Co amoxiclav

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

IV: 1.2 g every 8 hours (increasing to every 6 hours in severe infections) Oral: 375–625 mg 3 times daily

PHARMACOKINETICS

  • Molecular weight                           :Amoxycillin: 365.4; clavulanic acid: 199.2
  • %Protein binding                           :Amoxycillin: 20; clavulanic acid: 25
  • %Excreted unchanged in urine     : Amoxycillin: 60; clavulanic acid: 40
  • Volume of distribution (L/kg)       :Amoxycillin: 0.3; clavulanic acid: 0.3
  • half-life – normal/ESRD (hrs)      :Amoxycillin: 1–1.5/7–20; clavulanic acid: 1/3–4

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

    30–50 Dose as in normal renal function 10–30 IV: 1.2 g every 12 hours Oral: Dose as in normal renal function

  • <10           : IV: 1.2 g stat followed by 600 mg every 8 hours or 1.2 g every 12 hours Oral: Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Dialysed. Dose as in GFR
  • <10           : mL/min
  • HD                     :Dialysed. Dose as in GFR
  • <10           : mL/min
  • HDF/high flux   :Dialysed. Dose as in GFR
  • <10           : mL/min
  • CAV/VVHD      :Dialysed. Dose as in GFR=10–30 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugsAnticoagulants: effects of coumarins are potentially enhancedOral contraceptives: potentially reduced efficacyMethotrexate: reduced excretion thereby increasing risk of toxicity

    ADMINISTRATION

    Reconstition

    600 mg with 10 mL water for injection; 1.2 g with 20 mL water for injection

    Route

    Oral, IV

    Rate of Administration

    IV bolus: over 3–4 minutes Infusion: infuse over 30–40 minutes in 50–100 mL sodium chloride 0.9%

    Comments

    IV preparation is less stable in infusion solutions containing glucose, dextran or bicarbonate. May be injected into drip tubing over period of 3–4 minutesDo not mix with aminoglycosides

    OTHER INFORMATION

    CSM has advised that cholestatic jaundice may occur if treatment exceeds a period of 14 days or up to 6 weeks after treatment has been stopped. The incidence of cholestatic jaundice occurring with co-amoxiclav is higher in males than in females, and prevalent particularly in men over the age of 65 yearsThe probability of co-amoxiclav associated cholestatic jaundice is 6 times more common than with amoxicillin, and with higher doses of clavulanic acidEach 1.2 g vial contains: sodium 2.7 mmol, potassium 1 mmol

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