(amoxicillin · DailyMed)
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AMOXICILLIN TRIHYDRATE BP, CLARITHROMYCIN USP, ESOMEPRAZOLE MAGNESIUM TRIHYDRATE BP
What it does
Amoxicillin is an antibiotic used to treat infections caused by bacteria.
Commonly used for: infections of the ear, nose, and throat, urinary tract infections, pneumonia, skin infections
Read more in plain English ↓Plain-language summary for general understanding - not medical advice. Always follow your pharmacist/doctor.
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Source: Pharmacy and Poisons Board · fetched 2026-01-28 20:35:19 · updated 2026-07-26 11:25:56
Drug Interactions
220Pharmacodynamic Warnings
Clarithromycin appears in TABLE 9: Drugs that prolong the QT interval
Severe (36)
Acalabrutinib - increases exposure
Clarithromycin is predicted to increase the exposure to acalabrutinib. Avoid.
Alprazolam - increases exposure
Clarithromycin moderately increases the exposure to benzodiazepines (alprazolam). Avoid.
Antihistamines,non-Sedating - increases exposure
Clarithromycin is predicted to increase the exposure to antihistamines, non-sedating (mizolastine). Avoid.
Avapritinib - increases exposure
Clarithromycin is predicted to increase the exposure to avapritinib. Avoid.
Benzodiazepines - increases exposure
Clarithromycin moderately increases the exposure to benzodiazepines (alprazolam). Avoid.
Moderate (50)
Alfentanil - increases exposure
Clarithromycin is predicted to increase the exposure to opioids (alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and adjust dose.
Aminophylline - increases exposure
Clarithromycin is predicted to increase the exposure to aminophylline. Adjust dose.
Amlodipine - increases exposure
Clarithromycin is predicted to increase the exposure to calcium channel blockers (amlodipine, felodipine, lacidipine, nicardipine, nifedipine, nimodipine). Monitor and adjust dose.
Antiarrhythmics - increases exposure
Clarithromycin is predicted to increase the exposure to antiarrhythmics (propafenone). Monitor and adjust dose.
Anticholinesterases, Centrally Acting - increases exposure
Clarithromycin is predicted to increase the exposure to anticholinesterases, centrally acting (galantamine). Monitor and adjust dose.
Unknown (134)
Abemaciclib - increases exposure
Clarithromycin is predicted to increase the exposure to abemaciclib. Avoid or adjust abemaciclib dose, p. 1056.
Afatinib - increases exposure
Macrolides are predicted to increase the exposure to afatinib.
Alitretinoin - increases exposure
Clarithromycin is predicted to increase the exposure to retinoids (alitretinoin). Adjust alitretinoin dose, p. 1382.
Almotriptan - increases exposure
Clarithromycin increases the exposure to triptans (almotriptan).
Alphablockers - increases exposure
Clarithromycin is predicted to increase the exposure to alpha blockers (doxazosin).
Data from BNF 85 (British National Formulary). This is not a substitute for professional medical advice. Matched via: exact
About amoxicillin
Amoxicillin is an antibiotic used to treat infections caused by bacteria.
What it treats
- infections of the ear, nose, and throat
- urinary tract infections
- pneumonia
- skin infections
How it works
It kills bacteria or stops their growth, helping to clear up infections.
Who it's for
Amoxicillin is suitable for adults and children who have bacterial infections.
Drug class
Penicillins
AI-assisted summary grounded in BNF data - general information only, not medical advice. Always confirm with your pharmacist or doctor.
About clarithromycin
Clarithromycin is an antibiotic used to treat infections caused by bacteria.
What it treats
- bacterial infections
- chest infections (pneumonia)
- skin infections
- ear infections (otitis media)
How it works
It works by stopping the growth of bacteria, helping your body to fight off the infection.
Who it's for
It is for adults and children with certain bacterial infections.
Drug class
Macrolides
Cautions
- • Be cautious if you are taking other medications that affect heart rhythm.
AI-assisted summary grounded in BNF data - general information only, not medical advice. Always confirm with your pharmacist or doctor.
About esomeprazole
Esomeprazole is a medication used to reduce stomach acid and help with digestive issues.
What it treats
- gastroesophageal reflux disease (GERD)
- stomach ulcers
- excess stomach acid production
How it works
Esomeprazole works by blocking the production of acid in the stomach, helping to relieve symptoms and heal the stomach lining.
Who it's for
This medication is for adults and children who need help managing stomach acid-related conditions.
AI-assisted summary grounded in BNF data - general information only, not medical advice. Always confirm with your pharmacist or doctor.
Clinical monograph: Amoxicillin
BNF-referencedAmoxicillin is a broad-spectrum antibiotic belonging to the penicillin class, effective against a variety of bacterial infections. It is commonly used to treat conditions such as urinary tract infections, sinusitis, community-acquired pneumonia, and salmonellosis.
Indications
- Bacterial infections
- Urinary tract infections
- Sinusitis
- Uncomplicated community-acquired pneumonia
- Salmonellosis
- Oral infections
- Lyme disease (under expert supervision)
- Acute exacerbation of bronchiectasis
- Anthrax (treatment and post-exposure prophylaxis)
Dosage
Children: 1 month–11 years: 30 mg/kg 3 times a day for 21 days; children 1–4 years: 250 mg 3 times a day; children 5–11 years: 500 mg 3 times a day.
Adults: 500 mg 3 times a day; increased if necessary up to 1 g 3 times a day in severe infections.
Mechanism of action
Amoxicillin works by inhibiting bacterial cell wall synthesis, leading to cell lysis and death. It binds to penicillin-binding proteins (PBPs) located inside the bacterial cell wall, interfering with the transpeptidation process necessary for cell wall integrity.
Pharmacodynamics
Amoxicillin exhibits bactericidal activity against susceptible bacteria. Its action is time-dependent, meaning that its effectiveness is related to the duration of time that the drug concentration remains above the minimum inhibitory concentration (MIC) for the target pathogen.
Pharmacokinetics
Amoxicillin is well absorbed from the gastrointestinal tract, with peak plasma concentrations achieved within 1-2 hours after oral administration. It is widely distributed in body tissues and fluids, and it is excreted primarily via the kidneys. The elimination half-life is approximately 1 hour, and renal impairment may necessitate dosage adjustments.
Adverse effects
- Skin rash
- Gastrointestinal disturbances (nausea, vomiting, diarrhea)
- Allergic reactions (including anaphylaxis)
- Superinfection (due to resistant organisms)
Interactions
- Allopurinol (increases risk of skin rash)
Precautions
- History of penicillin allergy
- Renal impairment (reduce dose)
- Use with caution in patients with mononucleosis
Pregnancy
Use only if clearly needed; no adequate studies in pregnant women.
Breast-feeding
Amoxicillin is excreted in breast milk; use with caution.
Storage
Store in a cool, dry place away from direct sunlight.
Formulations
- Phenoxymethylpenicillin 250mg/5ml oral solution
- Phenoxymethylpenicillin 250 mg tablets
AI-synthesized from BNF references - general information only, not a substitute for professional medical advice or the current BNF. Verify doses with a pharmacist.
Clinical monograph: Esomeprazole
BNF-referencedEsomeprazole is a proton pump inhibitor (PPI) that is primarily used to reduce gastric acid secretion. It is effective in the treatment of various gastric acid disorders and ulcerations, including gastroesophageal reflux disease (GERD), erosive esophagitis, and the eradication of Helicobacter pylori to help prevent duodenal ulcer recurrence. Esomeprazole works by irreversibly inhibiting the H+/K+-ATPase enzyme in gastric parietal cells, leading to decreased gastric acid production. Its antisecretory effects can last longer than 24 hours, making it suitable for once-daily dosing.
Indications
- Gastroesophageal reflux disease (GERD)
- Erosive esophagitis
- Peptic ulcers
- Helicobacter pylori eradication
- Zollinger-Ellison syndrome
Dosage
Adults: The usual oral dose
Mechanism of action
Esomeprazole exerts its stomach acid-suppressing effects by covalently binding to cysteine residues on the H+/K+-ATPase enzyme at the secretory surface of gastric parietal cells. This action inhibits both basal and stimulated gastric acid secretion irreversibly, requiring the synthesis of new enzyme to restore acid production. By blocking the final step of gastric acid production, esomeprazole reduces gastric acidity in a dose-dependent manner.
Pharmacodynamics
Esomeprazole is a substituted benzimidazole that inhibits gastric acid secretion without exhibiting anticholinergic or H2 receptor antagonistic properties. It is indicated for the treatment of GERD, healing of erosive esophagitis, and eradication of H. pylori to reduce duodenal ulcer recurrence. The suppression of gastric acid secretion is dose-related and effective against various stimuli that promote acid secretion.
Pharmacokinetics
Esomeprazole is rapidly absorbed after oral administration, with peak plasma concentrations typically occurring within 1-2 hours. It undergoes extensive hepatic metabolism primarily by the cytochrome P450 system, especially CYP2C19, resulting in several metabolites. The elimination half-life is approximately 1-2 hours, though its antisecretory effects last longer. It is excreted predominantly in the urine. Dose adjustments may be necessary in patients with hepatic impairment.
Contra-indications
- Hypersensitivity to esomeprazole or any of its components
- Concomitant use with rilpivirine-containing products
Adverse effects
- Abdominal pain
- Constipation
- Diarrhea
- Dizziness
- Dry mouth
- Headache
- Insomnia
- Nausea
- Skin reactions
- Vomiting
- Bone fractures
- Confusion
- Depression
- Drowsiness
- Leucopenia
- Malaise
- Myalgia
- Paraesthesia
- Peripheral edema
- Thrombocytopenia
- Vertigo
- Vision disorders
- Agranulocytosis
- Alopecia
- Gynaecomastia
- Hallucination
- Hepatic disorders
- Hyperhidrosis
- Hyponatraemia
- Nephritis
- Tubulointerstitial nephritis
- Pancytopenia
- Photosensitivity reaction
- Severe cutaneous adverse reactions (SCARs)
- Stomatitis
- Taste altered
- Hypomagnesaemia
Interactions
- Esomeprazole may increase the exposure to cannabidiol
- Esomeprazole may increase the exposure to cilostazol
Precautions
- Increased risk of fractures, particularly in the elderly and when used at high doses for over a year
- Caution in patients at risk of osteoporosis; adequate intake of calcium and vitamin D is recommended
- May increase the risk of gastrointestinal infections, including Clostridioides difficile
- Symptoms of gastric cancer should be ruled out before treatment
- Use with caution in patients with hepatic impairment
Pregnancy
Use with caution. The manufacturer advises avoiding use unless necessary since the effects on the fetus are not fully known.
Breast-feeding
Manufacturer advises avoiding use as esomeprazole is present in breast milk and may cause diarrhea in nursing infants. However, amounts are probably too small to be harmful.
Storage
Store in a cool, dry place below 25°C. Keep out of
AI-synthesized from BNF references - general information only, not a substitute for professional medical advice or the current BNF. Verify doses with a pharmacist.
Clinical monograph: Clarithromycin
BNF-referencedClarithromycin is a macrolide antibiotic effective against a range of bacterial infections. It is primarily used in the treatment of community-acquired pneumonia, skin infections, and as a prophylactic measure for certain infections. Clarithromycin works by inhibiting bacterial protein synthesis, making it a crucial agent in combating gram-positive and some gram-negative bacteria.
Indications
- Bacterial infections
- Community-acquired pneumonia
- Skin infections
- Prophylaxis for certain infections
Dosage
Adults: 500 mg once daily for
Mechanism of action
Clarithromycin is metabolized to 14-OH clarithromycin, which is active. It penetrates bacterial cell walls and reversibly binds to domain V of the 23S ribosomal RNA of the 50S ribosomal subunit, blocking the translocation of aminoacyl-tRNA and inhibiting polypeptide synthesis. It may be bactericidal in high concentrations against susceptible organisms, particularly Streptococcus pyogenes, S. pneumoniae, Haemophilus influenzae, and Chlamydia trachomatis. Additionally, clarithromycin inhibits the hepatic microsomal CYP3A4 isoenzyme and P-glycoprotein.
Pharmacodynamics
Clarithromycin exhibits a broad spectrum of activity against numerous gram-positive bacteria, including Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes. It also shows activity against gram-negative bacteria such as Haemophilus influenzae and Moraxella catarrhalis, as well as against various anaerobic bacteria, mycobacteria, and other organisms like Mycoplasma, Ureaplasma, and Chlamydia. While typically bacteriostatic, it can sometimes demonstrate bactericidal properties depending on the concentration and the organism.
Pharmacokinetics
Clarithromycin is well absorbed after oral administration, with its bioavailability enhanced by food. It is extensively metabolized in the liver, primarily via CYP3A4, leading to active metabolites. The drug has a half-life of approximately 3 to 4 hours, but its active metabolite, 14-OH clarithromycin, has a longer half-life, contributing to its prolonged activity. Renal impairment can significantly affect its clearance, necessitating dosage adjustments in patients with reduced renal function.
Adverse effects
- Nausea
- Diarrhea
- Abdominal pain
- Dysgeusia
- Headache
- Rash
- Liver enzyme elevations
- QT prolongation
Interactions
- Clarithromycin + acalabrutinib: Severe (increases exposure)
- Clarithromycin + antiarrhythmics: Severe (increases exposure)
- Clarithromycin + dronedarone: Severe (increases exposure)
- Clarithromycin + non-sedating antihistamines: Severe (increases exposure)
- Clarithromycin + mizolastine: Severe (increases exposure)
- Clarithromycin + lurasidone: Severe (increases exposure)
- Clarithromycin + quetiapine: Severe (increases exposure)
- Clarithromycin + avapritinib: Severe (increases exposure)
- Clarithromycin + benzodiazepines: Severe (increases exposure)
- Clarithromycin + alprazolam: Severe (increases exposure)
Precautions
- Caution in hepatic impairment
- Use with caution in renal impairment
- Monitor for signs of QT prolongation
- Consider alternative therapy in patients with history of arrhythmias
- Use with caution in patients with myasthenia gravis due to potential exacerbation
Pregnancy
Manufacturers advise use only if adequate alternatives are not available.
Breast-feeding
Present in milk; use only if no suitable alternatives.
Storage
Store in a cool, dry place away from light. Keep out of reach of children.
Formulations
- Oral suspension 200 mg/5 mL
- Capsules 250 mg
AI-synthesized from BNF references - general information only, not a substitute for professional medical advice or the current BNF. Verify doses with a pharmacist.
Molecular reference: Amoxicillin
PubChem CID 33613Molecular formula: C16H19N3O5S
Mechanism of action
Amoxicillin competitively inhibits penicillin-binding protein 1 and other high molecular weight penicillin binding proteins. Penicillin bind proteins are responsible for glycosyltransferase and transpeptidase reactions that lead to cross-linking of D-alanine and D-aspartic acid in bacterial cell walls. Without the action of penicillin binding proteins, bacteria upregulate autolytic enzymes and are unable to build and repair the cell wall, leading to bacteriocidal action. The penicillins and their metabolites are potent immunogens because of their ability to combine with proteins and act as haptens for acute antibody-mediated reactions. The most frequent (about 95 percent) or "major" determinant of penicillin allergy is the penicilloyl determinant produced by opening the beta-lactam ring of the penicillin. This allows linkage of the penicillin to protein at the amide group. "Minor" determinants (less frequent) are the other metabolites formed, including native penicillin and penicilloic acids. /Penicillins/ Amoxicillin is similar to penicillin in its bactericidal action against susceptible bacteria during the stage of active multiplication. It acts through the inhibition of cell wall biosynthesis that leads to the death of the bacteria.
Pharmacodynamics
Amoxicillin competitively inhibit penicillin binding proteins, leading to upregulation of autolytic enzymes and inhibition of cell wall synthesis. Amoxicillin has a long duration of action as it is usually given twice daily. Amoxicillin has a wide therapeutic range as mild overdoses are not associated with significant toxicity. Patients should be counselled regarding the risk of anaphylaxis, _Clostridium difficile_ infections, and bacterial resistance.
Biological pathways
Source: PubChem (NCBI) · pathways from PathBank, Reactome, WikiPathways & PharmGKB.
Molecular reference: Clarithromycin
PubChem CID 84029Molecular formula: C38H69NO13
Mechanism of action
Clarithromycin is first metabolized to 14-OH clarithromycin, which is active and works synergistically with its parent compound. Like other macrolides, it then penetrates bacteria cell wall and reversibly binds to domain V of the 23S ribosomal RNA of the 50S subunit of the bacterial ribosome, blocking translocation of aminoacyl transfer-RNA and polypeptide synthesis. Clarithromycin also inhibits the hepatic microsomal CYP3A4 isoenzyme and P-glycoprotein, an energy-dependent drug efflux pump. Clarithromycin usually is bacteriostatic, although it may be bactericidal in high concentrations or against highly susceptible organisms. Bactericidal activity has been observed against Streptococcus pyogenes, S. pneumoniae, Haemophilus influenzae, and Chlamydia trachomatis. Clarithromycin inhibits protein synthesis in susceptible organisms by penetrating the cell wall and binding to 50S ribosomal subunits, thereby inhibiting translocation of aminoacyl transfer-RNA and inhibiting polypeptide synthesis. The site of action of clarithromycin appears to be the same as that of erythromycin, clindamycin, lincomycin, and chloramphenicol.
Pharmacodynamics
Clarithromycin is a macrolide antibiotic whose spectrum of activity includes many gram-positive (<i>Staphylococcus aureus, S. pneumoniae, and S. pyogenes</i>) and gram-negative aerobic bacteria (<i>Haemophilus influenzae, H. parainfluenzae, and Moraxella catarrhalis</i>), many anaerobic bacteria, some mycobacteria, and some other organisms including <i>Mycoplasma, Ureaplasma, Chlamydia, Toxoplasma</i>, and <i>Borrelia</i>. Other aerobic bacteria that clarithromycin has activity against include <i>C. pneumoniae and M. pneumoniae</i>. Clarithromycin has an in-vitro activity that is similar or greater than that of erythromycin against erythromycin-susceptible organisms. Clarithromycin is usually bacteriostatic, but may be bactericidal depending on the organism and the drug concentration.
Biological pathways
Source: PubChem (NCBI) · pathways from PathBank, Reactome, WikiPathways & PharmGKB.
Molecular reference: Esomeprazole
PubChem CID 9568614Molecular formula: C17H19N3O3S
Mechanism of action
Esomeprazole exerts its stomach acid-suppressing effects by preventing the final step in gastric acid production by covalently binding to sulfhydryl groups of cysteines found on the (H+, K+)-ATPase enzyme at the secretory surface of gastric parietal cells. This effect leads to inhibition of both basal and stimulated gastric acid secretion, irrespective of the stimulus. As the binding of esomeprazole to the (H+, K+)-ATPase enzyme is irreversible and new enzyme needs to be expressed in order to resume acid secretion, esomeprazole's duration of antisecretory effect that persists longer than 24 hours. Esomeprazole is a proton pump inhibitor that suppresses gastric acid secretion by specific inhibition of the H+/K+-ATPase in the gastric parietal cell. The S- and R-isomers of omeprazole are protonated and converted in the acidic compartment of the parietal cell forming the active inhibitor, the achiral sulphenamide. By acting specifically on the proton pump, esomeprazole blocks the final step in acid production, thus reducing gastric acidity. This effect is dose-related up to a daily dose of 20 to 40 mg and leads to inhibition of gastric acid secretion.
Pharmacodynamics
Esomeprazole is a compound that inhibits gastric acid secretion and is indicated in the treatment of gastroesophageal reflux disease (GERD), the healing of erosive esophagitis, and <i>H. pylori</i> eradication to reduce the risk of duodenal ulcer recurrence. Esomeprazole belongs to a new class of antisecretory compounds, the substituted benzimidazoles, that do not exhibit anticholinergic or H2 histamine antagonistic properties, but that suppress gastric acid secretion by specific inhibition of the H<sup>+</sup>/K<sup>+</sup> ATPase at the secretory surface of the gastric parietal cell. By doing so, it inhibits acid secretion into the gsatric lumen. This effect is dose-related and leads to inhibition of both basal and stimulated acid secretion irrespective of the stimulus. Esomeprazole is the s-isomer of [DB00338], which is a racemate of the S- and R-enantiomer. Esomeprazole has been shown to inhibit acid secretion to a similar extent as [DB00338], without any significant differences between the two compounds _in vitro_. PPIs such as esomeprazole have also been shown to inhibit the activity of dimethylarginine dimethylaminohydrolase (DDAH), an enzyme necessary for cardiovascular health. DDAH inhibition causes a consequent accumulation of the nitric oxide synthase inhibitor asymmetric dimethylarginie (ADMA), which is thought to cause the association of PPIs with increased risk of cardiovascular events in patients with unstable coronary syndromes. Due to their good safety profile and as several PPIs are available over the counter without a prescription, their current use in North America is widespread. Long term use of PPIs such as esomeprazole has been associated with possible adverse effects, however, including increased susceptibility to bacterial infections (including gastrointestinal _C. difficile_), reduced absorption of micronutrients including iron and B12, and an increased risk of developing hypomagnesemia and hypocalcemia which may contribute to osteoporosis and bone fractures later in life.
Biological pathways
Source: PubChem (NCBI) · pathways from PathBank, Reactome, WikiPathways & PharmGKB.
This drug in other countries
The same active ingredient registered across other registries we cover - including different brands.
- AC-CLAV 1000 TABLETS (Each film coated tablet contains Amoxicillin and Cluvalanate Potassium 1000mg · Kiux Pharma
- AC-CLAV 625 TABLETS (Each film coated tablet contains Amoxicillin and Clavulanate Potassium 625 · Kiux Pharma
- ACICLAVCARE 1G TABLETS (Each film-coated tablet contains Amoxicillin trihydrate / Potassium clavulanate 1g) · East African Overseas
- ACINET 1.2G INJECTION (Each vial contains Amoxicillin Sodium/Potassium Clavulanate 1g/0.2g · East African Creasteas
- ACINET 228.5MG/5ML DRY SUSPENSION (Each 5ml of reconstituted suspension contains Amoxicillin Trihydrate/Potassium Clavulanate 200mg/28.5mg) · Indchemie Health Specialities
- ACINET 457MG/5ML DRY SUSPENSION (Each 5ml of reconstituted suspension contains Amoxicillin Trihydrate/Potassium Clavulanate 400mg/57mg) · Indchemie Health Specialities