Klacid
Klacid: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. Drug interactions
- 12. Analogs
- 13. Terms and conditions of storage
- 14. Terms of dispensing from pharmacies
- 15. Reviews
- 16. Price in pharmacies
Latin name: Klacid
ATX code: J01FA09
Active ingredient: clarithromycin (clarithromycin)
Producer: Abbott SpA (Italy)
Description and photo update: 2019-16-08
Prices in pharmacies: from 415 rubles.
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Klacid is an antibiotic of the macrolide group.
Release form and composition
Dosage forms of Klacid:
- Film-coated tablets: oval biconvex, yellow or light yellow (250 mg, 7, 10 or 14 pieces in blisters, in a cardboard box 1, 2 or 3 blisters; 500 mg each, 7 pieces in blisters, in a cardboard box 2 blisters);
- Powder for preparation of suspension for oral administration: granular mass of white or almost white color with a fruity aroma; when mixed with water, an opaque suspension with a fruity aroma of white or almost white color is formed (42.3 g or 70.7 g each in plastic bottles with a volume of 60 ml or 100 ml, in a cardboard box 1 bottle complete with a dosing syringe or dosing spoon);
- Lyophilisate for preparation of solution for infusion: from white to almost white, has a weak aroma (500 mg in glass colorless vials, in a cardboard box 1 vial).
The active substance is clarithromycin:
- 1 tablet - 250 or 500 mg;
- 5 ml of the finished suspension - 125 or 250 mg;
- 1 bottle of lyophilisate - 500 mg.
Auxiliary components:
- Tablets: microcrystalline cellulose, croscarmellose, magnesium stearate, silicon dioxide, stearic acid, povidone, talc; in addition, in tablets of 250 mg - pregelatinized starch, quinoline yellow (E104);
- Powder: carbomer (carbopol 974P), hypromellose phthalate, povidone K90, castor oil, maltodextrin, silicon dioxide, sucrose, xanthan gum, titanium dioxide, fruit flavor, anhydrous citric acid, potassium sorbate;
- Lyophilisate: lactobionic acid, sodium hydroxide 4%.
Additionally, as part of the film coating of tablets: hypromellose, hydroxypropyl cellulose, propylene glycol, sorbitan monooleate, titanium dioxide, sorbic acid, vanillin, quinoline yellow (E104).
Pharmacological properties
Pharmacodynamics
The antibacterial effect of clarithromycin is due to its interaction with the 50S ribosomal subunit and suppression of protein production by bacteria sensitive to this substance. It is characterized by high in vitro activity in relation to both standard bacterial strains obtained in the laboratory, and strains isolated from the body of patients in the course of clinical practice. Klacid effectively affects many anaerobic and aerobic gram-negative and gram-positive microorganisms. The minimum inhibitory concentrations (MICs) of clarithromycin for most pathogens are lower than the corresponding MICs of erythromycin on average by one log 2 dilution.
There is a high in vitro activity of clarithromycin against Mycoplasma pneumoniae and Legionella pneumophila. It also has a bactericidal effect against Helicobacter pylori, and the effect is more pronounced at neutral pH than at acidic.
Also, the results of in vivo and in vitro studies confirm the effect of clarithromycin on clinically significant mycobacterial species. Sensitivity to Klacid is completely absent in the bacteria Pseudomonas spp. and Enterobacteriaceae, as in other gram-negative microorganisms that do not ferment lactose.
Clarithromycin demonstrates high activity against most strains of the bacteria listed below (confirmed both by use in clinical practice and by in vitro studies):
- mycobacteria: Mycobacterium avium complex (MAC), including Mycobacterium intracellulare and Mycobacterium avium, Mycobacterium leprae, Mycobacterium fortuitum, Mycobacterium chelonae, Mycobacterium kansasii;
- aerobic gram-positive microorganisms: Listeria monocytogenes, Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus aureus;
- aerobic gram-negative microorganisms: Legionella pneumophila, Haemophilus parainfluenzae, Haemophilus influenzae, Neisseria gonorrhoeae, Moraxella catarrhalis;
- other microorganisms: Chlamydia pneumoniae (TWAR), Mycoplasma pneumoniae.
Beta-lactamase synthesis does not alter the activity of clarithromycin. Staphylococcal strains resistant to oxacillin and methicillin are predominantly resistant to the action of Klacid.
The sensitivity of Helicobacter pylori to clarithromycin was studied on isolates of the microorganism obtained from 104 patients before starting treatment with Klacid. In 4 patients, clarithromycin-resistant strains of Helicobacter pylori were found, in 2 - strains with moderate resistance to the substance, and in the remaining 98 patients, bacterial isolates showed sensitivity to clarithromycin.
In vitro, clarithromycin also acts on most strains of the following bacteria (however, the efficacy and safety of Klacid's use in clinical practice has not been confirmed by the results of clinical studies, so the practical significance of the drug remains unclear):
- anaerobic gram-negative microorganisms: Bacteroides melaninogenicus;
- anaerobic gram-positive microorganisms: Propionibacterium acnes, Peptococcus niger, Clostridium perfringens;
- aerobic gram-negative microorganisms: Pasteurella multocida, Bordetella pertussis;
- aerobic gram-positive microorganisms: Viridans group streptococci, Streptococci (groups C, F, G), Streptococcus agalactiae;
- campylobacter: Campylobacter jejuni;
- spirochetes: Treponema pallidum, Borrelia burgdorferi.
The main metabolite of clarithromycin in the human body is 14-hydroxyclarithromycin (14-OH-clarithromycin), which shows signs of microbiological activity that is either the same as that of the parent substance, or one to two times weaker in relation to most bacteria. An exception to this rule is Haemophilus influenzae, in relation to which 14-OH-clarithromycin exhibits an activity that is approximately 2 times greater than that of clarithromycin. The active component of Klacid and its main metabolite have either a synergistic or additive effect against Haemophilus influenzae both in vivo and in vitro, depending on the strain of the bacterium.
Pharmacokinetics
Clarithromycin is absorbed at a high rate in the gastrointestinal tract. The absolute bioavailability of 500 mg clarithromycin tablets is about 50%. Taking it together with food slightly delays the onset of absorption and inhibits the formation of the active metabolite of 14-OH-clarithromycin, but the bioavailability of the substance remains unchanged.
The results of in vitro studies showed that clarithromycin binds to plasma proteins by an average of 70% in the range of concentrations of 0.45–4.5 μg / ml, which are clinically significant. The bioavailability and pharmacokinetic parameters for clarithromycin suspension have been studied in children and healthy adults. With a single dose of the suspension by adult patients, its bioavailability was similar to that in the case of taking tablets (in both cases, the dose was 250 mg) or slightly exceeded it. When using the drug both in the form of tablets and in the form of a suspension, food intake somewhat slows down the absorption of clarithromycin, but does not change its overall bioavailability. The maximum concentration, the area under the concentration-time curve (AUC) and the half-life of the active substance when the Klacid suspension is administered to children (after meals) are 0,95 μg / ml, 6.5 μg × h / ml and 3.7 hours, respectively. When taking a tablet of 250 mg on an empty stomach, these indicators are 1.1 μg / ml, 6.3 μg × h / ml and 3.3 hours, respectively.
When taking a suspension of Klacid at a dose of 250 mg every 12 hours in adult patients, the equilibrium concentrations of clarithromycin in the blood were determined approximately by the time of taking the 5th dose. In this case, the maximum concentration of the active substance was reached in 2.8 hours and was 1.98 μg / ml, the AUC was 11.5 μg × h / ml, and the half-life reached 3.2 hours. For 14-OH-clarithromycin, these parameters were 2.9 hours, 0.67 μg / ml, 5.33 μg × h / ml and 4.9 hours, respectively.
In healthy individuals, peak serum clarithromycin concentrations were recorded within 2 hours of oral fasting. Taking Klacid in the form of tablets at a dose of 250 mg every 12 hours is accompanied by the achievement of the maximum equilibrium concentration of clarithromycin in the blood serum within 2-3 days (their values were approximately 1 μg / ml). Corresponding maximum equilibrium concentrations for the 500 mg dose taken every 12 hours ranged from 2 to 3 μg / ml.
When 250 mg tablets are given every 12 hours, the half-life of clarithromycin is usually 3-4 hours, but when the drug is taken at a dose of 500 mg every 12 hours, it increases to 5-7 hours. The maximum equilibrium concentration of 14-OH-clarithromycin is approximately 0.6 µg / ml, and its half-life when taking Klacid at a dose of 250 mg every 12 hours is 5-6 hours. Taking the drug at a dose of 500 mg every 12 hours leads to a slight increase in the maximum equilibrium concentration of 14-OH-clarithromycin (up to 1 μg / ml), the half-life is approximately 7 hours. When prescribing the drug in both doses, the equilibrium concentrations of 4-hydroxy-clarithromycin are usually determined after 2–3 days. When Klacid is taken at a dose of 250 mg every 12 hours, about 20% of the dose is excreted in the urine unchanged. When the drug is taken at a dose of 500 mg every 12 hours, approximately 30% of the dose is excreted in the urine unchanged. The renal clearance of clarithromycin is practically independent of the dose and has approximately the same value as the normal glomerular filtration rate. The main metabolite found in the urine is 14-hydroxy-clarithromycin in an amount of 10-15% of the dose taken (250 or 500 mg taken every 12 hours).is 14-hydroxy-clarithromycin in an amount equal to 10-15% of the dose taken (250 or 500 mg taken every 12 hours).is 14-hydroxy-clarithromycin in an amount of 10-15% of the dose taken (250 or 500 mg taken every 12 hours).
In clinical trials in which healthy volunteers took part, clarithromycin in the form of a solution for infusion was administered once intravenously at doses of 75, 125, 250 and 500 mg for 30 minutes (the volume of infusion was 100 ml), as well as at doses of 500, 750 or 1000 mg over 60 minutes (infusion volume was 250 ml). The maximum concentration range was from 5.16 to 9.4 μg / ml after infusion of 500 mg and 1000 mg of Clacid over 60 minutes, respectively. The maximum concentration of 14-OH-clarithromycin was 0.66 μg / ml after infusion of clarithromycin at a dose of 500 mg and 1.06 μg / ml after infusion of 1000 mg of the drug for 60 minutes.
In the steady state, the terminal half-life is determined by the dose of clarithromycin and varies from 3.8 to 4.5 hours with intravenous doses of 500 to 1000 mg over 60 minutes, respectively. The half-life of the main metabolite is dose-dependent when taking Clacid in higher doses and is equal to 7.3 hours after administration of 500 mg and 9.3 hours after administration of 1000 mg of clarithromycin for 60 minutes.
The average AUC of clarithromycin after intravenous administration increases nonlinearly depending on the dose from 22.29 μg × h / ml after administration of the drug at a dose of 500 mg to 53.26 μg × h / ml after administration of the drug at a dose of 1000 mg. The mean value of this parameter for 14-OH-clarithromycin varied from 8.16 to 14.76 μg × h / ml with infusion of Klacid at the same doses for 60 minutes.
The clinical study, carried out over 7 days, was accompanied by repeated intravenous administration of clarithromycin in doses of 125 and 250 mg (infusion volume was 100 ml) over 30 minutes and in doses of 500 and 750 mg (infusion volume was 250 ml) for 60 minutes after every 12 hours. The maximum equilibrium concentration increased from 5.5 μg / ml with an infusion of 500 mg to 8.6 μg / ml with an infusion of 750 mg of clarithromycin. The half-life of the drug in an equilibrium state after intravenous administration for more than 1 hour at doses of 500 mg and 750 mg is 5.3 and 4.8 hours, respectively. The equilibrium maximum concentration of the main metabolite after administration of 500 mg and 750 mg clarithromycin doses increased from 1.02 to 1.37 μg / ml, respectively. The half-life of 14-OH-clarithromycin in patients after infusion of 500 or 750 mg of Clacid was 7.9 hours and 5.4 hours, respectively. There is no dose-dependent effect on the pharmacokinetic parameters of this metabolite.
Clarithromycin and 14-OH-hydroxy-clarithromycin penetrate into tissues and body fluids within a minimal period of time. Its content in tissues is usually several times higher than in blood serum. When Klacid is taken at a dose of 250 mg every 12 hours, the concentration of clarithromycin in the tonsils is 1.6 μg / g (at a serum concentration of 0.8 μg / ml), and in the lungs - 8.8 μg / g (at a serum concentration of 1, 7 μg / ml).
In children requiring oral antibiotics, clarithromycin was highly bioavailable. Moreover, the pharmacokinetic profile of Klacid is similar to that in adults who took it in the same dosage form. Clarithromycin is rapidly and highly absorbed in children. Food slows down its absorption slightly, but does not significantly change its pharmacokinetic characteristics or bioavailability. 5 days after the start of Clacid (9th dose), the equilibrium pharmacokinetic parameters of clarithromycin approach the following values: the maximum concentration is 4.6 μg / ml, the time to reach it is 2.8 hours, AUC is 15.7 μg × h / ml. The corresponding values for 14-OH-clarithromycin are 1.64 μg / ml, 2.7 hours and 6.69 μg × h / ml, respectively. The half-lives of clarithromycin and its metabolite,obtained by calculation, equal to 2.2 and 4.3 hours, respectively.
In patients with otitis media, the concentrations of clarithromycin and 14-OH-clarithromycin in the middle ear fluid 2.5 hours after taking the 5th dose of Clacid (dosage 7.5 mg / kg 2 times a day) averaged 2.53 and 1.27 μg / g. The level of the active ingredient and its metabolite in this liquid is 2 times higher than the serum concentration.
In patients with liver dysfunctions, the equilibrium concentrations of the active substance are identical to those in healthy people, while the content of 14-hydroxy-clarithromycin is somewhat reduced. This effect is at least partially offset by an increase in the renal clearance of clarithromycin compared to that in healthy volunteers.
In patients with renal dysfunction, who have repeatedly taken Klacid in doses of 500 mg, the pharmacokinetics of the drug also changes. In such patients, the AUC, plasma concentrations, minimum and maximum concentrations and half-life of clarithromycin and its metabolite are higher than in people with normal renal function. Deviations in these parameters directly correlate with the severity of renal failure. With more pronounced renal dysfunctions, there are more significant differences.
In elderly patients, the content of clarithromycin and 14-OH-clarithromycin in the blood is higher than in younger patients. An increase in the half-life is also noted. However, dose adjustments based on renal creatinine clearance minimized the differences in both groups. Therefore, renal function, and not the patient's age, mainly affects the pharmacokinetic parameters of clarithromycin.
In patients with HIV infection who took clarithromycin in standard doses (adults - in the form of tablets, children - in the form of a suspension), the equilibrium concentrations of clarithromycin and its metabolite were identical to those in healthy people. However, when Klacid is prescribed in higher doses necessary for the treatment of mycobacterial infectious diseases, the level of the active substance in the body can significantly exceed the usual one.
In HIV-infected children who took Klacid at a daily dose of 15–30 mg / kg in two divided doses, the maximum equilibrium concentrations of clarithromycin usually varied in the range of 8–20 μg / ml. In patients of this category, who took a suspension of clarithromycin at a daily dose of 30 mg / kg in two divided doses, a maximum steady-state concentration of 23 μg / ml was recorded. Reception of Klacid in higher doses was accompanied by a prolongation of the half-life compared with that in people without HIV who received the drug in standard doses. The increase in plasma levels and an increase in the half-life when taking Klacid at higher doses is due to the nonlinear pharmacokinetics of the drug.
Indications for use
According to the instructions, Klacid is used in the treatment of infectious and inflammatory diseases caused by microorganisms sensitive to clarithromycin:
- Pneumonia, bronchitis and other infectious pathologies of the lower respiratory system;
- Pharyngitis, sinusitis and other infectious diseases of the upper respiratory system;
- Erysipelas, inflammation of the subcutaneous tissue, folliculitis and other infections of soft tissues and skin;
- Mycobacterial localized or disseminated infections caused by Mycobacterium intracellulare and Mycobacterium avium;
- Localized infections due to Mycobacterium fortuitum, Mycobacterium chelonae and Mycobacterium kansasii.
In addition, Klacid tablets are prescribed: for the eradication of Helicobacter pylori and to reduce the frequency of recurrence of duodenal ulcers; HIV-infected patients with a CD4 lymphocyte (T-helper lymphocyte) count of no more than 100 in 1 mm 3 to prevent the spread of infections caused by the Mycobacterium avium complex (MAC); in the treatment of odontogenic infections (only tablets of 250 mg).
The powder is also used in the treatment of acute otitis media.
Contraindications
Contraindications to the use of all dosage forms of Klacid:
- Simultaneous use with cisapride, pimozide, astemizole, terfenadine; ergotamine, dihydroergotamine and other ergot alkaloids; oral midazolam; colchicine;
- Hypokalemia (risk of prolongation of the QT interval);
- Severe hepatic impairment with renal impairment;
- History of ventricular arrhythmia or ventricular tachycardia of the "pirouette" type, prolongation of the QT interval;
- Combination with HMG-CoA reductase inhibitors (statins), which are mainly metabolized by the CYP3A4 isoenzyme (simvastatin, lovastatin), due to the high risk of myopathy and rhabdomyolysis;
- A history of cholestatic hepatitis or jaundice that developed with clarithromycin;
- Breastfeeding period;
- Hypersensitivity to drug components and other macrolides.
It is recommended to prescribe Klacid with caution: in case of renal and / or hepatic insufficiency of severe and moderate degree, ischemic heart disease, severe heart failure, severe bradycardia (less than 50 beats per minute), hypomagnesemia; during pregnancy; simultaneously with taking: benzodiazepines (triazolam, alprazolam, midazolam for intravenous use), drugs that are metabolized by the CYP3A isoenzyme (including cilostazol, carbamazepine, cyclosporin, methylprednisolone, disopyramide, indirect anticoagulants, rieprazolam, quinfarine), omini tacrolimus), drugs that induce the isoenzyme CYP3A4 (such as rifampicin, carbamazepine, phenytoin, St. John's wort, phenobarbital), slow calcium channel blockers,metabolized by the isoenzyme CYP3A4 (including amlodipine, verapamil, diltiazem), class III antiarrhythmics (amiodarone, dofetilide, sotalol) and class IA (procainamide, quinidine).
In addition, clarithromycin tablets or lyophilisate should not be taken at the same time as ranolazine or ticagrelor.
Prescription of Klacid in the form of tablets and powder is contraindicated in patients with porphyria.
With caution, tablets and lyophilisate should be prescribed when used simultaneously with other ototoxic agents, especially aminoglycosides; fluvastatin and other statins that do not depend on the metabolism of the CYP3A isoenzyme.
Do not take the powder for patients with glucose-galactose malabsorption syndrome, congenital fructose intolerance, sucrase-isomaltase deficiency.
Patients with diabetes mellitus, myasthenia gravis take the powder with caution.
Age restrictions for the use of Klacid:
- Tablets: up to 12 years old;
- Lyophilisate: up to 18 years old.
Instructions for the use of Klacid: method and dosage
- Tablets: taken orally before or after meals. The dose and the period of treatment are prescribed by the doctor based on clinical indications. The usual dose of Klacid for children over 12 years of age and adults is 250 mg 2 times a day. The recommended dosage for adults in the treatment of mycobacterial infections (except tuberculosis), peptic ulcer caused by Helicobacter pylori infection, for the prevention of infections caused by MAC is 500 mg 2 times a day. The duration of treatment is 5-14 days. In AIDS patients, treatment of disseminated MAC infections is recommended to continue until there is a microbiological and clinical effect. The use of Klacid is recommended to be combined: in the treatment of mycobacterial infections - with other antibacterial agents active against these pathogens;for the eradication of Helicobacter pylori - with antimicrobial drugs and proton pump inhibitors. The dose for the treatment of odontogenic infections is 250 mg 2 times a day, the period of administration is 5 days. Patients with renal insufficiency are recommended to take half of the usual dose: 250 mg 1 time per day, with severe infections - 250 mg 2 times a day for no more than 14 days;
- Powder: to prepare the suspension, dilute with water, gradually adding it to the vial to the mark, then shake it until a solution with a homogeneous structure is obtained. The suspension is taken orally before or after meals, it can be diluted with milk. Recommended daily dosage for children: for non-mycobacterial infections - at the rate of 7.5 mg per 1 kg of the child's weight (but not more than 500 mg) 2 times a day for 5-10 days; with disseminated or local mycobacterial infections - 7.5-15 mg per 1 kg of body weight 2 times a day, treatment lasts until the moment there is no clinical effect. For the treatment of mycobacterial infections, the powder is prescribed in combination with other antimicrobial agents that are active against these pathogens. In renal insufficiency, the usual doses are halved, and the period of use is extended to 14 days. Shake well before taking the contents of the bottle;
- Lyophilisate: intended for intravenous (IV) infusion only. The recommended dosage for adults is 1 g per day. The daily dose is divided into 2 infusions, the duration of each is no more than 60 minutes. IV injection of Klacid in severe disease - 2-5 days with further prescription, if necessary, taking the drug inside. For patients with renal insufficiency, the dose is halved.
Side effects
- On the part of the body as a whole: infrequently - asthenia, hyperthermia, chills, malaise, fatigue, chest pain;
- From the digestive system: often - nausea, vomiting, abdominal pain, dyspepsia, diarrhea or constipation; infrequently - gastroesophageal reflux disease, esophagitis, gastritis, stomatitis, proctalgia, glossitis, dry mouth, bloating, belching, cholestasis, flatulence, hepatitis (including hepatocellular, cholestatic); frequency unknown - cholestatic jaundice, discoloration of teeth and tongue, acute pancreatitis, liver failure;
- From the side of metabolism and nutrition: infrequently - decreased appetite, anorexia;
- From the nervous system: often - insomnia, headache; infrequently - drowsiness, dyskinesia, loss of consciousness, dizziness, tremors, increased excitability, anxiety; frequency unknown - psychotic disorders, convulsions, confusion, depression, depersonalization, disorientation, nightmares, hallucinations, mania, paresthesia;
- From the side of the cardiovascular system: often - vasodilation; infrequently - atrial fibrillation, cardiac arrest, extrasystole, prolongation of the QT interval on the electrocardiogram (ECG), atrial flutter; frequency unknown - ventricular tachycardia (including pirouette type);
- From the respiratory system: infrequently - epistaxis, asthma, pulmonary embolism;
- From the senses: often - taste perversion, dysgeusia; infrequently - hearing impairment, vertigo, ringing in the ears; frequency unknown - ageusia, deafness, anosmia, parosmia;
- From the urinary system: the frequency is unknown - interstitial nephritis, renal failure;
- From the musculoskeletal system: infrequently - musculoskeletal stiffness, muscle spasm, myalgia; frequency unknown - myopathy, rhabdomyolysis;
- On the part of the skin: often - heavy sweating; frequency unknown - hemorrhages, acne;
- Parasitic and infectious diseases: infrequently - candidiasis, secondary infections (including vaginal), cellulitis, gastroenteritis; frequency unknown - erysipelas, pseudomembranous colitis;
- Allergic reactions: often - rash; infrequently - hypersensitivity, anaphylactoid reactions, pruritus, bullous dermatitis, maculopapular rash, urticaria; frequency unknown - angioedema, Lyell's syndrome, anaphylactic reaction, drug rash, Stevens-Johnson syndrome;
- On the part of laboratory parameters: often - a deviation in the liver test; infrequently - leukopenia, change in the albumin-globulin ratio, neutropenia, thrombocythemia, eosinophilia, increased plasma concentrations of creatinine and / or urea, alanine aminotransferase (ALT), alkaline phosphatase (ALP), asparaginine aminotransferase (ACT), gamma-glutamylpolyprase (GAM), lactate dehydrogenase (LDH); the frequency is unknown - thrombocytopenia, agranulocytosis, prolongation of prothrombin time, an increase in the MHO value (international normalized ratio), an increase in the level of bilirubin concentration in the blood, a change in the color of urine.
In addition, the use of Klacid in powder form can cause the following side effects:
- On the part of the skin: the frequency is unknown - Shenlein-Henoch purpura;
- From the side of metabolism and nutrition: hypoglycemia;
- From the musculoskeletal system: exacerbation of symptoms of myasthenia gravis.
The undesirable effects of the use of lyophilisate also include: very often - inflammation of the vein walls at the injection site; often pain and / or inflammation at the injection site.
Particularly frequent side effects in patients with AIDS and other immunodeficiencies on the background of clarithromycin at a dose of 1000 mg per day: perverted taste, nausea, vomiting, abdominal pain, rash, diarrhea, flatulence, constipation, hearing impairment, headache, increased ACT activity and ALT in the blood; infrequently - dry mouth, shortness of breath, insomnia. In this category of patients, it is difficult to distinguish the side effects of Klacid from the symptoms of concomitant disease or HIV infection.
Overdose
Taking Klacid in large doses in the form of tablets or suspension can provoke disturbances in the work of the gastrointestinal tract. In isolated cases, hypoxemia, hypokalemia, paranoid behavior and changes in mental state were observed in patients with bipolar disorder after taking 8 g of the drug.
In case of an overdose of Klacid, it is recommended to remove unabsorbed clarithromycin from the gastrointestinal tract by gastric lavage and subsequent intake of activated charcoal, as well as prescribe symptomatic therapy. Peritoneal dialysis and hemodialysis do not significantly affect serum clarithromycin levels. There are currently no reports of drug overdose with intravenous administration.
special instructions
With prolonged use of antibiotics, it is necessary to prescribe concomitant therapy aimed at preventing the formation of insensitive fungi and bacteria in the colony.
Antibacterial drugs disrupt the intestinal microflora and often cause pseudomembranous colitis. The appearance of diarrhea in a patient, while taking Klacid, may indicate Clostridium difficile. The use of the drug is recommended under close medical supervision.
The action of Clacid has a significant effect on liver function and can cause undesirable effects of varying severity. Therefore, in case of darkening of urine, pain on palpation of the abdomen, itching, anorexia, jaundice, you should immediately stop taking it.
In patients with chronic liver disease, it is necessary to regularly monitor the concentration of enzymes in the blood serum.
Under regular ECG monitoring for the state of the QT interval, Klacid should be taken in patients with coronary heart disease, severe bradycardia, severe heart failure, concomitant use of class IA antiarrhythmic drugs (quinidine, procainamide) and class III (dofetilide, amiodarone, sotalol).
When prescribing Klacid, the possibility of developing cross-resistance to macrolides, clindamycin, lincomycin should be taken into account. Patients with community-acquired pneumonia should be tested for sensitivity to the drug, and hospitalized patients should be prescribed the drug in combination with adequate antibiotics.
A sensitivity test is also recommended when treating mild to moderate soft tissue and skin infections. The use of Klacid is recommended for the treatment of acne, erysipelas, infections caused by Corynebacterium minutissimum, as well as in the absence of the possibility of prescribing penicillin.
When combined with indirect anticoagulants, including warfarin, regular monitoring of MHO and prothrombin time is necessary.
If acute hypersensitivity reactions occur, the drug should be discontinued and appropriate treatment should be prescribed.
The possibility of the development of side effects of Klacid in the form of confusion, dizziness, disorientation, vertigo should be taken into account, and during the period of treatment, be careful when driving vehicles and mechanisms.
Application during pregnancy and lactation
The safety of using Klacid during pregnancy and lactation has not been reliably established. Its appointment during pregnancy is undesirable (especially in the first trimester) and is allowed only in the absence of alternative treatment options. In this case, the potential benefits of treatment for the mother should significantly outweigh the possible risks to the fetus.
Clarithromycin passes into breast milk, therefore, if necessary, breastfeeding is stopped.
Pediatric use
Contraindications to the appointment of Klacid for children: tablets - up to 12 years old, lyophilisate for the preparation of infusions - up to 18 years.
At the moment, information on the efficacy and safety of using Klacid suspension in children under 6 months of age is scarce and considered insufficient.
Drug interactions
When prescribing Klacid, the attending physician, based on clinical indications, determines the degree of risk of drug interaction of the drug, taking into account the high activity of clarithromycin.
Analogs
Analogues of Klacid are: Binoclar, Klacid SR, Clarexid, Klabaks, Claricit, Claromine, Clarithrosin, Clarithromycin, Ecositrin, Fromilid, Fromilid Uno.
Terms and conditions of storage
Store in a dark place at a temperature of 15 to 30 ° C. Keep out of the reach of children.
Shelf life: tablets - 5 years; powder - 2 years, ready-made suspension - 14 days; lyophilisate - 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Klacid
Currently, there are both positive and negative reviews about Klacid. Many patients note the high effectiveness of the antibiotic and the fact that it significantly speeds up the healing process. However, there are reports of adverse reactions (allergies, itching, blackening of the teeth), which forces specialists to cancel this drug. The opinions of parents whose children have taken Klacid also differ dramatically. Nevertheless, doctors consider it a fairly effective drug when used in both adults and children.
The price of Klacid in pharmacies
The approximate price for Klacid in the form of tablets with a dosage of 250 mg is 456-759 rubles (the package includes 10 pcs.), And for a dosage of 500 mg - 742-947 rubles (the package includes 14 pcs.). You can buy powder for preparation of a suspension for oral administration for 336-426 rubles (the bottle contains 42.3 g of clarithromycin). A lyophilisate for preparing a solution for infusion will cost approximately 551-640 rubles.
Klacid: prices in online pharmacies
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Drug name Price Pharmacy |
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Klacid SR 500 mg film-coated tablets with prolonged release 5 pcs. 415 RUB Buy |
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Klacid (for infusion) 500 mg lyophilisate for preparation of solution for infusion 1 pc. RUB 417 Buy |
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Klacid 125 mg / 5 ml granules for oral suspension 70.7 g 1 pc. 466 r Buy |
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Klacid SR tablets p.o. with prolonged release. 500mg 5 pcs. RUB 471 Buy |
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Klacid SR 500 mg film-coated tablets with prolonged release 7 pcs. 493 r Buy |
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Klacid SR tablets p.o. with prolonged release. 500mg 7 pcs. 507 r Buy |
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Klacid 250 mg film-coated tablets 10 pcs. 508 RUB Buy |
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Klacid 125 mg / 5 ml powder for suspension for oral administration 42.3 g 1 pc. 542 r Buy |
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Klacid tablets p.o. 250mg 10 pcs. 591 r Buy |
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Klacid granules for suspension for internal approx. 125mg / 5ml fl. 100ml 628 RUB Buy |
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Klacid 250 mg / 5 ml granules for preparation of suspension for oral administration 70.7 g 1 pc. RUB 636 Buy |
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Klacid 500 mg coated tablets 14 pcs. 659 r Buy |
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Klacid 250 mg / 5 ml granules for preparation of suspension for oral administration 49.5 g 1 pc. 703 r Buy |
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Klacid tablets p.o. 500mg 14 pcs. 798 r Buy |
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Klacid since. d / suspension internal 250mg / 5ml 70.7g n1 (100ml) 808 RUB Buy |
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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!
