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					Proton Pump Inhibitors (5)
Acid reducers
Esomeprazole (nexium)
Esomeprazole decreases the amount of acid produced in the stomach.
Esomeprazole is used to treat ulcers, gastroesophageal reflux disease (GERD or heartburn), erosive esophagitis, and
other conditions involving excessive stomach acid production.
Dose:
Erosive Esophagitis & Gastroesophageal Reflux Disease
20 to 40 mg orally once a day for 4 to 8 weeks.
Helicobacter pylori Infection
40 mg orally once a day for 10 days along with amoxicillin 1000 mg and clarithromycin 500 mg orally twice a day
for 10 days.
Side Effects
headache; diarrhea; nausea, flatulence, abdominal pain, or constipation; or dry mouth.
Contraindication
Pregnacy class B
Liver disease
NEXIUM is contraindicated in patients with known hypersensitivity to any component of the formulation or to
substituted benzimidazoles.
Drug-Drug Interaction
digoxin (Lanoxin, Lanoxicaps); itraconazole (Sporanox) or ketoconazole (Nizoral); or iron (Feosol, Mol-Iron,
Fergon, Femiron, others).
esomeprazole (Nexium) and atazanavir Concurrent use of proton pump inhibitors may decrease the oral
bioavailability of atazanavir and substantially reduce its concentrations in plasma. Atazanavir solubility decreases
with increasing pH, thus inhibition of gastric acid secretion may interfere with dissolution of the drug.
Other
Pharmacology: Esomeprazole, the S-isomer of omeprazole, is a "proton pump" inhibitor. Esomeprazole inhibits
gastric acid secretion via selective binding to and permanent inhibition of H+/K+ -ATPase, the "proton pump", on
the secretory surface of gastric parietal cells. Esomeprazole is approved by the FDA for treatment of erosive
esophagitis, gastroesophageal reflux disease (GERD) and symptoms associated with it, and for the eradication of H.
pylori infection (with clarithromycin +/- amoxicillin).

Omeprazole (prilosec)
Omeprazole decreases the amount of acid produced in the stomach.
Omeprazole is used to treat ulcers, gastroesophageal reflux disease (GERD or heartburn), and other conditions
involving excessive stomach acid production.
Dose:
Dyspepsia Prevention of frequent heartburn:
20 mg orally once daily, before a meal, for 14 days.
Erosive Esophagitis
20 mg orally once a day before a meal. This dosage may be increased to 40 mg per day based on desired clinical
response and patient tolerance. Studies have been completed up to 12 months for maintenance therapy of erosive
esophagitis.
Gastric Ulcer
40 mg orally once a day before a meal for 4 to 8 weeks.
Gastroesophageal Reflux Disease
Initial: 20 mg orally once a day before a meal for 4 to 8 weeks. This dosage may be increased to 40 mg per day if
needed.
Maintenance: long-term treatment with doses of 10 to 20 mg per day may be required for maintenance therapy of
refractory disease and appears to be safe.
Helicobacter pylori Infection
Dual therapy: omeprazole 40 mg orally once a day in the morning plus clarithromycin 500 mg orally 3 times a day
on days 1 to 14. Beginning on day 15, omeprazole 20 mg orally once a day in the morning on days 15 to 28.
Triple therapy: omeprazole 20 mg plus clarithromycin 500 mg plus amoxicillin 1000 mg all given orally twice a day
for 10 days. If an ulcer is present at the initiation of therapy, continue omeprazole 20 mg orally once a day for an
additional 18 days.
Study(n=294) - Canadian Adult Dyspepsia Empiric Treatment-Helicobacter pylori positive (CADET-Hp):
Omeprazole 20 mg, metronidazole 500 mg, and clarithromycin 500 mg, twice daily for 7 days.
Side Effects
drowsiness, dizziness, or headache; diarrhea, increased gas, or bloating; or itching.
Contraindication
NONE
Drug-Drug Interaction
omeprazole and atazanavir Concurrent use of proton pump inhibitors may decrease the oral bioavailability of
atazanavir and substantially reduce its concentrations in plasma. Atazanavir solubility decreases with increasing pH,
thus inhibition of gastric acid secretion may interfere with dissolution of the drug.
Other
Pharmacology: Omeprazole, a prodrug, is an antisecretory agent which is converted to the active sulphenic acid and
sulphenamide moieties at an acidic pH. These compounds inhibit gastric acid secretion through selective binding to
and permanent inhibition of H+/K+ -ATPase, the "proton pump", on the secretory surface of gastric parietal cells.
Maximum inhibition occurs approximately two hours after dosing and decreases to 50% of maximum inhibition by
24 hours. Omeprazole is approved by the FDA for use in the treatment of active duodenal ulcer disease,
gastroesophageal reflux disease (GERD), severe erosive esophagitis, benign and active gastric ulcers, and
pathological hypersecretory conditions such as Zollinger-Ellison syndrome, multiple endocrine adenomas, and
systemic mastocytosis, and for eradication of H. pylori infection (with clarithromycin +/- amoxicillin). Omeprazole
OTC is available for the treatment of frequent heartburn. Omeprazole is also used for duodenal ulcer maintenance,
although not FDA-approved.

Lansoprazole (prevacid)
Lansoprazole decreases the amount of acid produced in the stomach.
Lansoprazole is used to treat and prevent stomach and intestinal ulcers, erosive esophagitis (damage to the
esophagus from stomach acid), and other conditions involving excessive stomach acid such as Zollinger-Ellison
syndrome.
Dose:
Duodenal Ulcer
15 mg orally once a day 30 minutes before eating. Therapy should be continued for up to 4 weeks.
Duodenal Ulcer Prophylaxis
15 mg orally once a day 30 minutes before eating. Studies evaluating maintenance therapy for duodenal ulcers have
not extended beyond 12 months.
Erosive Esophagitis
Initial dose: 30 mg orally once a day for up to 8 weeks. Alternatively, if patient is unable to use oral route the dose
may be given as an IV infusion of 30 mg per day administered over 30 minutes for up to 7 days.
Maintenance dose: 15 mg orally once a day.
Gastric Ulcer
30 mg orally once a day 30 minutes before eating. Therapy should be continued for 4 to 8 weeks.
Gastroesophageal Reflux Disease
15 mg orally once a day. Therapy should be continued for up to 8 weeks.
Helicobacter pylori Infection
Triple therapy: lansoprazole 30 mg is combined with 1 gm of amoxicillin and 500 mg of clarithromycin given orally
every 12 hours for 10 or 14 days. Most investigators recommend treatment with at least two antimicrobial agents in
order to achieve eradication. Monotherapy with lansoprazole is ineffective and should be avoided.
Dual therapy: lansoprazole 30 mg is combined with 1 gram of amoxicillin given orally every 8 hours for 14 days.
Refer to the monograph for amoxicillin and/or clarithromycin for dosing information specific to elderly or renally-
impaired patients .
Side Effects
diarrhea, nausea, or abdominal pain; dizziness; or headache.
Contraindication
Liver disease
Drug-Drug Interaction
lansoprazole (lansoprazole) and atazanavir GENERALLY AVOID: Concurrent use of proton pump inhibitors
may decrease the oral bioavailability of atazanavir and substantially reduce its concentrations in plasma. Atazanavir
solubility decreases with increasing pH, thus inhibition of gastric acid secretion may interfere with dissolution of the
drug.
Other
Pharmacology: Lansoprazole, a prodrug, is an antisecretory agent which is converted to active sulfone derivatives in
gastric parietal cells, also known as a gastric acid-pump inhibitor. Lansoprazole inhibits gastric acid secretion
through selective binding to and permanent inhibition of H+/K+ -ATPase, the "proton pump", on the secretory
surface of parietal cells. Lansoprazole is indicated for the short-term treatment of active, and maintenance of healed,
duodenal ulcers, gastroesophageal reflux disease (GERD) and the short-term treatment, and maintenance of healing,
of erosive esophagitis, and treatment of active benign gastric ulcers, healing and risk reduction of NSAID-associated
gastric ulcer. Lansoprazole is also indicated for the long-term treatment of pathological hypersecretory conditions,
including Zollinger-Ellison syndrome. Lansoprazole is also approved for the treatment of H. pylori infections in
combination with clarithromycin and amoxicillin or amoxicillin alone. Triple therapy is preferred when possible.
Eradication rates of 83% to 86% have been reported.

Pantoprazole (protonix)
Pantoprazole decreases the amount of acid produced in the stomach.
Pantoprazole is used to treat damage to the esophagus associated with gastroesophageal reflux disease (GERD) and
other conditions involving excessive stomach acid production (e.g. Zollinger-Ellison Syndrome).
Dose:
Duodenal Ulcer
40 mg orally once a day, dose was increased every 12 weeks by 40 mg increments to a maximum of 120 mg per day,
for 28 weeks. Data have revealed that monotherapy with daily doses of 40 mg have been associated with complete
duodenal ulcer healing in up to 87% and 94% of patients after 4 weeks and 8 weeks respectively.
Erosive Esophagitis Treatment of Erosive Esophagitis:
40 mg orally once a day for up to 8 weeks; however an additional 8 weeks may be considered for patients who have
not healed after the initial treatment. Safety and efficacy beyond 16 weeks of therapy have not been established.
Maintenance of Healing of Erosive Esophagitis:
40 mg orally once a day. Controlled studies have been limited to 12 months of pantoprazole therapy.
Gastric Ulcer
40 mg orally once a day. Data have revealed that monotherapy with daily doses of 40 mg have been associated with
complete gastric ulcer healing in up to 87% and 97% of patients after 4 weeks and 8 weeks respectively.
Gastroesophageal Reflux Disease
Parenteral: 40 mg once a day for 7 to 10 days, administered via intravenous infusion over a period of 15 minutes.
Intravenous therapy should be discontinued as soon as the patient is able to resume oral therapy.
Oral: 40 mg orally once a day, for short-term administration (up to 8 weeks); however an additional 8 weeks may be
considered for patients who have not healed after the initial treatment. Safety and efficacy beyond 16 weeks of
therapy have not been established.
Helicobacter pylori Infection
Triple therapy: 40 mg orally twice daily for 7 days, commonly in conjunction with clarithromycin and either
amoxicillin or metronidazole to eradicate H. pylori, followed with 40 mg pantoprazole orally once daily until day
28. Triple therapy has resulted in eradication rates of greater than 95%.
Quadruple therapy: 40 mg orally twice daily for 7 days, concomitantly with bismuth subcitrate and tetracycline,
both four times daily, and metronidazole 200 mg three times daily and 400 mg at bedtime. H. Pylori eradication was
achieved in 82% of patients.
Side Effects
flatulence (gas); upset stomach or diarrhea; insomnia; or a rash.
Contraindication
Liver disease
Drug-Drug Interaction
pantoprazole (pantoprazole) and atazanavir GENERALLY AVOID: Concurrent use of proton pump inhibitors
may decrease the oral bioavailability of atazanavir and substantially reduce its concentrations in plasma. Atazanavir
solubility decreases with increasing pH, thus inhibition of gastric acid secretion may interfere with dissolution of the
drug.
Other
Pharmacology: Pantoprazole is a proton pump inhibitor. Pantoprazole suppresses the final step in the production of
gastric acid by forming a covalent bond to two sites of the proton pump (H+, K+)-ATPase enzyme system at the
secretory surface of the gastric parietal cell. Binding from a single recommended dose persists for 24 hours and
inhibits both basal and stimulated gastric acid secretion. Pantoprazole is approved by the FDA for the short-term
treatment of erosive esophagitis associated with gastroesophageal reflux disease (GERD), for maintenance of
healing of erosive esophagitis, and for the long-term treatment of pathological hypersecretory conditions, including
Zollinger-Ellison syndrome. While not FDA approved indications, data on pantoprazole have shown its efficacy at
healing NSAID-related peptic ulcers, in the treatment and prevention of duodenal ulcer, including infection with
Helicobacter pylori, and in the prevention of stress-related bleeding in the intensive care unit.

Rabeprazole (Aciphex)
Rabeprazole decreases the amount of acid produced in your stomach.
Rabeprazole is used to treat ulcers, gastroesophageal reflux disease (GERD or heartburn), and other conditions
involving excessive stomach acid production.
Dose:
Duodenal Ulcer
20 mg orally once a day, after the morning meal. The usual duration of therapy is four weeks in most patients,
however, some patients may require additional therapy to achieve ulcer healing.
Duodenal Ulcer Prophylaxis
20 mg orally once a day, after the morning meal. Studies evaluating maintenance therapy for duodenal ulcers have
not extended beyond 12 months.
Erosive Esophagitis & Gastric Ulcer
20 mg orally once a day, after the morning meal. Therapy should be continued for 4 to 8 weeks.
Gastroesophageal Reflux Disease
20 mg orally once a day, after the morning meal. Therapy should be continued for 4 to 8 weeks.
Maintenance therapy may be required in some patients as part of relapse of erosive esophagitis or ulcerative
gastroesophageal reflux disease is not uncommon. Studies have shown rabeprazole 20 mg orally once a day for 52
weeks to provide 86% to 90% maintenance of healing.
Helicobacter pylori Infection
20 mg orally twice a day, for 7 to 14 days.
In triple therapy studies, rabeprazole 20 mg was combined with either clarithromycin 500 mg and metronidazole 400
mg, or amoxicillin 1000 mg and clarithromycin 500 mg, or amoxicillin 1000 mg and metronidazole 400 mg each
given orally twice a day for 7 days. These combinations provided eradication rates of 100%, 95%, and 90%
respectively.
In dual therapy studies, rabeprazole 20 mg was combined with clarithromycin 500 mg orally twice a day for 7 days
which provided an eradication rate of 63%.
Side Effects
headache; upset stomach or diarrhea; insomnia or nervousness; or a rash or itching.
Contraindication
Pregnancy Category B
Liver disease
Drug-Drug Interaction
rabeprazole (rabeprazole) and atazanavir GENERALLY AVOID: Concurrent use of proton pump inhibitors may
decrease the oral bioavailability of atazanavir and substantially reduce its concentrations in plasma. Atazanavir
solubility decreases with increasing pH, thus inhibition of gastric acid secretion may interfere with dissolution of the
drug.
Other
Pharmacology: Rabeprazole, a prodrug, is an antisecretory agent which is converted to the active sulphenic acid and
sulphenamide moieties at an acidic pH. These compounds inhibit gastric acid secretion through partially reversible
binding to and inhibition of H+/K+ -ATPase, the "proton pump", on the secretory surface of gastric parietal cells.
Rabeprazole is indicated in the treatment of erosive or ulcerative gastroesophageal reflux disease (GERD) for both
active and maintenance therapy, active duodenal ulcer disease, and pathological hypersecretory conditions such as
Zollinger-Ellison syndrome. Rabeprazole is also used for gastric ulcer, duodenal ulcer maintenance, and
Helicobacter pylori associated peptic ulcer disease, although not FDA-approved.

H2 receptor antagonists (4)
Acid Reducer

Famotidine (pepcid)
Famotidine is in a class of drugs called histamine receptor antagonists. Famotidine works by decreasing the amount
of acid the stomach produces.
Famotidine is used to treat and prevent ulcers in the stomach and intestines. Famotidine is also used to treat
conditions in which the stomach produces too much acid and conditions in which acid comes up into the esophagus
and causes heartburn, such as gastroesophageal reflux disease (GERD).
Dose:
Dyspepsia
10 mg orally once or twice daily.
Erosive Esophagitis
Parenteral: 20 mg IV every 12 hours. Alternatively, some clinicians recommend a continuous IV infusion of 3.2
mg/hour for up to 72 hours following a 10 mg IV bolus dose.
Oral: 20 to 40 mg orally twice a day for up to 12 weeks.
Gastric Ulcer
Parenteral: 20 mg IV every 12 hours. Alternatively, some clinicians recommend a continuous IV infusion of 3.2
mg/hour for up to 72 hours following a 10 mg IV bolus dose.
Oral: 40 mg orally once a day at bedtime or 20 mg orally twice a day.
Gastroesophageal Reflux Disease
Parenteral: 20 mg IV every 12 hours. Alternatively, some clinicians recommend a continuous IV infusion of 3.2
mg/hour for up to 72 hours following a 10 mg IV bolus dose.
Oral: 20 mg orally twice a day for up to 6 weeks.
Side Effects
Less Serious
dizziness; headache; or diarrhea, nausea, or constipation.
Serious
an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); easy
or unusual bruising or bleeding; bleeding gums; irregular heartbeat; yellowing of the skin or eyes; or a rash.
Contraindication
Renal Dysfunction
Phenylketonuria
Drug-Drug Interaction
No drug-drug interaction
Do not take antacids within 1 hour of taking famotidine. Antacids may decrease the effectiveness of famotidine
Other
Pharmacology: Famotidine is a histamine-2 antagonist that decreases gastric acid secretion by selective blockade of
the histamine receptor on parietal cells. Famotidine is used in the acute or maintenance therapy of duodenal ulcers
and for the treatment of gastric ulcers, gastroesophageal reflux disease, erosive esophagitis, and hypersecretory
disorders such as the Zollinger-Ellison syndrome. Duodenal and gastric ulcers have been associated with
Helicobacter Pylori infection. A triple drug regimen of metronidazole, bismuth subsalicylate, and tetracycline yields
an eradication rate of approximately 90%. Single-agent therapy is discouraged due to the development of resistance.
Concomitant antisecretory agents such as H2 antagonists (i.e. cimetidine) are recommended if the patient exhibits
active ulcer disease. Famotidine was recently approved for over-the-counter use for the "relief of symptoms of
occasional heartburn, acid indigestion and sour stomach and for prevention of such symptoms caused by
consumption of food or beverages". The self-medication dosage recommended by the manufacturer for these
symptoms is 10 mg orally once or twice a day (for less than 2 weeks of continuous therapy). While not FDA
approved indications, famotidine is also used in the management of upper gastrointestinal bleeding and for stress
ulcer prophylaxis in the ICU, and to prevent NSAID-induced duodenal and gastric ulceration.

Ranitidine (zantac)
Ranitidine is in a class of drugs called histamine receptor antagonists. Ranitidine works by decreasing the amount of
acid the stomach produces.
]Ranitidine is used to treat and prevent ulcers in the stomach and intestines. Ranitidine is also used to treat
conditions in which the stomach produces too much acid and conditions in which acid comes up into the esophagus
and causes heartburn, such as gastroesophageal reflux disease (GERD).
Dose:
Dyspepsia
75 mg orally once daily. Dose may be increased to 75 mg twice daily. Maximum duration of therapy if self-
medicating is 14 days.
Erosive Esophagitis
Initial: 150 mg orally 4 times a day.
Maintenance: 150 mg orally twice daily.
Gastric Ulcer
Parenteral: 50 mg IV or IM every 6 to 8 hours. Alternatively, a continuous IV infusion may be administered at a rate
of 6.25 mg/hour over 24 hours. Dosage should not exceed 400 mg per day.
Oral: 150 mg orally 2 times a day or 300 mg orally once a day at bedtime.
Gastric Ulcer Maintenance
150 mg orally once a day at bedtime.
Gastroesophageal Reflux Disease
150 mg orally twice daily.
Side Effects
Less Serious
dizziness; headache; or diarrhea, nausea, or constipation.
Serious
an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
easy or unusual bruising or bleeding; bleeding gums; irregular heartbeat; or yellowing of the skin or eyes.
Contraindication
Preg B
Renal Dysfunction
Porphyria
Phenylketonuria
Liver Disease
hemodialysis
Drug-Drug Interaction
None
Do not take antacids within 1 hour of taking ranitidine. Antacids may decrease the effectiveness of ranitidine.
Other
Pharmacology: Ranitidine is a histamine-2 antagonist that decreases gastric acid secretion by selective blockade of
the histamine receptor on parietal cells. Ranitidine is indicated for the treatment or prophylaxis of duodenal ulcers,
for the treatment of gastric ulcers, gastroesophageal reflux disease, erosive esophagitis, and hypersecretory disorders
such as Zollinger-Ellison syndrome. While not FDA approved indications, ranitidine is also used in the management
of upper gastrointestinal bleeding and for stress ulcer prophylaxis in the ICU. Duodenal and gastric ulcers have been
associated with Helicobacter pylori infection. A triple drug regimen of metronidazole, bismuth subsalicylate, and
tetracycline yields an approximate 90% eradication rate of H. Pylori. Single agent therapy is discouraged due to the
development of resistance. Concomitant antisecretory agents such as H2 antagonists (i.e. cimetidine) are
recommended if the patient exhibits active ulcer disease. A combination of ranitidine and bismuth citrate is available
for use with clarithromycin in the treatment and eradication of Helicobacter pylori-associated duodenal ulcer.

Nizatidine (axid)
Nizatidine is in a class of drugs called histamine receptor antagonists. Nizatidine works by decreasing the amount of
acid the stomach produces.
Nizatidine is used to treat and prevent ulcers in the stomach and intestines. Nizatidine is also used to treat conditions
in which the stomach produces too much acid and conditions in which acid comes up into the esophagus and causes
heartburn, such as gastroesophageal reflux disease (GERD).
Dose:
Dyspepsia
75 mg orally once or twice a day, taken right before or up to 60 minutes before eating.
Erosive Esophagitis & Gastroesophageal Reflux Disease
150 mg twice daily.
Gastric Ulcer
300 mg orally once a day at bedtime, or alternatively may use 150 mg orally twice a day.
Side Effects
Less Serious
dizziness; headache; or diarrhea, nausea, or constipation.
Serious
an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
easy or unusual bruising or bleeding; bleeding gums; irregular heartbeat; fever and sore throat; or yellowing of the
skin or eyes
Contraindication
Preg C
Renal Dysfunction
hypersensitivity
Drug-Drug Interaction
None
Do not take antacids within 1 hour of taking nizatidine. Antacids may decrease the effectiveness of nizatidine.
Other
Pharmacology: Nizatidine is a histamine-2 antagonist which decreases gastric acid secretion by selective blockade
of the histamine receptor on parietal cells. Nizatidine is indicated in the treatment or prophylaxis of duodenal ulcers,
in the treatment of gastroesophageal reflux disease (GERD), and in the treatment of erosive esophagitis. Duodenal
and gastric ulcers have been associated with Helicobacter pylori infection. A triple drug regimen of metronidazole,
bismuth subsalicylate, and tetracycline yields an approximate 90% eradication rate of H. Pylori. Single agent
therapy is discouraged due to the development of resistance. Concomitant antisecretory agents such as H2
antagonists (i.e. cimetidine) are recommended if the patient exhibits active ulcer disease.

Cimetidine (tagamet)
Cimetidine is in a class of drugs called histamine receptor antagonists. Cimetidine works by decreasing the amount
of acid the stomach produces.
Cimetidine is used to treat and prevent ulcers in the stomach and intestines. Cimetidine is also used to treat
conditions in which the stomach produces too much acid and conditions in which acid comes up into the esophagus
and causes heartburn, such as gastroesophageal reflux disease (GERD).
Dose:
Dyspepsia
200 mg orally right before (or up to 30 minutes) eating. Maximum per 24 hours: 2 doses.
Erosive Esophagitis
Parenteral: 300 mg IV or IM every 6 hours. Alternatively, a continuous IV infusion may be administered at a rate of
50 mg/hour initially, with 25 mg/hour incremental increases up to a maximum rate of 100 mg/hour (2.4 g/day).
Oral: 800 mg twice a day, or alternatively, 400 mg four times a day.
Gastric Ulcer
Parenteral: 300 mg IV or IM every 6 hours. Alternatively, a continuous IV infusion may be administered at a rate of
50 mg/hour.
Oral: 800 mg once a day at bedtime, or 300 mg 4 times a day.
Gastroesophageal Reflux Disease
Parenteral: 300 mg IV or IM every 6 hours. Alternatively, a continuous IV infusion may be administered at a rate of
50 mg/hour. Maximum daily dose should not exceed 2.4 g.
Oral: 800 mg twice a day, or 400 mg 4 times a day.
Stress Ulcer Prophylaxis
Parenteral: 300 mg IV or IM every 6 hours. Alternatively, a continuous IV infusion may be administered at a rate of
50 mg/hour.
Side Effects
Less Serious
dizziness; headache; or diarrhea, nausea, or constipation.
Serious
an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
easy or unusual bruising or bleeding; bleeding gums; irregular heartbeat; yellowing of the skin; or a rash.
Contraindication
Preg B
Hemodialysis
Liver Disease
Renal Dysfunction
Drug-Drug Interaction
Do not take antacids within 1 hour of taking cimetidine. Antacids may decrease the effectiveness of cimetidine.
astemizole, carmustine, dofetilide, epirubicin, halofantrine, levomethadyl acetate, pimozide, terfenadine,
thioridazine
Cimetidine, apparently through an effect on certain microsomal enzyme systems, has been reported to reduce the
hepatic metabolism of warfarin-type anticoagulants, phenytoin, propranolol, nifedipine (for oral solution only),
chlordiazepoxide, diazepam, certain tricyclic antidepressants, lidocaine, theophylline and metronidazole, thereby
delaying elimination and increasing blood levels of these drugs. Interaction with phenytoin, lidocaine and
theophylline has also been reported to produce adverse clinical effects.
Other
Pharmacology: Cimetidine is a histamine-2 antagonist. Cimetidine decreases gastric acid secretion by selective
blockade of the histamine receptor on parietal cells. Cimetidine is approved by the FDA for use in the treatment of
active duodenal ulcer, and the maintenance therapy of duodenal ulcers; for the treatment of gastric ulcers;
gastroesophageal reflux disease; erosive gastroesophageal reflux disease; hypersecretory disorders such as
Zollinger-Ellison syndrome; and for the prevention of upper gastrointestinal bleeding in critically ill patients. While
not an FDA approved indication, cimetidine may be useful when given concomitantly with other drugs for the
treatment of dermatologic conditions such as urticaria, mastocytosis, and warts. Duodenal and gastric ulcers have
been associated with Helicobacter pylori infection. A triple drug regimen of metronidazole, bismuth subsalicylate,
and tetracycline yields approximately a 90% eradication rate of H. Pylori. Single agent therapy is discouraged due to
the development of resistance. Concomitant antisecretory agents such as H2 antagonists are recommended if the
patient exhibits active ulcer disease.

Selective serotonin reuptake inhibitors (4)
Antidepressants

Fluoxetine (prozac, Sarafem)
Fluoxetine is in a class of drugs called selective serotonin reuptake inhibitors. Fluoxetine affects chemicals in the
brain that may become unbalanced and cause depression or mood disturbances, eating disorders, or obsessive or
compulsive symptoms.
Fluoxetine is used to treat depression, obsessive-compulsive disorders, panic disorder, and bulimia (binge eating and
purging). Fluoxetine is also used to treat premenstrual dysphoric disorder (PMDD), symptoms of which occur in the
week or two before a woman's menstrual period and commonly include irritability, mood swings, and tension as
well as the physical symptoms of bloating and breast tenderness.
Dose:
Depression
Immediate release capsules or tablets:
Initial dose: 20 mg orally once a day in the morning.
Maintenance dose: 20 to 80 mg/day.
Extended release capsules: Patients taking 20 mg/daily may be converted to 90 mg orally once a week. The first
weekly dose should be given 7 days after the last daily dose.
Bulimia
Initial dose: 60 mg orally once a day in the morning. Some patients have started with lower doses. Doses greater
than 60 mg/day have not been systematically studied.
Obsessive Compulsive Disorder & Panic Disorder
Initial dose: 20 mg orally once a day in the morning.
Maintenance dose: 20 to 60 mg/day in 1 to 2 divided doses.
Maximum dose: 80 mg/day.
Side Effects
Less Serious
headache, tremor, nervousness, or anxiety; difficulty concentrating; nausea, diarrhea, dry mouth, or changes in
appetite or weight; weakness; increased sweating; sleepiness or insomnia; or decreased sex drive, impotence, or
difficulty having an orgasm.
Serious
an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); an
irregular heartbeat or pulse; low blood pressure (dizziness, weakness); high blood pressure (severe headache,
blurred vision); chills or fever; unusual bleeding or bruising; a rash or hives.
Contraindication
Coagulation Defect
Bleeding
Liver Disease
Thrombocytopathy
Vitamin K Deficiency
Drug-Drug Interaction
Do not take fluoxetine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan),
phenelzine (Nardil), or tranylcypromine (Parnate) during the last 2 weeks. Serious, and sometimes fatal, reactions
have occurred when these medicines have been used together. Also, do not take fluoxetine if you are taking
thioridazine (Mellaril). Dangerous, even fatal irregular heartbeats may occur if these medicines are taken together.
You must wait 5 weeks after stopping fluoxetine before taking thioridazine (Mellaril).
Other
Pharmacology: Fluoxetine is a phenylpropylamine-derivative selective serotonin reuptake inhibitor (SSRI). The
mechanism of action of fluoxetine as an antidepressant is believed to be linked to potentiation of serotonergic
activity in the CNS resulting from inhibition of CNS neuronal reuptake of serotonin (5-HT). Like other SSRIs,
fluoxetine exerts little if any direct effects on neuroreceptors. Fluoxetine does not significantly affect the reuptake of
norepinephrine or dopamine. Fluoxetine also does not inhibit monoamine oxidase. Fluoxetine is approved by the
FDA for use in the treatment of major depression, premenstrual dysphoric disorder, bulimia nervosa, panic disorder
(with or without agoraphobia), and obsessive compulsive disorder. One study has reported that fluoxetine was
effective for the prophylactic treatment of recurrent unipolar major depression. Fluoxetine and other SSRIs may also
have clinical utility for the treatment of a number of other conditions including substance abuse, headaches,
premature ejaculation, posttraumatic stress disorder, seasonal affective disorder, chronic pain, and bipolar ll major
depression. In vitro studies have demonstrated the antifungal effects of SSRIs (including fluoxetine as one of the
most active antifungal SSRIs) and suggest a rational for the local treatment of fungal infections with formulations
containing SSRIs. All of these uses are in need of initial or additional clinical testing and none of these uses are
approved by the FDA.

Sertraline (Zoloft)
Sertraline is in a class of drugs called selective serotonin reuptake inhibitors. Sertraline affects chemicals in the brain
that may become unbalanced and cause depression, panic or anxiety, obsessive or compulsive symptoms, or other
psychiatric symptoms.
Sertraline is used to treat depression, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder
(PTSD), premenstrual dysphoric disorder (PMDD), and social anxiety disorder, also known as social phobia.
Dose:
Depression & Obsessive Compulsive Disorder
Initial dose: 50 mg orally once a day.
Increase dose by 50 mg increments no more often than weekly.
Maintenance Dose: Can increase once a week, to a maximum of 200 mg once a day.
Panic Disorder & Post Traumatic Stress Disorder & Social Anxiety Disorder
Initial dose: 25 mg orally once a day, after one week, the dose may be increased to 50 mg once a day. Increase dose
by 50 mg increments no more often than weekly.
Maintenance dose: Can increase once a week, to a maximum of 200 mg once a day.
Side Effects
Less Serious
headache; tremor, nervousness, or anxiety; nausea, diarrhea, dry mouth, or changes in appetite or weight;
sleepiness or insomnia; or decreased sex drive, impotence, or difficulty having an orgasm.
Serious
an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); an
irregular heartbeat or pulse; low blood pressure (dizziness, weakness); high blood pressure (severe headache,
blurred vision); or chills or fever.
Contraindication
Bleeding
Coagulation Defect
Liver Disease
Vitamin K Deficiency
Thrombocytopathy
Drug-Drug Interaction
Do not take sertraline if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan),
phenelzine (Nardil), or tranylcypromine (Parnate) during the last 2 weeks. Serious, and sometimes fatal, reactions
have occurred when these medicines have been used together. Do not take sertraline if you are taking pimozide
(Orap). A dangerous drug interaction could result. Do not take the Zoloft Oral Concentrate without first talking to
your doctor if you are taking disulfiram (Antabuse). The oral solution contains alcohol, which may interact with
disulfiram.
Other
Pharmacology: Sertraline is a naphthalenamine-derivative selective serotonin reuptake inhibitor (SSRI). The
mechanism of action of sertraline as an antidepressant is believed to be linked to potentiation of serotonergic activity
in the CNS resulting from inhibition of CNS neuronal reuptake of serotonin (5-HT). Like other SSRIs, sertraline
exerts little if any direct effects on neuroreceptors. Sertraline does not significantly affect the reuptake of
norepinephrine or dopamine. Sertraline also does not inhibit monoamine oxidase. Sertraline is approved by the FDA
for use in the treatment of major depression, premenstrual dysphoric disorder, posttraumatic stress disorder, panic
disorder, social anxiety disorder, and obsessions and compulsions in patients with obsessive compulsive disorder as
defined in the DSM-III-R. Sertraline and other SSRIs may also have clinical utility in a number of other disorders
including eating disorders, substance abuse, premenstrual dysphoric disorder, and headaches, although none of these
uses is approved by the FDA for sertraline. One study (n=310) concluded that sertraline is effective in the treatment
of dysthymia without concurrent major depression. Another study (n=30) concluded that the use of sertraline in
patients with unexplained chest pain of noncardiac origin produced clinically significant reduction of daily pain. In
vitro studies have demonstrated the antifungal effects of SSRIs (including sertraline as one of the most active
antifungal SSRIs) and suggest a rational for the local treatment of fungal infections with formulations containing
SSRIs. All of these uses are in need of initial or additional clinical testing and none of these uses are approved by the
FDA.

Paroxetine (Paxil)
Paroxetine is in a class of drugs called selective serotonin reuptake inhibitors. Paroxetine affects chemicals in the
brain that may become unbalanced and cause depression, panic or anxiety, or obsessive or compulsive symptoms.
Paroxetine is used to treat depression, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder,
social anxiety disorder (social phobia), posttraumatic stress disorder (PTSD), and premenstrual dysphoric disorder
(PMDD).
Dose:
Depression
Immediate release tablets and suspension:
Initial dose: 20 mg orally once a day in the morning.
Maintenance dose: 20 to 50 mg orally once a day in the morning.
Extended release tablets:
Initial dose:
Paroxetine-naive patients: 25 mg orally once a day in the morning.
Conversion: 30 mg immediate release paroxetine corresponds to 37.5 mg extended release tablets.
Maintenance dose: The initial dose may be increased in 12.5 mg increments weekly, to a maximum of 62.5 mg/day.
Anxiety & Obsessive Compulsive Disorder
Immediate release tablets and suspension:
Initial dose: 20 mg orally once a day in the morning.
Maintenance dose: 40 mg orally once in the morning. Doses up to 60 mg orally once a day in the morning can be
used.
Panic Disorder
Immediate release tablets and suspension:
Initial dose: 10 mg orally once a day in the morning.
Maintenance dose: 40 mg orally once in the morning. Doses up to 60 mg orally once a day in the morning can be
used
Extended release tablets:
Initial dose:
Paroxetine-naive patients: 12.5 mg orally once a day in the morning.
Maintenance dose: The initial dose may be increased in 12.5 mg increments weekly, to a maximum of 75 mg/day.
Side Effects
Less Serious
headache; tremor, nervousness, or anxiety; nausea, diarrhea, dry mouth, or changes in appetite or weight;
sleepiness or insomnia; or decreased sex drive, impotence, or difficulty having an orgasm.
Serious
an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); an
irregular heartbeat or pulse; low blood pressure (dizziness, weakness); high blood pressure (severe headache,
blurred vision); unusual bleeding or bruising; or fever or chills.
Contraindication
Preg C
Bleeding
Coagulation Defect
Liver Disease
Renal Dysfunction
Vitamin K Deficiency
Thrombocytopathy
Drug-Drug Interaction
Do not take paroxetine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan),
phenelzine (Nardil), or tranylcypromine (Parnate) during the last 2 weeks. Serious, and sometimes fatal, reactions
have occurred when these medicines have been used together. Also, do not take paroxetine if you are taking
thioridazine (Mellaril). Dangerous, even fatal irregular heartbeats may occur if these medicines are taken together.
You must wait 5 weeks after stopping paroxetine before taking thioridazine (Mellaril).
Tryptophan-consisting primarily of headache, nausea, sweating, and dizziness,
Sumatriptan-weakness, hyperreflexia, and
Tricyclic Antidepressants (TCAs)-paroxetine may inhibit TCA metabolism.
Other
Pharmacology: Paroxetine is a phenylpiperidine-derivative selective serotonin reuptake inhibitor (SSRI). The
mechanism of action of paroxetine as an antidepressant is believed to be linked to potentiation of serotonergic
activity in the CNS resulting from inhibition of CNS neuronal reuptake of serotonin (5-HT). Like other SSRIs,
paroxetine exerts little if any direct effects on neuroreceptors. Paroxetine does not significantly affect the reuptake of
norepinephrine or dopamine. Paroxetine also does not inhibit monoamine oxidase. Paroxetine is approved by the
FDA for use in the treatment of major depression, posttraumatic stress disorder, obsessive compulsive disorder,
panic disorder, social anxiety disorder, and premenstrual dysphoric disorder. Paroxetine may also have clinical
utility in a number of other disorders including eating disorders, substance abuse, generalized anxiety disorder,
headaches, premenstrual dysphoric disorder, premature ejaculation, migraine prophylaxis, chronic pain, primary
insomnia, and episodic rages in Tourette's disorder patients. The drug has shown efficacy when used in the
prevention or treatment of depression induced by high-dose interferon alfa. Preliminary results also report
paroxetine to be effective in improving the negative symptoms of schizophrenia. However, further studies on the use
of paroxetine for these indications are needed and none of these uses are approved by the FDA.

Citalopram (Celexa)
Citalopram is in a class of drugs called selective serotonin reuptake inhibitors. Citalopram affects chemicals in the
brain that may become unbalanced and cause depression.
Citalopram is used to treat depression.
Dose:
ADULT
Depression
Initial dose: 20 mg orally once a day.
Maintenance dose: 20 to 40 mg/day. The initial dose may be increased in 20 mg increments not more often than
once a week up to a maximum of 60 mg/day.
PEDIATRIC
Depression
Safety and efficacy have not been established.
12 to 18 years:
Initial dose: 10 mg orally once a day (investigational).
Maintenance dose: 10 to 60 mg/day. The dosage may be increased in 10 mg increments at 7 to 14 day intervals.
Obsessive Compulsive Disorder
Safety and efficacy have not been established.
9 to 12 years:
Initial dose: 10 mg orally once a day (investigational).
Maintenance dose: 10 to 40 mg/day. The dosage may be increased in 10 mg increments at 7 to 14 day intervals.
13 to 18 years:
Initial dose: 10 mg orally once a day (investigational).
Maintenance dose: 20 to 70 mg/day. The dosage may be increased in 10 mg increments at 7 to 14 day intervals.
Side Effects
Less Serious
headache, tremor, nervousness, or anxiety; nausea, diarrhea, dry mouth, or changes in appetite or weight;
sleepiness or insomnia; or decreased sex drive, impotence, or difficulty having an orgasm.
Serious
an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); an
irregular heartbeat or pulse; low blood pressure (dizziness, weakness); high blood pressure (severe headache,
blurred vision); or chills or fever.
Contraindication
Preg C
Bleeding
Coagulation Defect
Liver Disease
Thrombocytopathy
Thrombocytopenia
Vitamin K Deficiency
Drug-Drug Interaction
You cannot take citalopram if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid
(Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) during the last 2 weeks. A dangerous drug interaction
can occur when citalopram is combined with any of these medications.
Other
Pharmacology: Citalopram is a racemic bicyclic phthalane derivative selective serotonin reuptake inhibitor (SSRI)
which potentiates serotonergic neurotransmission. The mechanism of action of citalopram as an antidepressant is
believed to be linked to potentiation of serotonergic activity in the CNS resulting from inhibition of CNS neuronal
reuptake of serotonin (5-HT). Like other SSRIs, citalopram exerts little if any direct effects on neuroreceptors.
Citalopram does not significantly affect the reuptake of norepinephrine or dopamine. Citalopram also does not
inhibit monoamine oxidase. Citalopram is approved by the FDA for use in the treatment of depression. Citalopram
and other SSRIs may also have clinical utility for the treatment of a number of other conditions including bulimia
nervosa, obsessive compulsive disorder, panic disorder, substance abuse, headaches, premenstrual dysphoria,
premature ejaculation, post-traumatic stress disorder, seasonal affective disorder, and chronic pain, although none of
these uses is approved by the FDA for citalopram and comparative efficacy trials for many of these uses have not
yet been performed.

Antibiotics: macrolides (3)
Azithromycin (zithromax)
Azithromycin is in a class of drugs called macrolide antibiotics. Azithromycin fights bacteria in the body.
Azithromycin is used to treat many different types of bacterial infections, such as bronchitis, pneumonia, tonsillitis,
skin infections, ear infections, and sexually transmitted diseases.
Dose:
ADULT
Gonococcal Infection -- Uncomplicated
2 grams orally once
Legionella Pneumonia
500 mg intravenously once a day for at least 2 days followed by 500 mg orally once a day to complete a 7 to 10 day
course of therapy. The intravenous dose should be reconstituted and diluted according to the manufacture's
recommendations and administered as an infusion over not less than 60 minutes
Lyme Disease -- Erythema Chronicum Migrans & Mycobacterium avium-intracellulare -- Treatment
500 mg orally once a day
Mycobacterium avium-intracellulare -- Prophylaxis
1200 mg orally once a week.
Mycoplasma Pneumonia
500 mg orally on the first day, followed by 250 mg orally once a day on days 2 through 5 for a total dose of 1500
mg. However, the duration of therapy is dependent on the nature and severity of the infection. If the infection is
severe, azithromycin 500 mg intravenously once a day can be administered for at least 2 days followed by 500 mg
orally once a day to complete a 7 to 10 day course of therapy. The intravenous dose should be reconstituted and
diluted according to the manufacture's recommendations and it should be administered as an infusion over not less
than 60 minutes.
Nongonococcal Urethritis & Cervicitis
1 g orally administered as a single dose.
Pelvic Inflammatory Disease
500 mg intravenously once a day for at least 2 days followed by 250 mg orally once a day to complete a 7-day
course of therapy. The intravenous dose should be reconstituted and diluted according to the manufacture's
recommendations and it should be administered as an infusion over not less than 60 minutes
Pharyngitis & Sinusitis & Skin or Soft Tissue Infection & Bronchitis & Upper Respiratory Tract
Infection & Otitis Media
500 mg orally on the first day, followed by 250 mg orally once a day on days 2 through 5 for a total dose of 1500
mg. However, the duration of therapy is dependent on the nature and severity of the infection.
Pneumonia
500 mg orally on the first day, followed by 250 mg orally once a day on days 2 through 5 for a total dose of 1500
mg. However, the duration of therapy is dependent on the nature and severity of the infection. If the infection is
severe, azithromycin 500 mg intravenously once a day can be administered for at least 2 days followed by 500 mg
orally once a day to complete a 7 to 10 day course of therapy. The intravenous dose should be reconstituted and
diluted according to the manufacture's recommendations and it should be administered as an infusion over not less
than 60 minutes.
Toxoplasmosis
1200 mg to 1500 mg orally once a day
Typhoid Fever
1000 mg orally on day 1, then 500 mg orally once a day for 6 days. Alternatively, a dosage of 1000 mg orally once a
day for 5 days can also be used.
CHILD
Otitis Media
> 6 months: 10 mg/kg orally as a single dose on the first day followed by 5 mg/kg orally once a day on days 2-5.
Tonsillitis/Pharyngitis
> 2 years: 12 mg/kg orally once a day on days 1-5.
Typhoid Fever
> 6 months: 10 mg/kg orally once a day for 7 days.
Side Effects
Less Serious
nausea, vomiting, diarrhea, or abdominal pain; unusual dizziness, fatigue, or headache; vaginal yeast infection; a
rash; or increased sensitivity to sunlight.
Serious
an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); or
liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising,
severe fatigue).
Contraindication
Preg B
Biliary Obstruction
Colitis/Enteritis (Noninfectious)
Liver Disease
Drug-Drug Interaction
Do not take azithromycin close to a dose of an antacid that contains aluminum or magnesium such as Rolaids,
Maalox, Mylanta, Milk of Magnesia, Pepcid Complete, and others. These antacids may decrease the effects of
azithromycin.
Ergotamine or Dihydroergotamine
Other
Pharmacology: Azithromycin is a long-acting, broad-spectrum, synthetic macrolide antibiotic. Azithromycin
interferes with protein synthesis in susceptible bacteria by binding to the 50S ribosomal subunit. Azithromycin has
useful activity against many gram-positive and gram-negative organisms, including Chlamydia, Mycoplasma,
Legionella, certain protozoa, Streptococcus pneumoniae, S. pyogenes, Staphylococcus aureus, Neisseria gonorrhea,
Neisseria meningitidis, Branhamella catarrhalis, Haemophilus influenzae, Helicobacter pylori, Gardnerella
vaginalis, and Toxoplasmosis gondii. Azithromycin is often an effective alternative for patients with a penicillin
allergy. The oral formulation is approved by the FDA for the following indications caused by susceptible
microorganisms: acute bacterial exacerbations of chronic obstructive pulmonary disease, community-acquired
pneumonia, pharyngitis/tonsillitis, uncomplicated skin and skin structure infections, urethritis/cervicitis, chancroid,
and acute otitis media. In addition, azithromycin is approved by the FDA and recommended by the USPHS/IDSA
(U.S. Public Health Service/Infectious Diseases Society of America) Prevention of Opportunistic Infections
Working Group for the prophylaxis and treatment of disseminated Mycobacterium avium complex (MAC) disease
in AIDS patients. The intravenous formulation is indicated for use in community-acquired pneumonia and pelvic
inflammatory disease caused by susceptible microorganisms. Azithromycin may also be used to treat Lyme disease,
uncomplicated Typhoid Fever, and toxoplasmosis. However, these uses are not approved by the FDA.

Clarithromycin (biaxin)
Clarithromycin is in a class of drugs called macrolide antibiotics. Clarithromycin fights bacteria in your body.
Clarithromycin is used to treat many different types of bacterial infections, such as bronchitis, pneumonia, sinusitis,
tonsillitis, skin infections, and stomach ulcers caused by bacteria.
Dose:
Bacterial Endocarditis Prophylaxis
500 mg orally one hour before the procedure.
Helicobacter pylori Infection
500 mg orally 3 times a day for 14 days.
Legionella Pneumonia
250 to 500 mg orally every 12 hours. Therapy should be continued for approximately 14 days, depending on the
nature and severity of the infection.
Mycobacterium avium-intracellulare -- Treatment
500 mg orally every 12 hours. The duration of therapy for unresectable pulmonary infiltrates is generally 18 to 24
months for the treatment of pulmonary MAI and at least 12 months after sputum conversion. The duration of therapy
for disseminated MAI is generally lifelong (as long as a clinical and microbiological response is documented).
Mycobacterium avium-intracellulare -- Prophylaxis
500 mg orally every 12 hours. Therapy is usually required indefinitely, depending on this patient's tolerance of
clarithromycin and immune status.
Mycoplasma Pneumonia & Skin or Soft Tissue Infection
250 to 500 mg orally every 12 hours. Therapy should be continued for approximately 7 to 14 days depending on the
nature and severity of the infection.
Nongonococcal Urethritis
250 to 500 mg orally every 12 hours. Therapy should be continued for approximately 3 to 7 days, depending on the
nature and severity of the infection.
Otitis Media
250 to 500 mg orally every 12 hours. If Haemophilus influenzae is a suspected or documented pathogen the 500 mg
dose is strongly recommended Therapy should be continued for approximately 10 to 14 days, depending on the
nature and severity of the infection.
Pharyngitis
250 to 500 mg orally every 12 hours. If Haemophilus influenzae is a suspected or documented pathogen the 500 mg
dose is strongly recommended. Therapy should be continued for 10 days.
Pneumonia
250 to 500 mg orally every 12 hours. If Haemophilus influenzae is a suspected or documented pathogen the 500 mg
dose is strongly recommended. Therapy should be continued for 7 to 14 days for pneumococcal pneumonia and for
14 to 21 days for other infecting organisms. The duration of therapy depends on the nature and severity of the
infection.
Sinusitis
clarithromycin 500 mg orally every 12 hours for 14 days or clarithromycin XL tablets 1000 mg every 24 hours for
14 days
Toxoplasmosis
1 gram orally every 12 hours. Therapy should be continued for approximately 3 to 6 weeks, depending on the nature
and severity of the infection. After completion of treatment, patients should begin life-long suppressive therapy with
an appropriate agent.
Upper Respiratory Tract Infection
250 to 500 mg orally every 12 hours. If Haemophilus influenzae is a suspected or documented pathogen the 500 mg
dose is strongly recommended. Therapy should be continued for approximately 7 to 14 days, depending on the
nature and severity of the infection.
Bronchitis
clarithromycin 500 mg orally every 12 hours for 7 to 14 days or clarithromycin XL tablets 1000 mg orally every 24
hours for 7 days.
The initial dosages recommended for this patient with H. parainfluenzae bronchitis are: clarithromycin 500 mg
orally every 12 hours for 7 days or clarithromycin XL tablets 1000 mg orally every 24 hours for 7 days.
The initial dosages recommended for this patient with M. catarrhalis or S. pneumoniae bronchitis are: clarithromycin
250 mg orally every 12 hours for 7 to 14 days or clarithromycin XL tablets 1000 mg orally every 24 hours for 7
days.
Side Effects
Less Serious
nausea, vomiting, diarrhea, or abdominal pain; dizziness, fatigue, or headache; vaginal yeast infection; a rash; or
increased sensitivity to sunlight.
Serious
an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives), or
liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising,
severe fatigue).
Contraindication
Preg C
Colitis/Enteritis (Noninfectious)
Renal Dysfunction
Drug-Drug Interaction
Do not take clarithromycin if you are taking cisapride (Propulsid), pimozide (Orap), or terfenadine (Seldane). These
medicines can interact, possibly leading to a dangerous irregular heartbeat pattern. Cardiac arrhythmias (QT
prolongation, ventricular tachycardia, ventricular fibrillation, and torsades de pointes) most likely due to inhibition
of hepatic metabolism of these drugs by erythromycin and clarithromycin. Fatalities have been reported.

Other
Pharmacology: Clarithromycin is a semi-synthetic macrolide antibiotic. Clarithromycin interferes with protein
synthesis in susceptible bacteria by binding to the 50S ribosomal subunit. Clarithromycin is active against a broad
spectrum of gram-positive and gram-negative organisms, including Chlamydia trachomatis, C. pneumoniae,
mycoplasma, Legionella pneumophila, mycobacteria, and certain protozoa. It achieves high intracellular levels,
which is important for the treatment of certain intracellular pathogens. Clarithromycin may be used as a primary
therapeutic agent for skin and soft tissue infections, respiratory tract infections, urethritis (nongonococcal), and is
often an effective alternative to patients with a penicillin allergy when oral therapy is adequate. It is also indicated
for the treatment and prevention of disseminated Mycobacterium avium-intracellulare infections in patients with
HIV infection and has been used in uncontrolled studies for the treatment of cerebral toxoplasmosis.

Erythromycin (Ery-tabs, E-mycin)
Erythromycin is in a class of drugs called macrolide antibiotics. Erythromycin fights bacteria in the body.
Erythromycin is used to treat many different types of bacterial infections, such as tonsillitis, bronchitis, pneumonia,
whooping cough, Legionnaire's disease, chlamydia, gonorrhea, skin infections, and others
Dose:
ADULT
Bacterial Endocarditis Prophylaxis
1 g (stearate) or 800 mg (ethylsuccinate) orally two hours before procedure, then one-half the amount six hours after
initial dose.
Erythromycin was previously recommended by the American Heart Association for prophylaxis prior to dental, oral
and upper respiratory tract procedures in at-risk, penicillin-allergic patients. It is no longer recommended because of
the high incidence of gastrointestinal adverse effects and complicated pharmacokinetics of the various formulations.
However, patients who have successfully received erythromycin for prophylaxis in the past may continue with this
regimen if desired. Currently, clindamycin, first-generation cephalosporins (in patients who have not had an IgE-
mediated anaphylactic reaction to penicillin), azithromycin or clarithromycin are drugs of choice for prophylaxis in
penicillin-allergic patients undergoing oral, dental, respiratory tract or esophageal procedures.
Bowel Preparation
1 g (base) orally at 1, 2, and 11 PM the day before surgery (assuming 8 a.m. surgery time); given with oral
neomycin 1 g and bowel evacuants.
Legionella Pneumonia
Although the dosage has not been established, clinical trials have used 1 to 4 g/day orally or IV in divided doses
every 6 hours or by continuous infusion.
Campylobacter Gastroenteritis & Chancroid & Lymphogranuloma Venereum & Mycoplasma
Pneumonia & Nongonococcal Urethritis & Otitis Media & Pharyngitis & Pneumonia & Skin or Soft
Tissue Infection & Syphilis -- Early & Upper Respiratory Tract Infection & Bronchitis & Chlamydia
Infection & Lyme Disease
Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6
hours.
Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Rheumatic Fever Prophylaxis
250 mg orally twice a day.
Erythromycin is recommended by the American Heart Association for long-term prophylaxis of streptococcal upper
respiratory tract infections in the prevention of recurrences of rheumatic fever in patients allergic to penicillin and
sulfonamides.
PEDIATRIC DOSE
Bacterial Endocarditis Prophylaxis
20 mg/kg (ethylsuccinate or stearate) orally two hours before procedure, then one-half the amount six hours after
initial dose.
Erythromycin was previously recommended by the American Heart Association for prophylaxis prior to dental, oral
and upper respiratory tract procedures in at-risk, penicillin-allergic patients. It is no longer recommended because of
the high incidence of gastrointestinal adverse effects and complicated pharmacokinetics of the various formulations.
However, patients who have successfully received erythromycin for prophylaxis in the past may continue with this
regimen if desired. Currently, clindamycin, first-generation cephalosporins (in patients who have not had an IgE-
mediated anaphylactic reaction to penicillin), azithromycin or clarithromycin are drugs of choice for prophylaxis in
penicillin-allergic patients undergoing oral, dental, respiratory tract or esophageal procedures.
Bowel Preparation
20 mg/kg (base) orally at 1, 2, and 11 PM the day before surgery (assuming 8 a.m. surgery time); given with oral
neomycin and bowel evacuants.
Chlamydia Infection
Neonatal chlamydial conjunctivitis: 50 mg/kg/day orally in divided doses every 6 hours for at least 2 weeks
Chlamydial pneumonia: 50 mg/kg/day orally in divided doses every 6 hours for at least 2 weeks
Rheumatic Fever Prophylaxis
250 mg orally twice a day.
Erythromycin is recommended by the American Heart Association for long-term prophylaxis of streptococcal upper
respiratory tract infections in the prevention of recurrences of rheumatic fever in patients allergic to penicillin and
sulfonamides.
Side Effects
Less Serious
nausea, vomiting, diarrhea, or abdominal pain (take erythromycin with food or milk if you experience any of these
side effects); dizziness, fatigue, or headache; vaginal yeast infection; a rash; or increased sensitivity to sunlight.
Serious
an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); or
liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising,
severe fatigue).
Contraindication
Preg B
Biliary Obstruction
Colitis/Enteritis (Noninfectious)
Liver Disease
Myasthenia Gravis
Drug-Drug Interaction
Do not take erythromycin if you are taking terfenadine (Seldane, Seldane-D), astemizole (Hismanal), cisapride
(Propulsid), or pimozide (Orap). Erythromycin may interact with these medicines resulting in dangerous or life-
threatening irregular heartbeats.
Other
Pharmacology: Erythromycin is a bacteriostatic antimicrobial agent of the macrolide class. Erythromycin interferes
with protein synthesis in susceptible bacteria by binding to the 50S ribosomal subunit. Erythrommycin is active
against a variety of gram-positive, a few gram-negative, and "atypical" organisms including Campylobacter jejuni,
Bordetella pertussis, and Haemophilus ducreyi. It is also active against Branhamella catarrhalis, Legionella,
Mycoplasma, and Chlamydia. It is not useful against Listeria. Erythromycin is the drug of choice for Legionnaire's
disease and mycoplasmal infections. It may be used to treat chlamydial infections and is frequently an alternative to
penicillin in penicillin-allergic patients.

				
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