

  • Before taking Amoxicillin, tell your doctor about your medical history if you have kidney disease, liver disease, asthma, liver disease, mononucleosis (also called “mono”), a bleeding or blood clotting disorder, or any type of allergy, hay fever or hives.
  • Take medical advice if you take medication of gonorrhoea.
  • Antibiotic agent occasionally can cause diarrhea, sometimes it may be a sign of a new infection. In case if you develop diarrhea (watery or bloody), do not take anti-diarrhea medicine and immediately stop taking Amoxicillin and call your doctor.
  • Amoxicillin therapy can reduce the effect/efficacy of birth control pills. Therefore, it is advisable to consult with your physician about alternate non-hormone method of birth control (i.e. diaphragm, condom, spermicide) to prevent pregnancy.
  • Consult with your doctor if you have phenylketonuria (inherited disorder of impaired metabolism of phenylalanine).
  • It is recommended to complete the entire course of the drug (full prescribed length of time) even if the symptoms improve before the infection is completely cleared.
  • Do not stop taking Amoxicillin until you do not finish the prescription. If you do not follow the prescription or stop taking amoxicillin too early, it may lead to the development of antibiotic resistance in bacteria.
  • Consult with your doctor and pharmacist if you are taking any prescription and non-prescription medications or herbal products.
  • Amoxicillin is an antibacterial agent therefore not effective against viral infection such as the flu or common cold.
  • The drug is not recommended to be used in person who is allergic to penicillin and other beta lactam class of antibiotics.
  • Amoxicillin use during pregnancy and breastfeeding does not show any harmful effect. However, it is recommended to consult with your physician while taking Amoxicillin during pregnancy or breastfeeding.

Amoxicillin side effects

In addition to the associated benefits, Amoxicillin also is accompanied with the side effects some of which are more common, others less common whereas some that fade away with time while you take the drug. It is always recommended to consult a doctor if you encounter any of the side effects.

Some of the commonly occurring side effects but requiring medical attention is outlined as:

  • Diarrhea
  • Stomach pain
  • Vomiting

Sometime, it may cause serious side effects. Upon appearing of these symptoms stop taking the medicine and immediately talk to your doctor:

  • Excessive tiredness
  • Hives
  • Lack of energy
  • Pale skin
  • Seizures
  • Severe skin rash
  • Unusual bleeding or bruising
  • Yellowing of the skin or eyes

Besides these, Amoxicillin may also be associated with some other side effects. These include:

  • Nervous system effects: confusion, insomnia, dizziness, headache, reversible hyperactivity, agitation, anxiety, behavioral changes and aseptic meningitis.
  • Immunological effect: vulvovaginal mycotic infection, mucocutaneous candidiasis.
  • Dermatologic effects: erythematous maculopapular rashes, fixed drug eruption.
  • Gastrointestinal effects: nausea, hemorrhagic colitis, pseudomembranous colitis, abdominal pain, vomiting, diarrhoea.
  • Hematologic effect: anaemia, leukopenia, thrombocytopenia, agranulocytosis, eosinophilia and granulocytopenia.
  • Hepatic effect: jaundice, hepatic cholestatic, acute cytolytic hepatitis.
  • Renal effect: crystalluria, acute interstitial nephritis.
  • Respiratory effects: cough and rhinorrhea.

What should I do in case of overdose

  • Try to avoid taking the overdose of the drug. If you overdose the drug contact with your doctor or pharmacist for symptomatic and supportive measures.
  • In case you or some other person has taken overdose of this medication contact your local poison control center at 1-800-222-12×22 or emergency room immediately.
  • Call local emergency services at 911 in case a patient collapses or faces difficulty in breathing.

What should I do in case of missed a dose

  • In case of missed dosage, take it as soon as you remember and maintain a regular dosing schedule.
  • Skip the missed dose if it is almost time for your next scheduled dose. Keep in mind to not use a double dose to make up a missed dose.

Amoxicillin drug interactions 

The Amoxicillin may interact with one of the following drugs. Care should be taken when you are taking these medications together. It is advisable that you do not start, stop or change the medication by your own and without professional consult.

  • Probenecid: Probenecid also known as Probalan, is a uricosurics medication that increases uric acid excretion in the urine. The drug effect decreases the renal tubular secretion of Amoxicillin and therefore maintains prolonged increased blood levels of Amoxicillin.
  • Oral Anticoagulants: Oral anticoagulants are group of medicines that are used orally to prevent blood clot formations. It has been observed that patients receiving oral anticoagulants and Amoxicillin showed unusual long or prolonged prothrombin time (test that is used to check for bleeding problems. It measures how long it takes blood to clot.)
  • Allopurinol: Clinical studies have suggested that simultaneous administration of Amoxicillin and Allopurinol cause rashes. Comparative studies using Amoxicillin alone or in combination with Alopurinol showed that incidence of rashes is higher in patients receiving both drugs as compared to patients receiving Amoxicillin alone. However, the potentiation of rashes by Amoxicillin is due to Allopurinol or the hyperuricemia present in these patients is not known.
  • Oral Contraceptives: It has been observed that Amoxicillin treatment significantly affects the gut microbial flora. The gut microbial flora is involved in the hydrolysis of estrogen conjugates and thereby reduces the estrogen reabsorption in the gastrointestinal tract. Due to this, Amoxicillin also reduces the efficacy of combined oral estrogen/progesterone contraceptives.
  • Other Antibacterials: In vitro studies suggested that some antibacterial drugs such as Sulfonamides, Macrolides, Chloramphenicol and Tetracyclines may interfere with bactericidal effects of penicillin. However, this observation is not clinically well documented.

Before starting the medication, it is recommended to inform your doctor or pharmacist about your medical history, all prescription and non-prescription and herbal products you may use.

Amoxicillin Drug Interactions

Does Amoxicillin have any interaction with diseases

Chemically Amoxicillin is glucocorticoid steroid therefore it may interact with one or more than one of the following disease conditions.

  • Renal Dysfunction: Amoxicillin is a beta-lactam class of antibiotics that are eliminated by kidney as sole drug or their metabolites. Therefore, in patients with impaired renal dysfunction the total serum concentration of beta-lactam antibiotics and their metabolites is comparatively higher with prolonged half lives. In some cases nephrotoxicity and alterations in renal function have been associated with the use of Amoxicillin and other beta lactam class of drugs. In this view, caution should be taken when prescribing Amoxicillin or any other beta-lactam class of drug to patients with renal impairment. Dosage adjustments and modifications are usually suggested and are typically based on severity of infection and the degree of renal impairment. Besides this, kidney function tests are recommended periodically during prolonged and/or high-dose Amoxicillin therapy.
  • Mononucleosis: It has been observed that when patients with mononucleosis (diseased condition associated with abnormally high content of monocytes in the blood) are treated with Amoxicillin or any other Aminopenicillin antibiotic (particularly Ampicillin), they develop skin rashes (known as pruritic erythematous maculopapular). These rashes are possibly developed due to an immune-mediated process or drug metabolism and not by hypersensitive reactions. The rashes usually develop within 5-10 days following drug therapy and resolved (self limiting) within few days once therapy is discontinued. In this view, Amoxicillin and other penicillin derivatives (Aminopenicillin antibiotics) are usually avoided in patients with mononucleosis.
  • Collitis: Colitis is a medical condition caused by inflammation of large intestine and associated with growth of unusal harmful bacteria (microbial infection) and range in severity from mild to life-threatening. The disease is associated with severe, persistent diarrhea, abdominal cramps, and passage of blood and mucus. It has been observed that colitis is occasionally caused by taking antibiotics and thus named as antibiotic associated colitis. Antibiotic therapy usually associated with reduced gut microbial flora, permits overgrowth of some of the harmful bacteria over normal gut flora. Clostridium difficile is one of such bacterial species that flourish well under antibiotic therapy. Its toxin is supposed to be a primary cause of antibiotic-associated colitis. The most common antibiotics that cause colitis are Lincomycin, Amoxicillin, Ampicillin (Aminopenicillins), Clindamycin, and Cephalosporins. Besides Clostridium, Pseudomembranous colitis has also been reported with broad spectrum antibacterial agents. Thus, antibiotic therapy with Amoxicillin and other broad-spectrum antibiotics agents should be managed cautiously in patients with a history of gastrointestinal diseases, particularly colitis. In such patients, antibiotic therapy should be discontinued immediately if significant diarrhea occurs and stool assay and large bowel endoscopy recommended to establish a definitive diagnosis.
  • Anaphylactic Reactions: In some clinical observations abnormal fatal hypersensitivite (anaphylactic) reactions have been reported during Amoxicillin and other Penicillin antibiotics therapy. The anaphylactic reactions are more frequent in patients with a previous history of Penicillin hypersensitivity or sensitivity to multiple allergens. Most of cases of anaphylactic reaction are observed following parenteral therapy (dosage forms that are intended for administration as an injection or infusion). Therefore, careful examination and enquiries are necessary regarding patients history about hypersensitivity reactions to Penicillins, Cephalosporins, or other allergens. In case of allergic or hypersensitive reaction drug administration should be discontinued and appropriate therapy instituted.
  • Development of Drug-Resistant Bacteria: Antibiotic therapy of Amoxicillin in the absence of suspected bacterial infection and discontinuation of therapy before time or too early increases the risk of the development of drug-resistant bacteria.

Where can I get more information

Your pharmacist or health care provider can provide more information about Amoxicillin.

Clinical research and current scenario of the drug

  • Studies indicate the effectiveness of Amoxicillin and Clavulanic acid taken orally over classical parenteral then oral sequence for treating acute hematogenous osteomyelitis in children.
  • Pregnant women who are not able to tolerate erythromycin are generally recommended to take Amoxicillin for treating chlamydia infections.
  • Amoxicillin in combination with Penicillin V are used for the treatment of early Lyme disease (an infectious disease that is caused by bacteria of the Borrelia type).
  • Amoxicillin is advised in combination with Probenecid, and Penicillin G (parenteral) to treat the advanced stages of Lyme disease, (including arthritis, cardiac manifestations, and mild neurological manifestations) and also to treat gonorrhea (a sexually transmitted disease characterized by inflammatory discharge from the urethra or vagina) caused by Neisseria gonorrhoea.
  • Amoxicillin has been recommended in combination with bismuth subsalicylate and metronidazole, in the treatment of peptic ulcer and gastritis caused by Helicobacter pylori.
  • Amoxicillin is used to treat bacterial pneumonia and urinary tract infections caused by susceptible organisms.
  • Amoxicillin is currently also used for the treatment of typhoid fever caused by Salmonella typhi.
  • Clinical studies in pregnant women do not demonstrate any risk to the fetus during first trimester or any risk in later trimesters.
  • Studies indicate the attenuation of the effectiveness of oral contraceptive in women who take Ampicillin, Penicillin V and, Amoxicillin that results in unplanned pregnancy.
  • In vitro studies indicate the mutual inactivation in case of simultaneous use of Penicillins (including Amoxicillin) with Aminoglycosides. Hence, concurrent use of these drugs requires their administration at different sites at interval of atleast 1 hour.
  • Penicillins and Probenecid are most commonly used in combination for the treatment of sexually transmitted diseases or other infections requiring high and prolonged antibiotic serum and tissue concentrations.
  • Both in vitro and in vivo studies suggest the combination of Amoxicillin or Ampicillin with Clavulanic acid or the combination of Amoxicillin or Ampicillin with Sulbactam resulting in enhanced activity against many strains of beta-lactamase-producing bacteria.
  • Studies indicate the development of rashes in 1.4-10% of patients who receive Amoxicillin or Ampicillin treatment.
  • The frequency of occurrence of adverse dermatologic effects, including rash, urticaria (a kind of skin rash characterized by pale red, raised, itchy bumps), erythema multiforme (an inflammatory skin eruption), and pruritus (severe itching of the skin) upon the administration of Aminopenicillin is substantially higher (about 10-fold) in patients suffering from human immunodeficiency virus (HIV) infections as compared to other patients.
  • Cases of acute interstitial nephritis have been associated rarely with the consumption of Ampicillin and Amoxicillin.
  • Clinical studies indicate a significant (p < 0.0001) enhancement in the prevalence of low-birth-weight (< 2.5 kg) babies among users (9.6%) of the drug Amoxicillin in comparison to the nonusers (6.6%).
  • Amoxicillin has also been recommended for the treatment of bronchitis, sinusitis and in prophylaxis of bacterial endocarditis caused by susceptible organisms.

References from chemical, biological and toxicological databases

  • DrugBank: Amoxicillin. http://www.drugbank.ca/drugs/DB01060
  • Amoxicillin: MedlinePlus Drug Information. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a685001.html
  • amoxicillin|C16H19N3O5S–PubChem. https://pubchem.ncbi.nlm.nih.gov/compound/amoxicillin
  • amoxicillin | C16H19N3O5S – Chemspider. http://www.chemspider.com/Chemical-Structure.31006.html
  • Wikipedia. https://en.wikipedia.org/wiki/Amoxicillin
  • Effect of amoxicillin use on oral microbiota in young children. http://www.ncbi.nlm.nih.gov/pubmed/15273096
  • Pubmed health.http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0008968/
  • Amoxicillin and amoxicillin plus clavulanate: a safety review. http://www.ncbi.nlm.nih.gov/pubmed/19236222
  • Common harms from amoxicillin: a systematic review and meta-analysis of randomized placebo-controlled trials for any indication. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284189/
  • Adverse drug reactions related to amoxicillin alone and in association with clavulanic acid: http://www.ncbi.nlm.nih.gov/pubmed/17449881
  • Documenting Penicillin Allergy: The Impact of Inconsistency. http://www.ncbi.nlm.nih.gov/pubmed/26981866
  • Is amoxicillin-cotrimoxazole the most appropriate antibiotic regimen for listeria meningoencephalitis? Review of 22 cases and the literature. http://www.ncbi.nlm.nih.gov/pubmed/8889993
  • Amoxycillin: A review of its antibacterial and pharmacokinietic properties and therapeutic use. http://www.ncbi.nlm.nih.gov/pubmed/1126306
  • Antibiotics for acute maxillary sinusitis in adults. http://www.ncbi.nlm.nih.gov/pubmed/24515610
  • Antibiotic prescribing practices by dentists: a review. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909496/

Is it OK to take expired amoxicillin for a strep infection?
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Flonase and Sudafed interaction

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Can you take Gabapentin and Tylenol together

Mar 29 2016 Published by under Drug Interactions

Gabapentin and Tylenol drug interactions

What is Gabapentin

Gabapentin is a Generic name for an antiepileptic drug and anticonvulsant that is used to control certain types of seizures in patients with epilepsy.

It works by affecting chemicals and nerves in the body that are the main cause of seizures and by decreasing abnormal neural excitation in the brain.

This drug can be also used for the treatment of certain types of pain, such as nerve pain caused by herpes zoster virus also known as shingles (prolonged the stabbing and burning aches and pain that may last for months or years).

Some of gabapentin indications are also: tremor, multiple sclerosis spasticity, mood disorders, and treatment of disruptive behaviors in dementia.

Gabapentin is available in capsule and tablet dosage forms in the following strengths: 100, 300, 400, 600 and 800 mg and also in the form of solution 250 mg/5mL.

Gabapentin is a very lipophilic drug; it isn’t metabolized by the liver, it doesn’t bind to proteins, and doesn’t have usual drug interactions.

Other common Brand names on the market containing gabapentin as an active ingredient are: Gralise, Horizant, Aclonium, Neurontin and Gabarone.

Gabapentin and Tylenol PM Drug Interactions

What is Tylenol

Tylenol is a Brand name for a drug that contains acetaminophen (also known as paracetamol) that has antypiretic and analgesic properties.

It is used for reducing pain and fever and also for relieving the symptoms of common cold, cough, headache, toothache, allergies and influenza. Usual per oral doses for Tylenol are 325-650 mg. It is available in tablets, caplets and liquid dosage forms.

Tylenol products on the market are: Tylenol Extra Strength Caplets, Tylenol Regular Strength Tablets, Tylenol 8 HR Extended-Release Caplets, Tylenol 8 HR Arthritis Pain, Tylenol Sinus Congestion & Pain Caplets, Tylenol Cold Multi-Symptom Caplets and Liquid, Tylenol Cold Head Congestion Severe Caplets, Tylenol PM Caplets and Tylenol Cold Sore Throat Liquid.

Tylenol Extra Strength are caplets containing only Acetaminophen 500mg as an active ingredient that is used as a pain reliever/fever reducer.

Tylenol Cold are also caplets containing: Acetaminophen 325mg as a pain reliever/fever reducer, Dextromethorphan 10mg as a cough suppressant and Phenylephrine HCl 5mg as a nasal decongestant.

Tylenol Sinus is another Tylenol product that is used for relieving the symptoms of: sinus headache, sinus pain and pressure, sinus congestion, aches and pain and runny nose and sneezing (in Nighttime only). It is available in tablet form containing: acetaminophen 500 mg as a pain

reliever/fever reducer and phenylephrine hydrochloride, 5 mg as a nasal decongestant, and chlorpheniramine maleate 2mg as an antihistamine.

Tylenol-Codeine is a combination of acetaminophen 500 mg and codeine 8 mg that is used for relieving mild to moderate pain, fever reduce and as a cough suppressant.

Tylenol and Ibuprofen

How does Gabapentin and Tylenol work in the body

Gabapentin works by interacting with cortical neurons and subunits of voltage-sensitive calcium channels. Gabapentin increases the synaptic amount of neurotransmitter GABA, improves responses to GABA at non-synaptic sites in neuronal tissues, and reduces the release of mono-amine neurotransmitters in the brain.

One of the mechanisms implicated in this effect of gabapentin is lowering the threshold of the axon excitability in hippocampus by binding to presynaptic NMDA receptors.

Other studies have shown that the antiallodynic and antihyperalgesic that can be used for the treatment of certain types of pain and also other effects of gabapentin are mediated by the descending noradrenergic system, resulting in the activation of spinal α 2-adrenergic receptors.

Gabapentin has also been shown to bind and activate the A1 -adenosine receptor. Other neurophysiological studies have found that gabapentin can also interact with inflammatory cytokines and protein kinase C.

Acetaminophen is highly selective COX-2 inhibitor that inhibits prostaglandin synthesis. It can inhibit COX-2 in CNS. Acetaminophen also acts on the hypothalamic heat regulating centers to produce antipyresis.

Acetaminophen’s reactive metabolite N-acetyl-p-benzoquinone imine (NAPQI) can cause a potentially fatal, hepatic necrosis through the process of lipid peroxidation if acetaminophen is overdosed (more than 4g daily).

Dextromethorphan acts on cough center in medulla by decreasing sensitivity of cough receptors and by interrupting impulse transmission.

Phenylephrine is sympathomimetic with direct action on the adrenergic receptor system. The vasoconstriction is produced after α-adrenergic receptors activation.

Chlorpheniramine is antagonist of histamine H1 receptor. It has been also shown that this drug is also a serotonin-norepinephrine reuptake inhibitor.

Codeine is an opioid analgesic which is chemically related to morphine but it has less potent analgesic properties and mild sedative effects. It also acts suppress cough by centrally mechanisms.

Can patients take Gabapentin and Tylenol together

Patients without contraindications may take these drugs together for a short-term in minimum recommended Tylenol dose and only if Tylenol product doesn’t contain antihistamines or codeine.

One study showed that combination of Tylenol and Gabapentin helps to decrease postoperative pain scores with less episodes of nausea than Tylenol and gabapentin alone.

However, patients should never mixed Gabapentin with Tylenol products containing combination of acetaminophen with codeine or antihistamines such as phenylephrine, chlorphenyramine or diphenhydramine.

Using codeine or antihistamines together with Gabapentin may increase the risk of side effects such as drowsiness, confusion, dizziness, and difficulties with concentrating.

So, patients on a gabapentin therapy always need to ask their doctor or pharmacist first what Tylenol product can use together with gabapentin.

Studies also showed that Gabapentin can speed up Acetaminophens metabolism. This may cause liver problems by increasing the levels of acetaminophens hepatotoxic metabolites.

The table below shows side effects after Gabapentin and Tylenol administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.

Very common side effects >10% Dizziness (16-20%), Somnolence (16-20%), Drowsiness (5-21%), Ataxia (1-13%), Fatigue (11-15%)
Common and rare side effects 1-10% Tremor (6-10%), Diplopia (6-10%), Nystagmus (6-10%), Hostility in children (5-8%), Back pain (1-5%), Depression (1-5%), Amblyopia (1-5%), Constipation (1-5%), Dysarthria (1-5%), Dyspepsia (1-5%), Dry mouth (1-5%), Pruritus (1-5%), Rhinitis (1-5%), Vasodilation (1-5%), Weight gain (1-5%), Hyperkinesia (3-5%), Increased appetite (1-5%), Leukopenia (1-5%), Myalgia (1-5%), Nervousness (1-5%), Peripheral edema (1-5%), Anorexia (>1%), Arthralgia (>1%), Asthenia (>1%), HTN (>1%), Pharyngitis (1-5%), Abnormal vision (>1%), Malaise (>1%), Paresthesia (>1%), Purpura (>1%), Vertigo (>1%)
Frequency Not Defined Disorientation, Angioedema, Gastrointestinal hemorrhage, Laryngeal edema, Pruritic maculopapular rash, Hyperammonemia, Leukopenia, Neutropenia, Pancytopenia, Thrombocytopenia, Agranulocytosis, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Urticaria, , Thrombocytopenic purpura, Hepatotoxicity, Liver failure, Nephrotoxicity, Pneumonitis
Postmarketing reports Fever, Hyponatremia, Angioedema, Breast enlargement, Erythema multiforme, Blood glucose fluctuation, Elevated liver function tests, Jaundice, Stevens-Johnson syndrome, Changes in libido, anorgasmia

Special precautions and warnings during Gabapentin and Tylenol administration:

  • Patients should tell their doctor and pharmacist if they are allergic to Gabapentin or Tylenol or any other NSAID or any other medicines, or any of the inactive ingredients in Gabapentin and Tylenol products.
  • Patients should also tell their doctor and pharmacist what prescription and nonprescription medicines, nutritional supplements, herbal products or vitamins, they are taking or plan to take. Patients using Gabapentin should mention if they are using some of the following drugs: hydrocodone, medicines that can cause dizziness or drowsiness, morphine and naproxen. Patients taking Tylenol should mention if they are taking some of the following drugs: enalapril, fosinopril, lisinopril, benazepril, captopril, moexipril diuretics, lithium and methotrexate. Doctor may need to change the doses of these medications or monitor more carefully for side effects.
  • Patients who are using Gabapentin and antacids such as Mylanta or Maalox should take antacids at least 2 hours before they take gabapentin.
  • Patients should tell their doctor if they have or have ever had kidney or liver disease.
  • Patients should avoid alcohol while using these medications. Drinking alcohol can increase certain side effects of Gabapentin and Tylenol. Alcohol may increase the risk of liver damage while taking Tylenol.
  • Patients should tell their doctor if they are pregnant or plan to become pregnant, or are breast-feeding. Gabapentin should not be used during pregnancy and breastfeeding.
  • Gabapentin can make patients drowsy and dizzy, may slow their thinking and cause loss of coordination. They shouldn’t drive a car or operate machinery while using this drug.
  • If Gabapentin is given to a child, child’s mental abilities and behavior may change while taking gabapentin. These changes can be sudden changes in mood, hyperactivity, difficulties with concentration and attention, clumsiness and drowsiness.
  • Patient should know that their mental health can change in unexpected ways and they may become suicidal while they are using gabapentin for the treatment of epilepsy, mental illness or other conditions. So, there is a risk that patients may experience changes in their mental health, but there may also be a risk that they will experience changes in their mental health if their helath condition is not treated. Decision should be made whether the risks of taking an anticonvulsant are greater than the risks of not taking it.
  • Acetaminophen overdose can lead to acute liver failure. Acetaminophen administration shouldn’t exceed the doses of 4g per day.
  • Patients should tell their doctor if they have ever had a rash while taking acetaminophen.
  • Patients with phenylketonuria should avoid these medicines.
  • Patients should also know that combination acetaminophen products for cough and colds containing cough suppressants expectorants, nasal decongestants and antihistamines, should not be used in children younger than 2 years of age. In children 2 through 11 years of age such combinations should be used carefully and only according to the directions on the label.
  • Tylenol can cause unusual results with certain laboratory tests for glucose in the urine.
  • Patients should avoid becoming dehydrated or overheated during exercises. Chlorpheniramine can decrease sweating and patients could become more prone to heat stroke
  • Patients should avoid these medications if they also take caffeine pills, diet pills, or other stimulants. Taking decongestants (pseudoefedrine, phenylephrine) together with stimulants can increase the risk of unpleasant side effects

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Can Omeprazole be taken with Amoxicillin

Mar 26 2016 Published by under Drug Interactions

What is Omeprazole

Omeprazole is a proton pump inhibitor that acts through blocking gastric acid secretion. The drug was approved by FDA in September, 1989 and grouped in World Health Organization’s List of the essential medications required in a basic health system.

Chemically, Omeprazole is a pro drug, which means normally it is biologically inactive agent that produces a drug only upon metabolization inside the body.

The generic name of the drug is Omeprazole, Omeprazole/Sodium bicarbonate and is available under several brand names such as Prilosec, Omesec, Prilosec OTC, Zegerid, Zegerid OTC etc.

Chemically, Omeprazole belongs to a class of organic compounds known as sulfinylbenzimidazoles (containing a sulfinyl group attached at the position 2 of a benzimidazole moiety).

Prescription Omeprazole is available as a delayed-release capsule (10, 20 and 40 mg), and packets of delayed-release granules (20 and 40 mg) for suspension, whereas nonprescription (over-the-counter) Omeprazole comes in the form of a delayed-release capsule or tablet (20 mg) to be taken by mouth.

The dose of the drug depends upon the disease, age and weight. The active ingredient in the delayed-release capsule and delayed-release granule (oral suspension) are Omeprazole and Omeprazole magnesium respectively.

What is Omeprazole

What is Amoxicillin

Amoxicillin is a beta lactam class of antibiotic that is primarily used for the treatment of a variety of bacterial infections. Besides bacterial infections, the drug is also prescribed for skin and urinary tract infections, pneumonia, and strep throat.

The drug is commonly available under generic name Amoxicillin and marketed under the various brand names such as Amoxil, Tycil, Trimox,  Amocla,  Actimoxi, Moxatag, Larotid  and Alphamox.

The drug was first available in 1972 and was listed on the World Health Organization’s List of Essential Medicines. Amoxicillin chemically belongs to the Penicillins class of drugs and characterized by the presence of penam ring.

The drug Amoxicillin is available in various forms such as capsule, tablets, oral solution and pediatric drops for oral uses. The recommended dose of Amoxicillin in adult is 500 mg thrice a day or 875 mg twice a day. However, the dose varies depending upon patient and diseased state.

What is Amoxicillin

How does Omeprazole and Amoxicillin work

The Omeprazole drug is a benzimidazole, which is a selective and irreversible proton pump inhibitor. The proton pumps are integral membrane proteins that are capable of moving protons across a biological membrane.

In stomach, proton pumps (such as hydrogen-potassium (H+/ K+) ATPase enzyme system) are present at the secretory surface of parietal cells in the stomach and involved in pronounced and long-lasting production of gastric acid or gastric juice.

The gastric acid is composed of hydrochloric acid (HCl), potassium chloride (KCl) and sodium chloride (NaCl). Omeprazole results in the suppression of gastric acid secretion by formation of a stable disulfide bond with the sulfhydryl group of the hydrogen-potassium (H+/ K+) ATPase enzyme system, thus inhibiting the final step in the acid production i.e., transport of hydrogen ions (via exchange with potassium ions) into the gastric lumen.

Due to its mode of action the Omeprazole is generally prescribed to be taken atleast one hour before meals. The drug (prescription) is prescribed either alone or in combination with other medications in therapy of acid-induced inflammation, gastroesophageal reflux disease (GERD), stomach and duodenum ulcers, erosive esophagitis, Zollinger-Ellison Syndrome (gastrin-producing tumour), and heartburn.

Similar to penicillin and other beta lactam class of drugs Amoxicillin acts against susceptible bacteria during the stage of active multiplication.

It acts on the bacteria through blocking or inhibiting the biosynthesis of cell wall mucopeptide (protein polysaccharide component of bacterial cell wall) during bacterial cell multiplication.

In bacterial cell wall Amoxicillin interacts with penicillin-binding protein 1A (PBP-1A) and inactivate it through acylation.  PBP-1A enzyme is involved in crosslinking of two linear peptidoglycan strands or polymer chain.

Inactivation of PBP-1 results in complete loss of development of cross-link formation and inhibition of cell wall biosynthesis that leads to the death of the bacteria.

Amoxicillin is primarily used for the treatment of bacterial infections such as bronchitis, pneumonia, gonorrhoea etc. Besides, this the drug is also  recommended to treat the infections of Salmonella and Chlamydia, Lyme disease, Streptococcal pharyngitis and Tonsillitis.

Omeprazole and amoxicillin

Can both Omeprazole and Amoxicillin be taken together in combination

Yes. Omeprazole can be taken in combination with Amoxicillin.  Dual combination therapy of proton pump inhibitor Omeprazole with beta lactam antibiotic Amoxicillin has been widely used as an alternative to treat gastric ulcer and other diseases associated with Helicobacter pylori infection.

Omeprazole – Amoxicillin regimen is strongly recommended and widespread routine use for the treatment and prevention of reoccurrence of ulcers caused by H. pylori.

In dual therapy, Omeprazole inhibits transport of hydrogen ions into the gastric lumen and suppressing gastric acid secretion, while Amoxicillin interrupts the synthesis of bacterial cell wall, thus cause weakening of the bacterial cell wall and cell lysis.

Amoxicillin show several advantages over other antibiotics such as high tolerability and digestibility, lack of resistance of H.pylori and potent activity and efficacy in eradicating H.pylori.

The dual therapy at a daily dose of Omeprazole (3×40=120 mg) along with Amoxicillin (750×3=1050 mg) for 14 days showed eradication rate of H. pylori over 90%. Omeprazole and Amoxicillin therapy is almost comparable to triple therapy of Omeprazole in combination with two antibiotics.

Clinical research and current scenario of Omeprazole –Amoxicillin dual therapy

  • In controlled human trials Amoxicillin at a dose of 15.6 mg/kg/day (Omeprazole-Amoxicillin combined therapy) showed favourable therapeutic effects to the eradication of pylori in gastrectomized patients who were H. pylori positive.
  • It has been observed that dual treatment with proton pump inhibitor Omeprazole plus Amoxicillin could cure pylori infection even after the failure to cure H. pylori infection by a usual proton pump inhibitor-based triple therapy in patients with the wt/wt homozygous extensive metabolizer genotype of CYP2C19.
  • Double-blind, multicenter evaluation of Omeprazole-Amoxicillin dual therapy have revealed the cure of Helicobacter pylori infection in 67% of the patients. Besides Omeprazole, this study also revealed significant improvement in patients when Lansaprazole replace Omeprazole.
  • Similarly, another double-blind trial of Omeprazole and Amoxicillin combination has revealed this therapy as a promising combination to cure Helicobacter pylori infection in patients with duodenal ulcers. It has been noted that dual therapy at a dose of 120 mg Omeprazole daily and 25 g Amoxicillin daily showed H. pylori cure rate of around 90% and it is one of the best tolerated and most effective treatment regimens.
  • Currently, Amoxicillin is also used as triple therapy forHelicobacter pylori infection and duodenal ulcer disease in combination with Clarithromycin and Lansoprazole.

Can Omeprazole be taken with Amoxicillin Can Amoxicillin be taken with Omeprazole

Safety and precautions while taking Omeprazole-Amoxicillin combination

  • The usual dosing of the drug in combination may vary depending upon the efficiency and side effects of the drug in a particular individual. Therefore, it is advisable to discuss all the health related issues with your doctor before taking Omeprazole in combination with Amoxicillin.
  • Omeprazole tablets, delayed release capsule or oral suspension are usually recommended at a dose of 20mg once, twice, or thrice a day before a meal.
  • The Amoxicillin tablets are usually prescribed before or after food and time duration between the drug use should be 12 hours (twice daily use) to 8 hours (thrice daily use).
  • Omeprazole and Amoxicillin can be taken together at the same time to treat an ulcer associated with pylori infection. However, the dose should be adjusted by professional healthcare, if needed.
  • Do not use the medicine if you are hypersensitive or allergic (e.g., anaphylaxis or Stevens-Johnson syndrome) to Amoxicillin or any other penicillin antibiotic (such as Ampicillin, Dicloxacillin and Oxacillin) or substituted benzimidazoles or to any ingredient of the drug formulation.
  • The Omeprazole and Amoxicillin may interact with other drugs. Therefore, care should be taken when you are taking any prescription or non-prescription medicines and herbal or vitamin supplements. It is advisable that you do not start, stop or change or take any medicine unless you have discussed with your doctor or professional consult.
  • It has been observed that Omeprazole may cause a serious type of allergic reaction when used in combination with antibiotics. In case of allergic hypersensitive reactions such as itching, trouble breathing or swallowing, or any swelling of your hands, face, or mouth, it is advisable to call your doctor right away.
  • Before taking Omeprazole-Amoxicillin, tell your doctor about your medical history if you have kidney disease, liver disease, asthma, liver disease, mononucleosis (also called “mono”), a bleeding or blood clotting disorder, or any type of allergy, hay fever or hives. Do not stop taking Amoxicillin until you do not finish the prescription. If you do not follow the prescription or stop taking amoxicillin too early, it may lead to the development of antibiotic resistance in bacteria.
  • The use of Omeprazole and Amoxicillin may sometimes increase the risk of Clostridium difficile-associateddiarrhea (CDAD).  If you experience symptom of diarrhea that does not seem to improve seek immediate medical attention.
  • Antibiotic therapy of Amoxicillin in the absence of suspected bacterial infection and discontinuation of therapy before time or too early increases the risk of the development of drug-resistant bacteria.
  • It has been observed that colitis is occasionally caused by taking antibiotics (antibiotic associated colitis). Antibiotic therapy usually associated with reduced gut microbial flora, permits overgrowth of some of the harmful bacteria over normal gut flora. Clostridium difficile is one of such bacterial species that flourish well under antibiotic therapy. Its toxin is supposed to be a primary cause of antibiotic-associated colitis. Thus, antibiotic therapy with Amoxicillin and other broad-spectrum antibiotics agents should be managed cautiously in patients with a history of gastrointestinal diseases, particularly colitis.

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