Lancid Kit set of pills and capsules 56 pcs
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Active ingredients
Lansoprazole + Amoxicillin + Clarithromycin
Composition
Tablets, film coated yellow, oval in shape, with a risk on one side; the color of the pills on the break is white (2 pieces in a blister). 1 tab. clarithromycin 500 mg Auxiliary substances: microcrystalline cellulose 31.5 mg, corn starch 8.9 mg, sorbic acid 1.1 mg, sorbitan and oleate 2 mg, povidone 30 mg, silicon dioxide colloidal 8 mg, magnesium stearate 11 mg, talc 24 mg, croscarmellose sodium 55 mg , stearic acid 20 mg. The composition of the film shell: hypromellose 20.65 mg, titanium dioxide 4.75 mg, propylene glycol 3.2 mg, quinoline yellow dye 0.195 mg, vanilla flavoring 1.2 mg. Hard gelatin capsules, yellow body, cap dark red; on the case there is an inscription "500", on the lid there is an inscription "AMOXI", made in black ink; capsule size - No0 (4 pieces in a strip). 1 caps Amoxicillin 500 mg which corresponds to the content of amoxicillin trihydrate 588 mg. Excipients: magnesium stearate 5 mg, talc 8 mg, sodium lauryl sulfate 3 mg. The composition of the capsule cap: propyl parahydroxybenzoate 0.2 mg, methyl parahydroxybenzoate 0.8 mg, water 14-15 mg, gelatin q.s., titanium dioxide 0.8132 mg, dye brilliant blue 0.0062 mg, dye sun-sunset yellow 0.0495 mg. The composition of the capsule body: propyl parahydroxybenzoate 0.2 mg, methyl parahydroxybenzoate 0.8 mg, water 14-15 mg, gelatin q.s., titanium dioxide 1.6266 mg, iron dye yellow oxide 0.9999 mg. The composition of the black ink is: ethanol 29-33%, isopropanol 9-12%, butanol 4-7%, shellac 24-28%, iron dye black oxide 24-28%, ammonia aqueous 1-3%, propylene glycol 0.5-2%. Enteric solid gelatin capsules, No1, with body and cap in pink color and black inscription "MICRO / MICRO"; the contents of the capsules are white or almost white granules (pellets) (2 pcs. in a strip). 1 caps lansoprazole 30 mg Excipients: mannitol 41.11 mg, sucrose 123.22 mg, povidone 1.09 mg, microspheres from sucrose 38.19 mg, sodium hydrogen phosphate 2.08 mg, carmellose calcium 10.41 mg, magnesium hydroxycarbonate 5.3 mg, polysorbate 80 0.99 mg, hypromellose 25.58 mg, titanium dioxide 2.19 mg, methacrylic acid polymer 65.78 mg, talc 8.77 mg, diethyl phthalate 8.11 mg, sodium hydroxide 0.44 mg. The composition of the capsule body: gelatin 38.9575 mg, sodium lauryl sulfate 0.0376 mg, propyl parahydroxybenzoate 0.376 mg, methyl parahydroxybenzoate 0.094 mg, titanium dioxide 0.712 mg, dye crimson (Ponce 4R) 0.0078 mg, water 6.815 mg.The composition of the capsule cap: gelatin 24.0376 mg, sodium lauryl sulfate 0.0232 mg, propyl parahydroxybenzoate 0.058 mg, methyl parahydroxybenzoate 0.232 mg, titanium dioxide 0.4393 mg, dye crimson (Ponso 4R) 0.0048 mg, water 4.205 mg.
Pharmacological effect
Lancid - anti-ulcer. Inhibits H + - K + ATPase (proton pump) of parietal cells, blocks the final stage of formation of hydrochloric acid, inhibits basal and stimulated secretion.
Indications
- peptic ulcer of the stomach and duodenum (treatment and eradication therapy of Helicobacter pylori infection).
Contraindications
- hypersensitivity to any component of drugs (the main substance and / or auxiliary components), to macrolides, to penicillins, cephalosporins, carbapenems; - simultaneous administration of clarithromycin with the following drugs: astemizole, cisapride, pimozide, terfenadine; with ergot alkaloids, for example, ergotamine, dihydroergotamine; with midazolam for oral use; - simultaneous administration of clarithromycin with HMG-CoA reductase inhibitors (statins), which are largely metabolized by the CYP3A4 isoenzyme (lovastatin, simvastatin), due to the increased risk of myopathy, including rhabdomyolysis; - simultaneous use of clarithromycin with colchicine in patients with impaired liver and kidney function; - patients with a history of prolonged QT interval, ventricular arrhythmia or ventricular tachycardia of the "pirouette" type; - patients with hypokalemia (risk of prolonged QT interval); - patients with severe hepatic insufficiency occurring simultaneously with renal insufficiency; - patients with cholestatic jaundice / a history of hepatitis, developed with the use of clarithromycin; - with porphyria; - during breastfeeding and pregnancy; - to patients with atopic dermatitis, asthma, pollinosis, infectious mononucleosis, lymphocytic leukemia, liver failure, gastrointestinal tract history (especially colitis associated with the use of antibiotics) - children under the age of 18. - in the presence of sucrase / isomaltase deficiency, fructose intolerance, glucose-galactose malabsorption. severe liver failure moderate and severemyasthenia gravis (possibly increased symptoms), concurrent use with drugs that are metabolized by a CYP3A aktivisth technologist aktiva (a), a carbamazepine, cilostazol, cyclosporine, disopyramide, methylprednisolone, omeprazole, indirect anticoagulants (for example, warfarin), quinidine, rifab, indirect anticoagulants (for example, warfarin) ; simultaneous use with drugs that induce CYP3A4 isoenzyme (for example, rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's wort); simultaneous administration with benzodiazepines, such as alprazolam, triazolam, midazolam for intravenous use; simultaneous use with calcium channel blockers that are metabolized by the CYP3A4 isoenzyme (for example, verapamil, amlodipine, diltiazem); patients with coronary heart disease (CHD), severe heart failure, hypomagnesemia, severe bradycardia (less than 50 beats / min), as well as patients simultaneously taking antiarrhythmic drugs of class IA (quinidine, procainamide) and class III (dofetilide, amiodarone, sotalol), advanced age, history of bleeding, allergic reactions (including history), concomitant therapy with clopidogrel.
Dosage and administration
Inside Take 500 mg (1 tablet) of clarithromycin, 1000 mg of amoxicillin (2 capsules) and 30 mg of lansoprazole (1 capsule), twice a day, morning and evening, before meals. Tablets and capsules should not be crushed and chewed, they should be swallowed whole. The duration of treatment is 7 days, if necessary, can be increased to 14 days. Each blister of the drug Lankid Kit contains two pills of clarithromycin (500 mg), four capsules of amoxicillin (500 mg) and 2 capsules of lansoprazole (30 mg) and is designed for one day of treatment. One package contains 7 blisters and is designed for one course of treatment.
Side effects
The following adverse events are distributed by frequency of occurrence in accordance with the following gradation: very often (1/10), often (from 1/100 to <1/10), infrequently (from 1/1000 to <1/100), rarely ( from 1/10000 to <1/1000), very rarely (<1/10000). Clarithromycin Infectious and parasitic diseases: rarely - candidiasis, gastroenteritis, development of superinfection (with prolonged or repeated use of clarithromycin), vaginal infections; frequency is unknown - pseudomembranous colitis, erysipelas, erythrasma. Disorders of the blood and lymphatic system: infrequently - leukopenia, neutropenia, thrombocythemia, eosinophilia; frequency is unknown - agranulocytosis, thrombocytopenia.Immune system disorders: infrequently, hypersensitivity; frequency unknown - anaphylactic reaction. Metabolic and nutritional disorders: infrequently - anorexia, loss of appetite; frequency is unknown - hypoglycemia (including while taking hypoglycemic drugs). Mental disorders: often - insomnia; infrequently - anxiety, nervousness; frequency is unknown - psychosis, confusion, depersonalization, depression, disorientation, hallucinations, "nightmarish" dreams, mania. Violations of the nervous system: often - a change in taste (dysgeusia), headache; infrequently - dizziness, loss of consciousness, drowsiness, tremor; frequency is unknown - convulsions, loss of taste, sense of smell, loss of smell, paresthesia. Disturbances from an organ of hearing and labyrinth disorders: infrequently -vertigo, hearing impairment, noise, ringing in the ears; frequency is unknown - hearing loss (passing after discontinuation of the drug). Cardiac abnormalities: infrequently - prolongation of the QT interval on the electrocardiogram, heartbeat; frequency is unknown - ventricular tachycardia of the "pirouette" type, ventricular tachycardia, fluttering and ventricular fibrillation. Vascular disorders: frequency unknown - unusual bleeding, hemorrhage. side of the gastrointestinal tract: often - diarrhea, vomiting, dyspepsia, nausea, abdominal pain, rarely - gastroesophageal reflux disease, gastritis, proctalgia, stomatitis, glossitis, abdominal distension, constipation, dry mouth, belching, flatulence, frequency unknown - acute pancreatitis, discoloration of the tongue and teeth Disorders of the liver and biliary tract: often - an atypical functional liver test, rarely - cholestasis, hepatitis, increased ALT activity, increased AST activity, increased GGT activity; frequency unknown - hepatic failure, hepatocellular jaundice Disorders of the skin and subcutaneous tissues: often - rash, increased sweating; infrequently - itching, urticaria, maculopapular rash; frequency is unknown - malignant exudative erythema (Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome), drug rash with eosinophilia and systemic manifestations, acne, Schoenlein-Henoch purpura.Disorders of the musculoskeletal and connective tissues: infrequently - muscle spasm, myalgia; frequency is unknown - rhabdomyolysis, myopathy, increased symptoms of myasthenia gravis. Disturbances from the kidneys and urinary tract: very rarely, renal insufficiency, interstitial nephritis. General disorders and disorders at the injection site: infrequently - malaise, fever, asthenia, chest pain, chills, weakness. Laboratory indicators: infrequently - increased activity of alkaline phosphatase, increased activity of LDH in the blood; very rarely, hypercreatininemia; the frequency is unknown - an increase in the international normalized ratio (MHO), an increase in prothrombin time, a change in urine color, an increase in bilirubin concentration. Amoxicillin Infectious and parasitic diseases: infrequently - the development of superinfection, oral mucosa candidiasis, vaginal candidiasis. Blood and lymphatic system disorders: rarely, eosinophilia, hemolytic anemia; very rarely - leukopenia, neutropenia, grandiocytopenia, thrombocytopenia, pancytopenia, anemia, myelosuppression, agranulocytosis, a reversible increase in prothrombin time and bleeding time. Immune system disorders: rarely - laryngeal edema, serum sickness, allergic purpura, anaphylactic reaction. Nervous system disorders: infrequently - headache; rarely, excitement, anxiety, insomnia, ataxia, confusion, hyperkinesia, behavioral changes, depression, peripheral neuropathy, dizziness, convulsions (in patients with impaired renal function, epilepsy or meningitis). Disorders of the gastrointestinal tract: often - nausea, loss of appetite, vomiting, flatulence, soft stools, diarrhea, a rash on the oral mucosa, dry mouth, distorted taste perception; rarely darkening of the tooth enamel; very rarely - pseudomembranous colitis, black "hairy" tongue. Disorders of the liver and biliary tract: infrequently - a reversible increase in the activity of "liver" transaminases; rarely - hepatitis, cholestatic jaundice. Violations of the skin and subcutaneous tissues: often - skin rashes, itching, urticaria; rarely - angioedema (Quincke's edema), polymorphic erythema, acute generalized exanthematous pustulosis, toxic epidermal necrolysis (Lyell's syndrome), malignant exudative erythema (Stevens-Johnson syndrome), exfoliative dermatitis and bullous.Renal disorders: rarely - acute interstitial nephritis, crystalluria. General disorders and disorders at the injection site: rarely - drug fever. Lansoprazol Disorders of the blood and lymphatic system: infrequently - thrombocytopenia, eosinophilia, leukopenia; rarely - anemia; very rarely - agranulocytosis, pancytopenia. Immune system disorders: very rarely - anaphylactic shock. Metabolic and nutritional disorders: rarely anorexia; frequency unknown - hypomagnesemia. Mental Disorders: Infrequently - Depression; rarely - insomnia, hallucinations, confusion. Nervous system disorders: often - headache, dizziness; rarely - anxiety, vertigo and paresthesia, drowsiness, tremor. Violations of the organ of vision: rarely - visual disturbance. Disorders of the gastrointestinal tract: often - nausea, diarrhea, abdominal pain, constipation, vomiting, flatulence, dry mouth or throat; rarely - glossitis, esophageal candidiasis, pancreatitis, a violation of taste perception; very rarely - colitis, stomatitis. Disorders of the liver and biliary tract: often - increased activity of "liver" transaminases; rarely - hepatitis, jaundice; very rarely, hyperbilirubinemia. On the part of the respiratory system: rarely - cough, pharyngitis, rhinitis, upper respiratory tract infection, flu-like syndrome. Violations of the skin and subcutaneous tissues: often - urticaria, itching, rash; rarely - petechiae, purpura, alopecia, angioedema (angioedema), polymorphic erythema, photosensitization; very rarely, malignant exudative erythema (Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome). Disorders of the musculoskeletal and connective tissues: infrequently - arthralgia, myalgia, fracture of the hip, wrist or spine. Kidney and urinary tract disorders: rarely interstitial nephritis. Disorders of the genital organs and breast: rarely - gynecomastia, impotence. General disorders and disorders at the injection site: often - weakness; infrequently - swelling; rarely fever, increased sweating. Laboratory indicators: very rarely - increased cholesterol and triglycerides, hyponatremia.
Overdose
Clarithromycin Symptoms: abdominal pain, nausea, vomiting, diarrhea, may cause headache, confusion. Treatment: gastric lavage, supportive therapy. Not removed during hemo- or peritoneal dialysis. Amoxicillin Symptoms: nausea, vomiting, diarrhea, violation of water and electrolyte balance (as a result of vomiting and diarrhea), crystalluria. Treatment: gastric lavage, activated carbon, saline laxatives, drugs to maintain water and electrolyte balance; hemodialysis.
Interaction with other drugs
Clarithromycin When co-administered with clarithromycin and drugs that are primarily metabolized by CYP3A isoenzymes, a mutual increase in their concentrations is possible, which can enhance or prolong both therapeutic and side effects. Concomitant use with astemizol, cisapride, pimozide, terfenadine, ergotamine and other ergot alkaloids, alprazolam, midazolam, triazolam is contraindicated. Take care of the carbs cytochrome P450). Correction of the dose of drugs and control of plasma concentration is necessary. When combined with cisapride, pimozide, terfenadine and astemizole, they can increase the plasma concentration of the latter, prolong the QT interval and develop cardiac arrhythmias, including ventricular paroxysmal tachycardia, fibrillation, atrial flutter or ventricular fibrillation, as well as to go through the same time for the polymorphic tachycardia, fibrillation, atrial flutter, ventricular fibrillation, wrist swelling, wrinkling, ventricular paroxysmal tachycardia, fibrillation, atrial flutter, ventricular fibrillation, wrist tissue, ventricular paroxysmal tachycardia, fibrillation, atrial flutter or ventricular fibrillation; "Contraindications"). A similar mechanism of interaction is observed when using drugs that are metabolized by another isoenzyme of the cytochrome P450 system - phenytoin, theophyll on and valproic acid. When concomitant administration of the above drugs require monitoring of their concentrations in the blood plasma, and ECG. Clarithromycin can reduce triazolam clearance and thus enhance its pharmacological effects of developmental confusion and sleepiness.For benzodiazepines, the elimination of which does not depend on CYP3A4 isoenzymes (temazepam, nitrazepam, lorazepam), a clinically significant interaction with clarithromycin is unlikely. There are reports of an increase in the concentration of digoxin in the blood plasma of patients who received both digoxin and clarithromycin. The content of digoxin in the blood plasma should be constantly monitored in order to avoid digitalis intoxication and the development of potentially lethal arrhythmias. Combined use with ergotamine and dihydroergotamine (ergot derivatives) can lead to acute ergotamine intoxication, manifested by severe peripheral vasospasm, ischemia of the limbs and other tissues, including the central nervous system, and perverted sensitivity. While taking clarithromycin with HMG-CoA reductase inhibitors - lovastatin and simvastatin - rare cases of rhabdomyolysis are described. Efavirenz, nevirapine, rifampicin, rifabutin, and rifapentin (cytochrome P450 inducers) reduce the concentration of clarithromycin in the blood plasma and weaken its therapeutic effect, and at the same time increase the concentration of 14 (R) -hydroxylarithromycin. When co-administration of fluconazole at a dose of 200 mg and clarithromycin at a dose of 1 g / day, the equilibrium concentration and clarithromycin AUC can be increased by 33% and 18%, respectively. Correction dose of clarithromycin is not required. Attention should be paid to the possibility of cross-resistance between clarithromycin and other macrolide antibiotics, as well as lincomycin and clindamycin. Simultaneous administration of clarithromycin and zidovudine in adult HIV-infected patients may lead to a decrease in the equilibrium level of zidovudine concentration. Selection of clarithromycin and zidovudine is necessary. With the simultaneous appointment of clarithromycin and ritonavir, atazanavir or other protease inhibitors, the plasma concentrations of both clarithromycin, which in this case should not be administered in doses above 1 g / day, and the protease inhibitor increase. When co-administration of clarithromycin and itraconazole, a mutual increase in the concentration of drugs in the blood plasma is possible. Patients at the same time taking itraconazole and clarithromycin, should be carefully monitored due to the possible enhancement or lengthening of the pharmacological effects of these drugs.With simultaneous administration of clarithromycin (1 g / day) and saquinavir (in soft gelatin capsules, 1200 mg 3 times a day), the AUC and equilibrium concentration of saquinavir may increase by 177% and 187%, respectively, and clarithromycin by 40%. When these two medicines are given together for a limited time in the doses / dosage forms indicated above, no dose adjustment is required. Since co-administration of colchicine, which is a substrate for CYP3A and P-glycoprotein, and clarithromycin, as well as other macrolides - inhibitors of CYP3A and P-glycoprotein, inhibition may lead to an increase in the action of colchicine, patients should be carefully monitored to identify the toxic effects of colchicine . When using clarithromycin with tolterodine in patients with low CYP2D6 isoenzyme, it may be necessary to reduce the dose of tolterodine in the presence of clarithromycin (an inhibitor of isoenzymes CYP3A). When co-administered with clarithromycin and verapamil, blood pressure reduction, bradyarrhythmia, and lactic acidosis are possible. When etravirine is used, the concentration of clarithromycin decreases, but the concentration of the active metabolite 14 (R) -hydroxylarithromycin increases. When combined with clarithromycin and oral hypoglycemic agents and / or insulin, severe hypoglycemia may occur. Against the background of simultaneous administration of clarithromycin and certain drugs that reduce the concentration of glucose, such as nateglinide, pioglitazone, repaglinide, and rosiglitazone, CYP3A isoenzyme inhibition of clarithromycin may occur, resulting in hypoglycemia. A careful monitoring of glucose concentration is recommended. Amoxicillin Antacids, glucosamine, laxatives, aminoglycosides, food slow down and reduce the absorption of amoxicillin; ascorbic acid increases absorption. Probenecid reduces the excretion of amoxicillin by the kidneys and increases the concentration of amoxicillin in bile and plasma. Bactericidal antibiotics (including aminoglycosides, cephalosporins, vancomycin, rifampicin) - synergistic effect; bacteriostatic drugs (macrolides, chloramfinecol, lincosamides, tetracyclines, sulfonamides) - antagonistic.When taking amoxicillin in combination with metronidazole, there is nausea, vomiting, anorexia, diarrhea, constipation, epigastric pain, digestive disorders, in rare cases jaundice, interstitial nephritis, impaired hemopoiesis. Amoxicillin increases the effectiveness of indirect anticoagulants (suppressing the intestinal microflora, reduces the synthesis of vitamin K and the prothrombin index), which leads to an increase in blood clotting time. If necessary, adjust the dose of indirect anticoagulants. The simultaneous use of amoxicillin and allopurinol increases the risk of skin rash. Amoxicillin reduces clearance and increases the toxicity of methotrexate, probably because of the competitive inhibition of tubular renal secretion of methotrexate by amoxicillin. In patients receiving both amoxicillin and methotrexate, plasma concentrations of the latter should be carefully monitored. Perhaps an increase in the time of absorption of digoxin during therapy with amoxicillin. If necessary, conduct a dose adjustment of digoxin. Diuretics, allopurinol, oxyphenbutazone, phenylbutazone, nonsteroidal anti-inflammatory drugs and other drugs that block tubular secretion, increase the concentration of amoxicillin in the blood plasma. Amoxicillin reduces the concentration of estrogen and progesterone in the blood plasma, which can lead to a loss of the contraceptive effect of oral contraceptives. During treatment with amoxicillin, additional non-hormonal methods of contraception should be used. Lansoprazole Lansoprazole slows down the elimination of drugs metabolized in the liver by microsomal oxidation (including diazepam, phenytoin, indirect anticoagulants). Reduces theophylline clearance by 10%. Slows down the pH-dependent absorption of drugs belonging to the groups of weak acids, and accelerates the absorption of drugs belonging to the groups of bases. It prevents the absorption of ketoconazole, itraconazole, ampicillin, iron salts, digoxin. Lansoprazole slows down the absorption of cyanocobalamin. Compatible with ibuprofen, indomethacin, diazepam, propranolol, warfarin, oral contraceptives, phenytoin, prednisolone.Sucralfate reduces the bioavailability of lansoprazole by 30%, therefore it is necessary to observe the interval between taking these medicines for 30-40 minutes. Antacids should be prescribed 1 hour before or 1-2 hours after taking lansoprazole, as they slow down and reduce its absorption. Volunteers who simultaneously received 60 mg of lansoprazole and 400 mg of atazanavir per day showed a 90% decrease in the AUC and Cmax of the latter. Lansoprazol should not be administered simultaneously with atazanavir. Ritonavir (substrate and inhibitor of CYP2C19) can vary variably affect the AUC of lansoprazole (increase or decrease). If necessary, concomitant therapy is recommended control of therapeutic and possible side effects, as well as dose adjustment of lansoprazole. Simultaneous administration of lansoprazole and tacrolimus (substrate of CYP3A4 isoenzyme and P-glycoprotein) leads to an increase in plasma concentration of the latter (up to 81%). Plasma tacrolimus should be monitored with simultaneous administration with lansoprazole. Simultaneous administration of fluvoxamine (an inhibitor of the isoenzyme CYP2C19) and lansoprazole leads to a fourfold increase in the concentration of the latter in the blood plasma. Rifampicin and St. John's wort (induce CYP2C19 and CYP3A4 isoenzymes) can significantly reduce plasma concentrations of lansoprazole.
special instructions
Before starting therapy, it is necessary to exclude the presence of a malignant process (especially in case of a stomach ulcer), since treatment, masking the symptoms, may delay the correct diagnosis. Clarithromycin Prolonged use of antibiotics can lead to the formation of colonies with an increased number of insensitive bacteria and fungi. When superinfection is necessary to prescribe the appropriate therapy. When using clarithromycin, hepatic dysfunction has been reported (elevated plasma enzyme concentrations of hepatic enzymes, hepatocellular and / or cholestatic hepatitis with or without jaundice). Hepatic dysfunction can be severe, but usually is reversible. There are cases of fatal liver failure, mainly related to the presence of serious comorbidities and / or the simultaneous use of other medicines. When signs and symptoms of hepatitis, such as anorexia, appear.jaundice, dark urine, abdominal tenderness with palpation, it is necessary to immediately stop the therapy with clarithromycin. In the presence of chronic liver disease it is necessary to conduct regular monitoring of plasma enzymes. In the treatment of virtually all antibacterial agents, including clarithromycin, described cases of pseudomembranous colitis, the severity of which can range from mild to life-threatening. Antibacterial drugs can change the normal intestinal microflora, which can lead to an increase in Clostridium difficile. Pseudomembranous colitis caused by Clostridium difficile should be suspected in all patients experiencing diarrhea after using antibacterial agents. After conducting a course of antibiotic therapy, careful medical supervision of the patient is necessary. Cases of the development of pseudomembranous colitis 2 months after taking antibiotics have been described. Clarithromycin should be used with caution in patients with coronary heart disease (CHD), severe heart failure, hypomagnesemia, severe bradycardia (less than 50 beats / min), and also when used simultaneously with class IA (quinidine, procainamide) and class III antiarrhythmic drugs ( dofetilide, amiodarone, sotalol). In these conditions and while taking clarithromycin with these drugs, you should regularly monitor the electrocardiogram for an increase in the QT interval. The development of cross-resistance to clarithromycin and other macrolide antibiotics, as well as lincomycin and clindamycin, is possible. In case of acute hypersensitivity reactions, such as anaphylactic reaction, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms (DRESS syndrome), Schonlein-Genoch purpura should immediately stop taking clarithromycin and initiate appropriate therapy. In patients taking clarithromycin, it has been reported that the symptoms of myasthenia gravis are aggravated. In the case of combined use with warfarin or other indirect anticoagulants, it is necessary to control MHO and prothrombin time. Amoxicillin Before taking amoxicillin, a detailed history should be collected regarding previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens. Serious and sometimes lethal hypersensitivity reactions (anaphylactic reactions) to penicillins are described.The risk of such reactions is highest in patients with a history of hypersensitivity reactions to penicillins. In the event of allergic reactions, it is necessary to stop taking Amoxicillin and begin therapy with another group of antibiotics. For serious hypersensitivity reactions, appropriate measures should be taken immediately. Epinephrine, oxygen therapy, intravenous glucocorticosteroids, and airway management, including intubation, may also be required. It is necessary to refrain from the use of amoxicillin in case of suspected infectious mononucleosis, since in patients with this disease, amoxicillin can cause a cortex-like skin rash that makes it difficult to diagnose. Long-term treatment with amoxicillin sometimes leads to overproduction of insensitive microorganisms. During the use of amoxicillin, it is recommended to periodically evaluate the function of the kidneys, liver and blood formation. Amoxicillin should be used with caution in patients with impaired liver function. Monitoring of liver function should be carried out on a regular basis. In patients with impaired renal function, the dose of amoxicillin should be reduced according to the degree of impairment. Amoxicillin can provoke nonspecific binding of immunoglobulins and albumin to the erythrocyte membrane, which can be the cause of a false-positive reaction during the Coombs test. In patients with reduced diuresis, crystalluria occurs very rarely. When performing amoxicillin therapy, adequate fluid intake and maintaining sufficient diuresis are extremely important. Patients with cholangitis or cholecystitis antibiotics can be prescribed only with a mild course of the disease and in the absence of cholestasis. During therapy with amoxicillin, it is necessary to remember about the possible development of superinfection (usually caused by bacteria of the genus Pseudomonas spp. Or fungi of the genus Candida). In this case, you should stop therapy with amoxicillin and / or prescribe appropriate treatment. With persistent diarrhea, pseudomembranous colitis caused by antibiotics should be suspected, which can pose a threat to the patient's life (watery feces mixed with blood and mucus; dull common or colicky pain in the abdomen; fever, sometimes tenesmus). In such cases, amoxicillin should be immediately canceled and treatment specific to the pathogen, such as vancomycin, should be prescribed.In this case, the means reducing perilstatics of the gastrointestinal tract are contraindicated. Removal of amoxicillin leads to its high content in the urine, which can lead to false-positive results in the determination of glucose in the urine (for example, Benedict's test, Felling's test). In this case, it is recommended to apply the glucose oxidase method for determining the concentration of glucose in the urine. If necessary, the simultaneous use of amoxicillin with anticoagulants, prothrombin time or INR should be carefully monitored for the appointment or cancellation of amoxicillin. With the simultaneous use of estrogen-containing oral contraceptives and amoxicillin, if possible, use other or additional methods of contraception. Special care is recommended with