Lancid Kit - Instructions For Use, Reviews, Price, Drug Analogues

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Lancid Kit

Lancid Kit: instructions for use and reviews

1. 1. Release form and composition
2. 2. Pharmacological properties
3. 3. Indications for use
4. 4. Contraindications
5. 5. Method of application and dosage
6. 6. Side effects
7. 7. Overdose
8. 8. Special instructions
9. 9. Application during pregnancy and lactation
10. 10. Use in childhood
11. 11. In case of impaired renal function
12. 12. For violations of liver function
13. 13. Use in the elderly
14. 14. Drug interactions
15. 15. Analogs
16. 16. Terms and conditions of storage
17. 17. Terms of dispensing from pharmacies
18. 18. Reviews
19. 19. Price in pharmacies

Latin name: Lancid Kit

ATX code: A02BD

Active ingredient: clarithromycin (Clarithromycin) + amoxicillin (Amoxicillin) + lansoprazole (Lansoprazole)

Manufacturer: Micro Labs Limited (India)

Description and photo updated: 30.11.2018

Prices in pharmacies: from 862 rubles.

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Lancid Kit is a remedy for the treatment of peptic ulcers.

Release form and composition

Lancid Kit is a set of tablets and capsules [in a blister separated by a perforated line into two parts (morning and evening), 2 clarithromycin tablets, 4 amoxicillin capsules and 2 lansoprazole capsules; in a cardboard box 7 blisters and instructions for use of Lancida Kit]:

• film-coated tablets containing clarithromycin: oval, with a line on one side, yellow, at the break - white;
• capsules containing amoxicillin: size No. 0, hard gelatinous, with a yellow body and a dark red cap, with a black inscription "500" on the body and "AMOXI" on the cap; contents - almost white or white crystalline powder;
• capsules containing lansoprazole: size No. 1, hard gelatinous, with a pink body and lid, with a black inscription "MICRO / MICRO"; content - granules (pellets) of almost white or white color.

Composition of 1 clarithromycin tablet:

• active substance: clarithromycin - 500 mg;
• auxiliary components: sodium croscarmellose, colloidal silicon dioxide, corn starch, microcrystalline cellulose, stearic acid, sorbitan oleate, sorbic acid, magnesium stearate, povidone, talc;
• film shell: propylene glycol, hypromellose, titanium dioxide (E171), quinoline yellow dye (E104), vanilla flavor.

Composition of 1 capsule of amoxicillin:

• active substance: amoxicillin (in the form of trihydrate) - 500 mg;
• auxiliary components: sodium lauryl sulfate, talc, magnesium stearate;
• capsule shell: body - gelatin, methyl parahydroxybenzoate, propyl parahydroxybenzoate, titanium dioxide (E171), iron dye yellow oxide (E172); cap - gelatin, water, methyl parahydroxybenzoate, propyl parahydroxybenzoate, titanium dioxide (E171), sunset yellow dye (E110), brilliant blue dye (E133);
• black ink: isopropanol, shellac, butanol, ethanol, propylene glycol, aqueous ammonia, iron oxide black oxide (E172).

Composition of 1 capsule of lansoprazole:

• active substance: lansoprazole - 30 mg;
• auxiliary components: diethyl phthalate, sodium hydroxide, calcium carmellose, sucrose, microspheres of sucrose, hypromellose, mannitol, polysorbate 80, magnesium hydroxycarbonate, sodium hydrogen phosphate, povidone, talc, titanium dioxide (E171), methacrylic acid copolymer (type A);
• capsule shell: body - gelatin, propyl parahydroxybenzoate, methyl parahydroxybenzoate, sodium lauryl sulfate, water, titanium dioxide (E171), crimson dye (Ponso 4R) (E124); cap - gelatin, propyl parahydroxybenzoate, sodium lauryl sulfate, water, methyl parahydroxybenzoate, titanium dioxide (E171), crimson dye (Ponso 4R) (E124);
• black ink: butanol, isopropanol, shellac, propylene glycol, ethanol, aqueous ammonia, iron dye black oxide (E172).

Pharmacological properties

Pharmacodynamics

Lancid Kit is a combined preparation used for the eradication of Helicobacter pylori. The mechanism of action is due to the properties of the active ingredients.

Clarithromycin

Clarithromycin is a semi-synthetic derivative of erythromycin A, a bacteriostatic macrolide antibiotic. The antibacterial effect is a consequence of binding of the 50S subunit of the ribosome membrane of a microbial cell and suppression of protein synthesis of microorganisms.

Shows activity against a large number of aerobic and anaerobic gram-negative and gram-positive microorganisms, including the bacterium Helicobacter pylori.

Amoxicillin

Amoxicillin is a semi-synthetic penicillin with a bactericidal effect and a broad spectrum of action. The antibiotic has the ability to inhibit transpeptidase, disrupt the synthesis of peptidoglycan (a supporting protein of the cell wall) during division and growth, and cause lysis of bacteria. Shows high activity against Helicobacter pylori.

The combination of clarithromycin + amoxicillin has a potentiated antimicrobial effect against H. pylori.

Lansoprazole

Lansoprazole is a specific proton pump inhibitor (H ⁺ / K ⁺ -ATPase). In parietal cells of the stomach, it is biotransformed to active sulfonamide derivatives, which inactivate H ⁺ / K ⁺ -ATP-ase. Reduces basal and stimulated secretion (regardless of the nature of the stimulus), thereby blocking the final stage of hydrochloric acid secretion. It has high lipophilicity, therefore it easily penetrates into the parietal cells of the stomach and concentrates in them. Increases oxygenation of the gastric mucosa and increases the secretion of bicarbonate, as a result of which it has a cytoprotective effect.

The rate and degree of suppression of basal and stimulated secretion of hydrochloric acid are dose-dependent: pH begins to increase in 1-2 hours and 2-3 hours after taking lansoprazole at a dose of 15 and 30 mg, respectively. When a dose of 30 mg is taken, the inhibition of hydrochloric acid production is 80–97%.

It does not affect the motility of the gastrointestinal tract.

The inhibitory effect increases in the first 4 days of taking the drug. After discontinuation of lansoprazole for 39 hours, acidity remains below 50% of the basal level. There is no ricochet increase in secretion. Secretory activity is normalized 3-4 hours after drug withdrawal.

With Zollinger-Ellison syndrome, the effect is longer.

Suppressing the growth of Helicobacter pylori, it promotes the formation of specific IgA to bacteria in the gastric mucosa. Increases the anti-Helicobacter activity of other drugs. Inhibits the production of pepsin and increases the plasma concentration of pepsinogen. The suppression of secretion is accompanied by an increase in the number of nitrosobacteria and the concentration of nitrates in gastric secretions.

The drug is effective for gastric ulcer and duodenal ulcer resistant to H ₂ -histamine receptor blockers. Provides faster healing of ulcerative lesions in the duodenum (85% of duodenal ulcers heal within 4 weeks of regular intake of lansoprazole in a daily dose of 30 mg).

Pharmacokinetics

Clarithromycin

The substance is rapidly and well absorbed from the gastrointestinal tract. The absolute bioavailability is approximately 50%. Simultaneous food intake somewhat slows down the absorption of clarithromycin, but does not significantly affect bioavailability. With repeated administration, accumulation in the body is not noted, the nature of metabolism does not change.

About 80% of the dose is bound to plasma proteins. After a single dose, 2 peaks of maximum concentration (C _max) are observed. The second is due to the accumulation of clarithromycin in the gallbladder, subsequent entry into the intestine and absorption. With a single dose of 500 mg, C _{max is} achieved within 2-3 hours.

It is metabolized with the participation of the CYP3A isoenzyme of the cytochrome P _{450 system}. It is an inhibitor of isoenzymes CYP3A4, CYP3A5 and CYP3A7.

Approximately 20% of the ingested dose is rapidly hydroxylated in the liver to form 14 (R) -hydroxyclarithromycin, the main metabolite, which also has a pronounced antimicrobial activity.

At equilibrium, the concentration of the metabolite does not increase in proportion to the doses of clarithromycin. The half-lives (T _½) of clarithromycin and 14 (R) -hydroxyclarithromycin increase with increasing dose.

When using clarithromycin in higher doses, there is a decrease in the formation of 14 (R) -hydroxyclarithromycin and N-demethylated metabolites, which indicates the nonlinear nature of the drug's pharmacokinetics.

With regular use of the drug in a daily dose of 500 mg, the equilibrium concentration (C _ss) in the blood plasma of unchanged clarithromycin and its main metabolite are, respectively, 2.7-2.9 μg / ml and 0.83-0.88 μg / ml, T _½ - 4.8–5 h and 6.9–8.7 h, respectively.

At therapeutic doses, clarithromycin accumulates in the lungs, skin, and soft tissues. Concentrations in soft tissues are 10 times higher than in blood plasma.

The drug is excreted by the kidneys and through the intestines: unchanged - 20-30%, the rest - in the form of metabolites.

Amoxicillin

It is quickly and well absorbed from the gastrointestinal tract. The extent and speed of absorption does not depend on food intake. The acidic environment of the stomach does not have a destructive effect. Absolute bioavailability is dose-dependent and amounts to 75–90%.

After a single dose of 500 mg, C _max is 6-11 mg / l and is observed after 1-2 hours. 17% binds to plasma proteins.

Amoxicillin crosses the histohematogenous barriers, with the exception of the unchanged blood-brain. It is well distributed in tissues: in high concentrations it is formed in blood plasma, pleural and peritoneal fluids, bronchial secretions (distribution is weak in purulent bronchial secretions), sputum, lung tissue, urine, intestinal mucosa, gallbladder (with normal liver function), fatty tissues, bones, middle ear fluid (with inflammation), contents of skin blisters, prostate gland, female genital organs. Penetrates through the placenta, in small quantities into breast milk. In the case of an increase in the dose of amoxicillin, a proportional increase in concentration in tissues and organs is noted. The content in bile is 2–4 higher than in plasma. The concentration of amoxicillin in the amniotic fluid and umbilical cord vessels is 25–30% of the concentration in the blood plasma of a pregnant woman. In small amounts, amoxicillin is excreted in breast milk.

The drug poorly penetrates the blood-brain barrier. In patients with meningitis (inflammation of the meninges), the concentration of the substance in the cerebrospinal fluid is approximately 20% of the plasma level.

Approximately 7-25% of the dose of amoxicillin undergoes biotransformation, resulting in the formation of inactive penicillic acid.

It is excreted: by the liver - 10–20%, by the kidneys - 50–70%, mainly unchanged by tubular secretion (80%) and glomerular filtration (20%). T _½ is 1–1.5 hours. In patients with impaired renal function [creatinine clearance (CC) less than 15 ml / min] T _½ increases to 5–20 hours. The drug is excreted during hemodialysis.

Lansoprazole

It is quickly and well absorbed from the gastrointestinal tract. Bioavailability is 80–90%. With the simultaneous intake of food, absorption and bioavailability are halved, however, the inhibitory effect of lansoprazole on gastric secretion does not change, regardless of food intake. Absorption can be slowed down by cirrhosis of the liver.

C _max and AUC (area under the concentration-time curve) are approximately proportional. When the drug is taken 30 minutes after a meal, both pharmacokinetic parameters decrease by 50%. Food has no significant effect when taken before meals.

Plasma proteins bind 97% of the dose, the connection may decrease by 1-1.5% with impaired renal function.

After taking lansoprazole at a dose of 30 mg, C _max is 0.75–1.15 mg / l and is reached within 1.5–2 hours. The drug penetrates well into tissues, including the lining cells of the stomach. The volume of distribution is 0.5 l / kg.

Lansoprazole is actively metabolized during the first passage through the liver. It is biotransformed with the participation of the isoenzyme CYP2C19 and, possibly, CYP3A4, as a result of which metabolites are formed, of which two are found in significant amounts in plasma - sulfinyl hydroxylate and a sulfone derivative, which are inactive. In the acidic environment of the tubules of parietal cells, the drug is biotransformed into two active metabolites, but they are not found in the systemic circulation.

After the first dose of 30 mg of lansoprazole, the pH of the gastric juice rises after 1-2 hours. When using the drug at a dose of 30 mg several times a day, this indicator increases in the first hour after administration. The effect persists for more than 24 hours. The level of hydrochloric acid secretion is restored to normal in 2–4 days after stopping several doses of lansoprazole.

T _½ is 1–2 hours, in old age it increases to 1.9–2.9 hours, in patients with impaired liver function - up to 3.2–7.2 hours.

The drug is excreted from the body in the form of lansoprazole sulfone and hydroxylansoprazole: with bile - ⅔, kidneys - 14–23%. In renal failure, the rate and magnitude of excretion do not change significantly.

Indications for use

Lancid Kit is intended for the treatment of gastric ulcer and duodenal ulcer, including for the eradication of Helicobacter pylori infection.

Contraindications

Absolute:

• lack of sucrase / isomaltase, fructose intolerance, glucose-galactose malabsorption;
• severe hepatic impairment concurrently with renal impairment;
• a history of gastrointestinal tract diseases, especially colitis associated with the use of antibiotics;
• porphyria;
• hay fever;
• bronchial asthma;
• atopic dermatitis;
• Infectious mononucleosis;
• lymphocytic leukemia;
• a history of cholestatic jaundice / hepatitis with clarithromycin;
• hypokalemia;
• lengthening of the QT interval, ventricular arrhythmia or ventricular tachycardia in the "pirouette" in history;
• the period of pregnancy and breastfeeding;
• age up to 18 years;
• concomitant use of the following drugs: terfenadine, pimozide, cisapride, astemizole, ergot alkaloids (eg ergotamine, dihydroergotamine), oral midazolam, HMG-CoA reductase inhibitors (statins), which are largely metabolized by the isoenzyme CYP3A4 (lovastatin) simvastatin), as well as colchicine in patients with impaired renal and hepatic function;
• hypersensitivity to any component of Lancid Kit, penicillins, macrolides, carbapenems or cephalosporins.

Relative (Lancid Kit should be used with caution):

• myasthenia gravis;
• a history of bleeding;
• moderate to severe hepatic / renal failure;
• severe bradycardia (less than 50 beats / min), severe heart failure, coronary heart disease;
• hypomagnesemia;
• allergic reactions, including history;
• elderly age;
• concomitant use of clopidogrel, benzodiazepines (intravenous midazolam, triazole, alprazolam), calcium channel blockers metabolized by the CYP3A4 isoenzyme (for example, amlodipine, verapamil, diltiazem);
• the need to use drugs that are metabolized by the CYP3A isoenzyme (indirect anticoagulants, cyclosporine, tacrolimus, methylprednisolone, disopyramide, carbamazepine, sildenafil, quinidine, omeprazole, rifabutin, cilostazol, vinblastine);
• the combined use of drugs that induce the isoenzyme CYP3A4 (for example, carbamazepine, rifampicin, phenobarbital, phenytoin, St. John's wort);
• concomitant therapy with class IA antiarrhythmic drugs (quinidine, procainamide) and class III (dofetilide, amiodarone, sotalol).

Lancid Kit, instructions for use: method and dosage

Lancid Kit should be taken orally, before meals, 1 clarithromycin tablet (500 mg), 2 capsules of amoxicillin (1000 mg) and 1 capsule of lansoprazole (30 mg) twice a day, morning and evening. Tablets and capsules should be swallowed whole without crushing or chewing, drinking plenty of water.

The course of treatment is 7 days, if necessary, the duration is increased to 14 days.

Side effects

There is no information on adverse reactions to Lancid Kit. The side effects inherent in each of the active substances of the drug are described below. In terms of frequency of occurrence, they are classified as follows: very often - ≥ 1/10, often - from ≥ 1/100 to <1/10, infrequently - from ≥ 1/1000 to <1/100, rarely - from ≥ 1/10 000 up to <1/1000, very rarely - <1/10 000, the frequency is unknown - based on the available data, it is not possible to assess the intensity of the occurrence of adverse reactions.

Clarithromycin

• from the gastrointestinal tract: often - abdominal pain, nausea, dyspepsia, diarrhea, vomiting; infrequently - dry mouth, stomatitis, flatulence, bloating, belching, constipation, glossitis, gastritis, gastroesophageal reflux disease, proctalgia; frequency unknown - discoloration of the tongue and teeth, acute pancreatitis;
• from the liver and biliary tract: often - atypical functional liver test; infrequently - cholestasis, increased activity of gamma-glutamyl transferase, aspartate aminotransferase and alanine aminotransferase, hepatitis; frequency unknown - hepatocellular jaundice, liver failure;
• from the side of the kidneys and urinary tract: very rarely - interstitial nephritis, renal failure;
• on the part of metabolism and nutrition: infrequently - decreased appetite, anorexia; frequency unknown - hypoglycemia;
• from the immune system: infrequently - hypersensitivity reactions; frequency unknown - anaphylactic reactions;
• on the part of the cardiovascular system: infrequently - palpitations, prolongation of the QT interval on the electrocardiogram; frequency unknown - hemorrhage, unusual bleeding, ventricular tachycardia, pirouette ventricular tachycardia, flutter and fibrillation of the ventricles;
• from the respiratory system: infrequently - epistaxis;
• from the blood and lymphatic system: infrequently - thrombocythemia, neutropenia, eosinophilia, leukopenia; frequency unknown - thrombocytopenia, agranulocytosis;
• from the nervous system: often - headache, change in taste (dysgeusia); infrequently - drowsiness, dizziness, tremors, loss of consciousness; frequency unknown - violation or loss of smell, loss of taste, paresthesia, convulsions;
• on the part of the psyche: often - insomnia; infrequently - nervousness, anxiety; frequency unknown - disorientation, confusion, hallucinations, mania, nightmares, depersonalization, psychosis, depression;
• from the musculoskeletal and connective tissue: infrequently - muscle spasm, myalgia; frequency unknown - increased symptoms of myasthenia gravis, myopathy, rhabdomyolysis;
• infectious and parasitic diseases: infrequently - the development of superinfection (with prolonged or repeated use of the drug), gastroenteritis, candidiasis, vaginal infections; frequency unknown - erythrasma, erysipelas, pseudomembranous colitis;
• on the part of the skin and subcutaneous tissues: often - skin rashes, increased sweating; infrequently - maculopapular rash, urticaria, itching; frequency unknown - acne, drug rash with eosinophilia and systemic manifestations, toxic epidermal necrolysis (Lyell's syndrome), malignant exudative erythema (Stevens-Johnson syndrome), Shenlein-Henoch purpura;
• on the part of the organ of hearing, as well as labyrinth disorders: infrequently - noise / ringing in the ears, hearing impairment, vertigo; frequency unknown - hearing loss (disappears after drug withdrawal);
• laboratory parameters: infrequently - increased activity of blood lactate dehydrogenase and alkaline phosphatase; very rarely - hypercreatininemia; the frequency is unknown - a change in the color of urine, an increase in the concentration of bilirubin, an increase in prothrombin time, an increase in the international normalized ratio (INR);
• others: infrequently - chest pain, weakness, fever, chills, malaise, asthenia.

Amoxicillin

• from the gastrointestinal tract: often - loss of appetite, soft stools, diarrhea, flatulence, dry mouth, rash on the oral mucosa, distortion of taste perception, nausea, vomiting; rarely - darkening of the tooth enamel; very rarely - black "hairy" tongue, pseudomembranous colitis;
• from the liver and biliary tract: infrequently - a reversible increase in the activity of hepatic transaminases; rarely - cholestatic jaundice, hepatitis;
• from the side of the kidneys: rarely - crystalluria, acute interstitial nephritis;
• from the nervous system: infrequently - headache; rarely - insomnia, anxiety, change in behavior, agitation, hyperkinesia, dizziness, confusion, ataxia, depression, peripheral neuropathy; in patients with meningitis, epilepsy and impaired renal function, convulsions;
• from the immune system: rarely - allergic purpura, serum sickness, laryngeal edema, anaphylactic reaction;
• on the part of the blood and lymphatic system: rarely - hemolytic anemia, eosinophilia; very rarely - a reversible increase in prothrombin time and bleeding time, pancytopenia, thrombocytopenia, neutropenia, anemia, agranulocytosis, granulocytopenia, leukopenia, myelosuppression;
• on the part of the skin and subcutaneous tissues: often - itching, skin rashes, urticaria; rarely - exfoliative and bullous dermatitis, polymorphic exudative erythema, angioedema, acute generalized exanthematous pustulosis, malignant exudative erythema, toxic epidermal necrolysis;
• infectious and parasitic diseases: infrequently - candidiasis of the oral mucosa, the development of superinfection, vaginal candidiasis;
• others: rarely - drug fever.

Lansoprazole

• from the gastrointestinal tract: often - dry mouth or throat, constipation, diarrhea, flatulence, nausea, vomiting, abdominal pain; rarely - glossitis, impaired taste perception, esophageal candidiasis, pancreatitis; very rarely - colitis, stomatitis;
• from the liver and biliary tract: often - increased activity of hepatic transaminases; rarely - jaundice, hepatitis; very rarely - hyperbilirubinemia;
• from the kidneys and urinary tract: rarely - interstitial nephritis;
• from the side of metabolism and nutrition: rarely - anorexia; frequency unknown - hypomagnesemia;
• from the immune system: very rarely - anaphylactic shock;
• from the respiratory system: rarely - rhinitis, pharyngitis, cough, flu-like syndrome, upper respiratory tract infection;
• from the musculoskeletal and connective tissue: infrequently - a fracture of the wrist, hip or spine, myalgia, arthralgia;
• from the nervous system: often - headache, dizziness; rarely - drowsiness, anxiety, paresthesia, vertigo, tremor;
• from the psyche: infrequently - depression; rarely - confusion, hallucinations, insomnia;
• on the part of the blood and lymphatic system: infrequently - leukopenia, eosinophilia, thrombocytopenia; rarely - anemia; very rarely - pancytopenia, agranulocytosis;
• from the genitals and mammary gland: rarely - gynecomastia, impotence;
• on the part of the organ of vision: rarely - visual disturbances;
• from the skin and subcutaneous tissues: often - itching, urticaria, skin rashes; rarely - photosensitization, alopecia, purpura, petechiae, erythema polymorphism, angioedema; very rarely - toxic epidermal necrolysis, malignant exudative erythema;
• laboratory parameters: very rarely - hyponatremia, increased triglyceride and cholesterol levels;
• others: often - weakness; infrequently - edema; rarely - increased sweating, fever.

Overdose

Overdose symptoms due to the presence of clarithromycin in Lancid Kit: abdominal pain, diarrhea, nausea, vomiting, headache, confusion. Treatment: gastric lavage and maintenance therapy. Hemodialysis and peritoneal dialysis are ineffective.

Overdose symptoms due to the presence of amoxicillin in the drug: crystalluria, diarrhea, nausea, vomiting, imbalance in water and electrolyte balance (a consequence of diarrhea and vomiting). Treatment: gastric lavage, intake of activated charcoal, saline laxatives and drugs to maintain water and electrolyte balance. Hemodialysis can be used to remove amoxicillin from the body.

Cases of lansoprazole overdose have not been described.

special instructions

Each blister of Lancida Kit is designed for one day of treatment, a package (7 blisters) - for one 7-day course.

Before taking the drug, the patient should be examined to exclude a malignant process (especially with gastric ulcer), since antiulcer therapy can mask the symptoms and, as a result, delay timely diagnosis.

Clarithromycin

Due to the prolonged use of antibiotics, the formation of colonies with an increased number of insensitive microorganisms is possible. If superinfection develops, appropriate treatment is prescribed.

Possible development of cross-resistance to clarithromycin, other macrolide antibiotics, clindamycin and lincomycin.

With the development of acute hypersensitivity reactions (drug rash with eosinophilia and systemic symptoms, toxic epidermal necrolysis, anaphylaxis, Stevens-Johnson syndrome, Schönlein-Genoch purpura), Lancid Kit should be discontinued immediately and appropriate therapy should be initiated.

There are known cases of the development of hepatic dysfunction (including severe) while taking clarithromycin. It is usually reversible, but requires discontinuation of antibiotic therapy. In the presence of serious diseases in the patient or the simultaneous administration of certain drugs, the development of liver failure with a fatal outcome is possible. Patients should be warned about the need to seek medical help if they show signs of hepatitis, such as soreness of the abdomen on palpation, dark urine, anorexia, jaundice.

Patients with chronic liver disease while taking Lancid Kit should regularly monitor blood plasma enzymes.

Like all antibacterial agents, clarithromycin can cause pseudomembranous colitis in varying degrees of severity, from mild to life-threatening. The antibiotic can affect the normal intestinal microflora, which increases the growth of Clostridium difficile. When a patient develops diarrhea, Clostridium difficile pseudomembranous colitis should always be suspected unless otherwise determined. In this regard, during antibiotic therapy and within 2 months after its completion, it is required to establish careful medical supervision of the patient.

With caution, clarithromycin should be used for hypomagnesemia, severe heart failure, severe bradycardia, coronary heart disease, and concomitant use of class IA and III antiarrhythmics. In all these cases, it is necessary to monitor the electrocardiogram for an increase in the QT interval.

There are known cases of aggravation of the symptoms of myasthenia gravis in patients receiving clarithromycin.

With the combined use of warfarin or other indirect anticoagulants, monitoring of prothrombin time and INR is necessary.

Amoxicillin

Cases of the development of serious hypersensitivity reactions to penicillins, sometimes fatal, have been described. The risk of their occurrence is highest in patients who have had similar reactions in the past. In this regard, before prescribing amoxicillin, the doctor should collect a detailed history of the patient for hypersensitivity reactions to penicillins, cephalosporins or other allergens. If allergic reactions occur during antibiotic therapy, the drug should be discontinued and appropriate measures should be taken immediately, which may include epinephrine administration, intravenous glucocorticosteroids, oxygen therapy, and airway management (intubation if necessary).

Amoxicillin is not recommended for use if a patient is suspected of having infectious mononucleosis, since there is a high risk of a measles-like skin rash, which makes diagnosis difficult.

The antibiotic should be used with caution in the presence of allergic diathesis, bronchial asthma, and also in the case of anamnestic data on colitis caused by antibiotic therapy.

With prolonged use of the drug, there is a possibility of excessive reproduction of insensitive microorganisms.

During the period of use of Lancid Kit, it is recommended to periodically check the functions of hematopoiesis, liver and kidneys. In patients with functional impairment of the liver, organ function should be monitored on a regular basis. With functional disorders of the kidneys, the dose of amoxicillin should be reduced depending on the degree of impairment.

It is necessary to take into account the likelihood of developing superinfection (usually caused by fungi of the genus Candida or bacteria of the genus Pseudomonas spp.), Which requires discontinuation of the antibiotic and appropriate treatment.

If diarrhea persists for some time, the development of pseudomembranous colitis, a disease that is caused by antibiotics and can be life-threatening, should always be suspected. Its main symptoms are: watery feces mixed with mucus and blood, colicky or dull common abdominal pains, fever, and sometimes tenesmus (pulling, cutting, burning pains in the rectum). When the described symptoms appear, amoxicillin should be discontinued and specific therapy should be started urgently (for example, the use of vancomycin). The use of drugs that reduce the peristalsis of the gastrointestinal tract is contraindicated.

With reduced urine output, the drug can cause crystalluria. For this reason, it is important to drink enough fluids and maintain adequate urine output while taking Lancid Kit. With cholangitis and cholecystitis, the drug can be prescribed only with a mild degree of the disease and in the absence of concomitant cholestasis.

Amoxicillin is excreted in large quantities from the body in the urine, as a result of which false-positive results may be obtained when determining the glucose content in urine (for example, when conducting a Benedict test or Fehling's test). If a urine glucose test is required, the glucose oxidase method should be used.

Amoxicillin sometimes causes nonspecific binding of albumin and immunoglobulins to the erythrocyte membrane, which can lead to a false positive reaction during Coombs' test.

In patients receiving warfarin or other indirect anticoagulants, prothrombin time and INR should be monitored during the period of amoxicillin use and after its cancellation.

The antibiotic can reduce the effectiveness of estrogen-containing oral contraceptives. It is recommended to use an additional reliable method of contraception while taking it.

During therapy, you should not consume alcoholic beverages.

In the case of long-term use of amoxicillin, concomitant administration of levorin, nystatin or other antifungal drugs is required.

Lansoprazole

Prolonged use of proton pump inhibitors increases the likelihood of developing infections (including Campylobacter, Salmonella and Clostridium difficile), as well as fractures in women during menopause.

Before prescribing the drug, the benefits of preventing bleeding from the upper gastrointestinal tract should be weighed against the possible risk of developing ventilator-associated pneumonia.

In patients receiving warfarin or other indirect anticoagulants, prothrombin time and INR should be monitored.

During therapy, you should not consume alcoholic beverages.

If the recommendations for the duration of lansoprazole use are followed, the withdrawal syndrome and "acid rebound" are not observed.

The action of lansoprazole depends on the genetic polymorphism CYP2C19. In patients who are slow metabolizers (PM type), the effect of the drug is higher, it is significantly more likely to achieve eradication of Helicobacter pylori than in patients who are fast metabolizers (homEM type), even in the presence of clarithromycin resistance.

Influence on the ability to drive vehicles and complex mechanisms

Lancid Kit can cause dizziness, drowsiness, and weakness. During the period of therapy, precautions should be taken when driving a car and engaging in other potentially hazardous activities that require concentration of attention and speed of reactions.

Application during pregnancy and lactation

Lancid Kit is contraindicated for pregnant and breastfeeding women.

Pediatric use

The drug is not used in pediatrics (for the treatment of children and adolescents under 18 years of age).

With impaired renal function

The drug is contraindicated in patients with renal failure occurring against the background of severe hepatic failure.

With caution, Lancid Kit should be used in case of moderate to severe renal failure.

For violations of liver function

The drug is contraindicated in patients in whom severe hepatic impairment occurs simultaneously with renal impairment.

With caution, Lancid Kit should be used for moderate to severe liver failure.

Use in the elderly

In old age, Lancid Kit should be taken with caution.

Drug interactions

Clarithromycin

A clinically significant interaction of clarithromycin with benzodiazepines, the excretion of which does not depend on CYP3A4 isoenzymes (eg, temazepam, nitrazepam, lorazepam), is unlikely.

The simultaneous use of the following drugs requires caution: indirect anticoagulants (including warfarin), valproic acid, disopyramide, cyclosporine, carbamazepine, omeprazole, vinblastine, methylprednisolone, cilostazol, phenytoin, rifabutin, quinidinastrolin, tacovofin, sildenafil, since they are metabolized through other cytochrome P ₄₅₀ isoenzymes. It is necessary to adjust the dose of drugs and monitor plasma concentrations.

The use of clarithromycin is contraindicated during the period of use of midazolam, triazolam, alprazolam, pimozide, terfenadine, cisapride, astemizole, ergotamine and other ergot alkaloids.

Possible drug interactions to consider:

• other macrolide antibiotics, clindamycin, lincomycin: possible development of cross-resistance;
• ergot derivatives (ergotamine, dihydroergotamine): there is a risk of developing acute ergotamine intoxication (manifested by symptoms such as perverse sensitivity, severe peripheral vasospasm, ischemia of the limbs and other tissues, including the central nervous system);
• HMG-CoA reductase inhibitors (simvastatin, lovastatin): rare cases of rhabdomyolysis have been described;
• drugs that are primarily metabolized by CYP3A isoenzymes, and drugs-inhibitors of the CYP3A4 isoenzyme (itraconazole): a mutual increase in concentrations is possible, as a result of which there may be an increase or prolongation of therapeutic and side effects;
• triazolam: it is possible to reduce its clearance and increase its pharmacological effects (including the development of drowsiness and confusion);
• digoxin: its plasma concentration may increase (control is required to avoid digitalis intoxication and the development of potentially lethal arrhythmias);
• atazanavir, ritonavir and other protease inhibitors: there is a mutual increase in plasma concentrations (clarithromycin in this case cannot be used in daily doses of more than 1000 mg);
• fluconazole at a dose of 200 mg (in the case of simultaneous use of clarithromycin at a daily dose of 1000 mg): an increase in AUC and equilibrium concentration of clarithromycin by 18 and 33%, respectively, is possible (dose adjustment is not required);
• etravirine: the concentration of clarithromycin decreases, but the content of its active metabolite increases;
• verapamil: there is a possibility of lowering blood pressure, the development of bradyarrhythmia and lactic acidosis;
• oral hypoglycemic agents, insulin: there is a risk of hypoglycemia (it is necessary to control blood glucose);
• some drugs that can cause a decrease in glucose concentration (pioglitazone, rosiglitazone, repaglinide, nateglinide): inhibition of the CYP3A isoenzyme by clarithromycin is possible, which leads to hypoglycemia (careful monitoring of glucose levels is required);
• inducers of cytochrome P ₄₅₀ (rifabutin, rifampicin, rifapentin, nevirapine, efavirenz): the plasma concentration of clarithromycin decreases, its therapeutic effect decreases, the content of the active metabolite 14 (R) -hydroxyclarithromycin increases;
• zidovudine: a decrease in its equilibrium level is possible (dose adjustment of drugs is required);
• astemizole, terfenadine, pimozide, cisapride: their plasma concentrations may increase, which leads to lengthening of the QT interval and the development of cardiac arrhythmias (including fibrillation or flutter of the ventricles, fibrillation, ventricular paroxysmal tachycardia, polymorphic ventricular tachycardia of the type "pirouette"). Similar interactions are possible with the use of drugs that are metabolized by the isoenzyme of the cytochrome P _{450 system} (for example, valproic acid, theophylline, phenytoin) (monitoring of drug concentrations in the blood and monitoring of the electrocardiogram are required);
• saquinavir in soft gelatin capsules, 1200 mg 3 times a day (simultaneously with clarithromycin in a daily dose of 1000 mg): it is possible to increase the AUC and equilibrium concentration of saquinavir by 177 and 187%, respectively, clarithromycin - by 40% (with short therapy with drugs in the indicated doses there is no need to correct the latter);
• tolterodine: its effect is enhanced in patients with low activity of the isoenzyme CYP2D6 (dose reduction may be required);
• colchicine (a substrate for CYP3A and P-glycoprotein): its effect may be enhanced (careful observation of patients is required for the development of symptoms of the toxic effect of colchicine).

Amoxicillin

• phenylbutazone, oxyphenbutazone, allopurinol, non-steroidal anti-inflammatory drugs, diuretics and other drugs that block tubular secretion: the plasma concentration of amoxicillin decreases;
• bacteriostatic drugs (chloramphenicol, sulfonamides, lincosamides, macrolides, tetracyclines): an antagonistic effect is noted;
• bactericidal antibiotics (including rifampicin, vancomycin, aminoglycosides and cephalosporins): there is a synergistic effect;
• methotrexate: its clearance decreases and toxicity increases (careful monitoring of plasma concentration is required);
• probenecid: the excretion of amoxicillin by the kidneys decreases, the concentration in plasma and bile increases;
• digoxin: an increase in the time of its absorption is possible (dose adjustment may be required);
• metronidazole: there are side effects such as digestive disorders, nausea, constipation, diarrhea, epigastric pain, anorexia, vomiting, in rare cases - hematopoietic disorders, jaundice, interstitial nephritis;
• estrogens, progesterones: their plasma concentration decreases, due to which a decrease in the contraceptive effect is possible (it is necessary to use additional non-hormonal methods of contraception);
• indirect anticoagulants: their effect is enhanced, blood coagulation time is lengthened (dose adjustment may be required);
• allopurinol: increased risk of skin rash;
• ascorbic acid: absorption of amoxicillin is enhanced;
• glucosamine, aminoglycosides, laxatives, antacids, food: absorption of amoxicillin slows down and decreases.

Lansoprazole

With the simultaneous use of other drugs, it should be borne in mind that lansoprazole:

• compatible with warfarin, propranolol, indomethacin, prednisolone, phenytoin, diazepam, ibuprofen, oral contraceptives;
• slows down the excretion of drugs that are metabolized in the liver by microsomal oxidation (including indirect anticoagulants, diazepam and phenytoin);
• prevents the absorption of iron salts, itraconazole, digoxin, ampicillin, ketoconazole;
• reduces the clearance of theophylline by 10%;
• slows down the pH-dependent absorption of drugs from the group of weak acids;
• accelerates the absorption of drugs from the base group;
• slows down the absorption of cyanocobalamin;
• increases the plasma concentration of tacrolimus (a substrate of the isoenzyme CYP3A4 and P-glycoprotein) to 81% (requires plasma concentration control);
• significantly reduces the C _max and AUC of atazanavir (contraindicated combination);
• increases the risk of myotoxicity of atorvastatin, lovastatin, simvastatin (patients should be under close medical supervision).

Effect of other drugs on lansoprazole:

• antacids reduce and slow down absorption (1-2 hour intervals between doses should be observed);
• fluvoxamine (an inhibitor of the isoenzyme CYP2C19) increases the plasma concentration by 4 times;
• St. John's wort, rifampicin (inducers of isoenzymes CYP3A4 and CYP2C19) can significantly reduce plasma concentration;
• sucralfate reduces bioavailability by 30% (intervals of 30–40 minutes should be observed between doses);
• ritonavir (a substrate and inhibitor of CYP2C19) can both increase and decrease AUC (dose adjustment of lansoprazole and control of therapeutic and possible side effects are required);
• imatinib increases the risk of side effects, especially in patients with a history of severe allergic reactions (due to potential interactions via CYP3A4).

With the simultaneous use of antiretroviral drugs (atazanavir, indinavir, nelfinavir), ketoconazole, cefpodoxime, posaconazole, itraconazole, ampicillin, cefuroxime, it is necessary to monitor their effects and symptoms of resistance development.

With the combined appointment of clopidogrel, the risk of repeated myocardial infarction, as well as hospitalization for stroke, unstable angina pectoris, heart attack, repeated revascularization, increases, therefore it is recommended to avoid its combination with lansoprazole. If it is absolutely necessary to jointly use drugs, it is necessary to ensure careful monitoring of patients.

It is not recommended to prescribe lansoprazole to HIV-infected patients on antiretroviral drugs. If simultaneous use is necessary, the intervals between doses of 12 hours should be observed, while the dose of lansoprazole should not exceed 30 mg.

Analogs

The analogues of Lancid Kit are Pilobact, Pilobact AM, Helitrix.

Terms and conditions of storage

Store at a temperature not exceeding 25 ° C in a dry, dark place out of the reach of children.

The shelf life is 3 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews of Lancide Kit

According to reviews, Lancid Kit is a potent combination drug that should be used exclusively as directed by a doctor and under his control, since it has many contraindications and can cause a large number of side effects. There are no messages on the forums and sites that would allow us to assess the degree of its effectiveness against the bacteria Helicobacter pylori. However, there are many complaints about the development of undesirable reactions, due to which many patients interrupted treatment, including general malaise, dizziness, drowsiness, bitter taste in the mouth, nausea, congestion and tinnitus, disorientation, headache, shortness of breath, pain in abdomen, diarrhea, vaginal candidiasis.

Price for Lancid Kit in pharmacies

Depending on the place of sale, the price of the Lancid Kit can be 790-989 rubles. per pack of 7 blisters, each of which contains a set of tablets and capsules.

Lancid Kit: prices in online pharmacies

Drug name Price Pharmacy

Lancid Kit tablets and capsules set 56 pcs. 862 RUB Buy

Lancid Kit tablets and capsules set 56 pcs. 906 r Buy

Maria Kulkes Medical journalist About the author

Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!