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Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals
Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
RX
AMOXYCILLIN
CAPSULES
500MG
1.NAME OF THE MEDICINAL PRODUCT
Amoxicillin 500 mg Capsules
2. QUALITATIVE AND QUANTITATIVE
COMPOSITION
Amoxicillin trihydrate equivalent to 500mg
Amoxycillin per capsule.
For a full list of excipients, see section 6.1.
3. PHARMACEUTICAL FORM
Hard Capsules.
White to off-white granular powder filled in
hard gelatine capsule shells size '0'. Scarlet
colour cap, buff colour body.
4. CLINICAL PARTICULARS
4.1 Therapeutic indications
Amoxicillin is indicated for the treatment of the
following infections in adults and children (see
section 4.2, 4.4 and 5.1).
• Acute bacterial sinusitis
• Acute streptococcal tonsillitis and pharyngitis
• Acute exacerbations of chronic bronchitis
• Community acquired pneumonia
• Acute otitis media
• Acute cystitis
• Acute pyelonephritis
• Asymptomatic Bacteriuria in pregnancy
• Typhoid and paratyphoid fevers
• Dental abscess with spreading cellulitis
• Prosthetic joint infections
• Helicobacter pylori eradication
• Lyme disease
Amoxicillin is also indicated for the prophylaxis
of endocarditis. Consideration should be given
to official guidance on the appropriate use of
antibacterial agents.
4.2 Posology and method of administration
The dose of Amoxicillin that is selected to treat
an individual infection should take into account:
• The expected pathogens and their likely
susceptibility to antibacterial agents (see section
4.4)
• The severity and the site of infection
• The age, weight and renal function of the
patient; as shown below
The duration of therapy should be determined by
the type of infection and the response of the
patient, and should generally be as short as
possible. Some infections require longer periods
of treatment (see section 4.4 regarding
prolonged therapy).
Adults and children ≥40 kg
Indication* Dose*
Acute bacterial sinusitis 250mg to 500mg every 8 hours
or 750mg to 1g every 12 hours
For severe infections 750mg to
1g every 8 hours
Acute cystitis may be treated with
3g twice daily for one day
Asymptomatic bacteriuria in
pregnancy
Acute pyelonephritis
Dental abscess with spreading
cellulitis
Acute cystitis
Acute otitis media 500mg every 8 hours, 750mg to
1g every 12 hours
For severe infections 750mg to
1g every 8 hours for 10 days
Acute streptococcal tonsillitis
and pharyngitis
Acute exacerbations of chronic
bronchitis
Community acquired
pneumonia
500mg to 1g every 8 hours
Typhoid and paratyphoid fever 500mg to 2g every 8 hours
Prosthetic joint infections 500mg to 1g every 8 hours
Prophylaxis of endocarditis 2g orally, single dose 30 to 60
minutes before procedure
Helicobacter pylori eradication 750mg to 1g twice daily in
combination with a proton pump
inhibitor (e.g. omeprazole,
lansoprazole) and another
antibiotic (e.g. clarithromycin,
metronidazole) for 7 days
Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals
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Lyme disease (see section 4.4) Early stage: 500mg to 1g every 8
hours up to a maximum of 4
g/day in divided doses for 14
days (10 to 21 days)
Late stage (systemic
involvement): 500mg to 2g every
8 hours up to a maximum of 6
g/day in divided doses for 10 to
30 days
*Consideration should be given to the official treatment guidelines
for each indication
Children <40 kg
Children may be treated with Amoxicillin
capsules, dispersible tablets, suspensions or
sachets.
Amoxicillin Paediatric Suspension is
recommended for children under six months of
age.
Children weighing 40kg or more should be
prescribed the adult dosage.
Recommended doses:
Indication+
Dose+
Acute bacterial sinusitis 20 to 90 mg/kg/day in
divided doses*
Acute otitis media
Community acquired
pneumonia
Acute cystitis
Acute pyelonephritis
Dental abscess with
spreading cellulitis
Acute streptococcal tonsillitis
and pharyngitis
40 to 90 mg/kg/day in
divided doses*
Typhoid and paratyphoid fever 100 mg/kg/day in three
divided doses
Prophylaxis of endocarditis 50 mg/kg orally, single dose
30 to 60 minutes before
procedure
Lyme disease (see section
4.4)
Early stage: 25 to 50
mg/kg/day in three divided
doses for 10 to 21 days
Late stage (systemic
involvement): 100 mg/kg/day
in three divided doses for 10
to 30 days
+ Consideration should be given to the official treatment
guidelines for each indication.
*Twice daily dosing regimens should only be considered
when the dose is in the upper range.
Elderly
No dose adjustment is considered necessary.
Renal impairment
GFR (ml/min) Adults and
children ≥ 40kg
Children < 40 kg#
greater than 30 No adjustment
necessary
No adjustment
necessary
10 to 30 Maximum 500mg
twice daily
15 mg/kg given
twice daily
(maximum 500mg
twice daily)
less than 10 Maximum 500
mg/day
15 mg/kg given as a
single dose
(maximum 500 mg)
#
In the majority of cases, parenteral therapy is preferred
In patients receiving haemodialysis
Amoxicillin may be removed from the
circulation by haemodialysis
Haemodialysis
Adults and
children over
40kg
500mg every 24h
Prior to haemodialysis one additional dose of
500mg should be administered. In order to restore
circulating blood levels, another dose of 500mg
should be administered after haemodialysis
Children under
40kg
15 mg/kg/day given as a single daily dose
(maximum 500mg).
Prior to haemodialysis one additional dose of 15
mg/kg should be administered. In order to restore
circulating blood levels, another dose of 15 mg/kg
should be administered after haemodialysis
In patients receiving peritoneal dialysis
Amoxicillin maximum 500mg/day
Hepatic impairment
Dose with caution and monitor hepatic function
at regular intervals (see section 4.4 and 4.8).
Method of administration
Amoxicillin is for oral use.
Absorption of amoxicillin is impaired by food.
Therapy can be started parenterally according to
the dosing recommendations of the intravenous
formulation and continued with an oral
preparation.
Swallow with water without opening capsule.
4.3 Contraindications
Hypersensitivity to the active substance, to any
Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals
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of the penicillins or to any of the excipients
listed in section 6.1.
History of a severe immediate hypersensitivity
reaction (e.g. anaphylaxis) to another beta-
lactam agent (e.g. a cephalosporin, carbapenem
or monobactam).
4.4 Special Warnings and precautions for use
Hypersensitivity reactions
Before initiating therapy with amoxicillin,
careful enquiry should be made concerning
previous hypersensitivity reactions to penicillin
and cephalosporins or other beta-lactam agents
(see sections 4.3 and 4.8).
Serious and occasionally fatal hypersensitivity
reactions (including anaphylactoid and severe
cutaneous adverse reactions) have been reported
in patients on penicillin therapy. These reactions
are more likely to occur in individuals with a
history of penicillin hypersensitivity and in
atopic individuals. If an allergic reaction occurs,
amoxicillin therapy must be discontinued and
appropriate alternative therapy instituted.
Non-susceptible microorganisms
Amoxicillin is not suitable for the treatment of
some types of infection unless the pathogen is
already documented and known to be
susceptible or there is a very high likelihood that
the pathogen would be suitable for treatment
with amoxicillin (see section 5.1). This
particularly applies when considering the
treatment of patients with urinary tract infections
and severe infections of the ear, nose and throat.
Convulsions
Convulsions may occur in patients with
impaired renal function or in those receiving
high doses or in patients with predisposing
factors (e.g. history of seizures, treated epilepsy
or meningeal disorders (see section 4.8).
Renal impairment
In patients with renal impairment, the dose
should be adjusted according to the degree of
impairment (see section 4.2).
Skin reactions
The occurrence at the treatment initiation of a
feverish generalised erythema associated with
pustula may be a symptom of acute generalised
exanthemous pustulosis (AGEP, see section
4.8). This reaction requires amoxicillin
discontinuation and contra-indicates any
subsequent administration.
Amoxicillin should be avoided if infectious
mononucleosis is suspected since the occurrence
of a morbilliform rash has been associated with
this condition following the use of amoxicillin.
Patients with lymphatic leukaemia and possibly
with HIV infection are particularly prone to
developing erythematous rashes with
amoxicillin. Amoxicillin should be discontinued
if a skin rash occurs.
Jarisch-Herxheimer reaction
The Jarisch-Herxheimer reaction has been seen
following amoxicillin treatment of Lyme disease
(see section 4.8). It results directly from the
bactericidal activity of amoxicillin on the
causative bacteria of Lyme disease, the
spirochaete Borrelia burgdorferi. Patients should
be reassured that this is a common and usually
self-limiting consequence of antibiotic treatment
of Lyme disease.
Overgrowth of non-susceptible microorganisms
Prolonged use of an anti-infective may result in
the overgrowth of non-susceptible organisms
(superinfection).
Antibiotic-associated colitis has been reported
with nearly all antibacterial agents and may
range in severity from mild to life threatening
(see section 4.8). Therefore, it is important to
consider this diagnosis in patients who present
with diarrhoea during, or subsequent to, the
administration of any antibiotics. Should
antibiotic-associated colitis occur, amoxicillin
should immediately be discontinued, a physician
consulted and an appropriate therapy initiated.
Anti-peristaltic medicinal products are contra-
indicated in this situation.
Prolonged therapy
Periodic assessment of organ system functions;
including renal, hepatic and haematopoietic
function is advisable during prolonged therapy.
Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals
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Elevated liver enzymes and changes in blood
counts have been reported (see section 4.8)
Crystalluria
In patients with reduced urine output,
crystalluria has been observed very rarely,
predominantly with parenteral therapy. During
the administration of high doses of amoxicillin,
it is advisable to maintain adequate fluid intake
and urinary output in order to reduce the
possibility of amoxicillin crystalluria. In patients
with bladder catheters, a regular check of
patency should be maintained (see section 4.8
and 4.9).
Anticoagulants
Prolongation of prothrombin time has been
reported rarely in patients receiving amoxicillin.
Appropriate monitoring should be undertaken
when anticoagulants are prescribed
concomitantly. Adjustments in the dose of oral
anticoagulants may be necessary to maintain the
desired level of anticoagulation (see section 4.5
and 4.8)
Interference with diagnostic tests
Elevated serum and urinary levels of amoxicillin
are likely to affect certain laboratory tests. Due
to high urinary concentrations of amoxicillin,
false positive readings are common with
chemical methods.
It is recommended that when testing for the
presence of glucose in urine during amoxicillin
treatment, enzymatic glucose oxidase methods
should be used.
The presence of amoxicillin may distort assay
results for oestriol in pregnant women.
4.5 Interaction with other medicinal products
and other forms of interaction
Oral anticoagulants
Oral anticoagulants and penicillin antibiotics
have been widely used in practice without
reports of interaction. However, in the literature
there are rare cases of increased international
normalised ratio in patients maintained on
acenocoumarol or warfarin and prescribed a
course of amoxicillin. If co-administration is
necessary, the prothrombin time or international
normalised ratio should be carefully monitored
with the addition or withdrawal of amoxicillin
(see sections 4.4 and 4.8).
Probenecid
Concomitant use of probenecid is not
recommended. Probencid decreases the renal
tubular secretion of amoxicilin. Concurrent use
with amoxicillin may result in increased and
prolonged blood levels of amoxicillin
Allopurinol
Concurrent administration of allopurinol during
treatment with amoxicillin can increase the
likelihood of allergic skin reactions.
Tetracyclines
Tetracyclines and other bacteriostatic drugs may
interfere with the bactericidal effects of
amoxicillin.
Methotrexate
Penicillins may reduce the excretion of
methotrexate causing potential increase in
toxicity.
4.6 Fertility, Pregnancy and lactation
Pregnancy:
Animal studies do not indicate direct or indirect
harmful effects with respect to reproductive
toxicity. Limited data on the use of amoxicillin
during pregnancy in humans do not indicate an
increased risk of congenital malformations.
Amoxicillin may be used in pregnancy when the
potential benefits outweigh the potential risks
associated with treatment.
Breastfeeding:
Amoxicillin is excreted into breast milk in small
quantities with the possible risk of sensitisation.
Consequently, diarrhoea and fungus infection of
the mucous membranes are possible in the
breast-fed infant, so that breast-feeding might
have to be discontinued. Amoxicillin should
only be used during breast-feeding after
benefit/risk assessment by the physician in
charge.
Fertility:
Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals
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There are no data on the effects of amoxicillin
on fertility in humans. Reproductive studies in
animals have shown no effects on fertility.
4.7 Effects on ability to drive and use
machines
No studies on the effects on the ability to drive
and use machines have been performed.
However, undesirable effects may occur (e.g.
allergic reactions, dizziness, convulsions), which
may influence the ability to drive and use
machines (see section 4.8).
4.8 Undesirable Effects
The following convention has been utilised for
the classification of undesirable effects:
Very common (≥1/10),
Common (≥1/100 to <1/10),
Uncommon (≥1/1000 to <1/100),
Rare (≥1/10,000 to <1/1000),
Very rare (<1/10,000),
Not known (cannot be estimated from the
available data)
The majority of side effects listed below are not
unique to amoxicillin and may occur when using
other penicillins.
The most commonly reported adverse drug
reactions (ADRs) are diarrhoea, nausea and skin
rash.
Unless otherwise stated, the frequency of
adverse events has been derived from more than
30 years of post-marketing reports.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after
authorisation of the medicinal product is
important. It allows continued monitoring of the
benefit/risk balance of the medicinal product.
4.9 Overdose
Symptoms and signs of overdose
Problems of overdosage with amoxicillin are
unlikely to occur. Gastrointestinal symptoms
(such as nausea, vomiting and diarrhoea) and
disturbances of the fluid and electrolyte balances
may be evident. Amoxicillin crystalluria, in
some cases leading to renal failure, has been
observed (see Section 4.4). Convulsions may
occur in patients with impaired renal function or
in those receiving high doses (see section 4.4
and 4.8).
Treatment of intoxication
Gastrointestinal symptoms may be treated
symptomatically, with attention to the
water/electrolyte balance.
Infections and infestations
Very Rare: Muco-cutaneous candidiasis
Blood and lymphatic system disorders
Very rare: Reversible leucopenia (including severe
neutropenia or agranulocytosis), reversible
thrombocytopenia and haemolytic anaemia.
Prolonged prothrombin and bleeding times (see
section 4.4 - Special Warnings and Precautions for
Use)
Immune system disorders
Very rare: As with other antibiotics, severe allergic reactions,
including angioneurotic oedema, anaphylaxis (see
Section 4.4 - Special Warnings and Precautions for
Use), serum sickness and hypersensitivity vasculitis
Not known: Jarisch-Herxheimer reaction (see section 4.4)
If any hypersensitivity reaction occurs the treatment should be
discontinued (See also Skin and subcutaneous tissue disorders).
Nervous system disorders
Very rare: Hyperkinesia, dizziness and convulsions.
Convulsions may occur in patients with impaired
renal function or in those receiving high doses.
Gastrointestinal disorders
Clinical Trial Data
*Common: Diarrhoea and nausea.
*Uncommon: Vomiting.
Post-marketing Data
Very rare: Antibiotic associated colitis (including
pseudomembraneous colitis and haemorrhagic
colitis see section 4.4).
Black hairy tongue
Hepato-biliary disorders
Very rare: Hepatitis and cholestatic jaundice. A moderate rise
in AST and/or ALT.
The significance of a rise in AST and/or ALT is unclear.
Skin and subcutaneous tissue disorders
Clinical Trial Data
*Common: Skin rash
*Uncommon: Urticaria and pruritus
Post-marketing Data
Very rare: Skin reactions such as erythema multiforme,
Stevens-Johnson syndrome, toxic epidermal
necrolysis, bullous and exfoliative dermatitis, acute
generalised exanthematous pustulosis (AGEP) (see
section 4.4) and drug reaction with eosinophilia and
systemic symptoms (DRESS).
(See also Immune system disorders).
Renal and urinary tract disorders
Very rare: Interstitial nephritis.
Very rare: Crystalluria (see Sections 4.4 and 4.9 Overdose).
*The incidence of these AEs was derived from clinical studies
involving a total of approximately 6,000 adult and paediatric
patients taking amoxicillin.
Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals
Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Amoxicillin can be removed from the circulation
by haemodialysis.
5. PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: penicillins with
extended spectrum
Mechanism of action
Amoxicillin is a semisynthetic penicillin (beta-
lactam antibiotic) that inhibits one or more
enzymes (often referred to as penicillin-binding
proteins, PBPs) in the biosynthetic pathway of
bactericidal peptidoglycan, which is an integral
structural component of the bacterial cell wall.
Inhibition of peptidoglycan synthesis leads to
weakening of the cell wall, which is usually
followed by cell lysis and death.
Amoxicillin is susceptible to degradation by
beta-lactamases produced by resistant bacteria
and therefore the spectrum of activity of
amoxicillin alone does not include organisms
which produce these enzymes.
Pharmacokinetic/ pharmacodynamic relationship
The time above the minimum inhibitory
concentration (T>MIC) is considered to be the
major determinant of efficacy for amoxicillin.
Mechanisms of resistance
The main mechanisms of resistance to
amoxicillin are:
• Inactivation by bacterial beta-lactamases
• Alteration of PBPs, which reduce the affinity
of the antibacterial agent for the target.
Impermeability of bacteria or efflux pump
mechanisms may cause or contribute to bacterial
resistance, particularly in Gram-negative
bacteria.
Breakpoints
MIC breakpoints for amoxicillin are those of the
European Committee on Antimicrobial
Susceptibility Testing (EUCASAT) version 5.0.
Organism MIC breakpoint (mg/L)
Susceptible ≤ Resistant >
Enterobacteriaceae 81
8
Staphylococcus spp. Note2
Note2
Enterococcus spp.3
4 8
Streptococcus groups A, B,
C and G
Note4
Note4
Streptococcus pneumoniae Note5
Note5
Viridans group steprococci 0.5 2
Haemophilus influenza 26
26
Moraxella catarrhalis Note7
Note7
Neisseria meningitides 0.125 1
Gram positive anaerobes
except Clostridium difficile8
4 8
Gram negative anaerobes8
0.5 2
Helicobacter pylori 0.1259
0.1259
Pasteurella multocida 1 1
Non-species related
breakpoints10
2 8
1
Wild type enterobacteriaceae are categorised as susceptible to
aminopenicillins. Some countries prefer to categorise wild type
isolates of E. coli and P. mirabilis as intermediate. When this is
the case, use the MIC breakpoint S≤ 0.5 mg/L
2
Most staphylococci are penicillinase producers, which are
resistant to amoxicillin. Methicillin resistant isolates are, with few
exceptions, resistant to all beta-lactam agents.
3
Susceptibility to amoxicillin can be inferred from ampicillin
4
The susceptibility of streptococcus groups A, B, C and G to
penicillins is inferred from the benzylpenicillin susceptibility
5
Breakpoints relate only to non-meningitis isolates. For isolates
categorised as intermediate to ampicillin avoid oral treatment
with amoxicillin. Susceptibility inferred from the MIC of ampicillin
6
Breakpoints are based on intravenous administration. Beta-
lactamase positive isolates should be reported resistant
7
Beta lactamase producers should be reported resistant
8
Susceptibility to amoxicillin can be inferred from benzylpenicillin.
9
The breakpoints are based on epidemiological cut-off values
(ECOFFs), which distinguish wild-type isolates from those with
reduced susceptibility.
10
The non-species related breakpoints are based on doses of at
least 0.5g x 3 or 4 doses daily (1.5 to 2 g/day).
The prevalence of resistance may vary
geographically and with time for selected
species, and local information on resistance is
desirable, particularly when treating severe
infections. As necessary, expert advice should
be sought when the local prevalence of
resistance is such that the utility of the agent in
at least some types of infections is questionable.
In vitro susceptibility of micro-organisms to Amoxicillin
Commonly Susceptible Species
Gram-positive aerobes:
Enterococcus faecalis
Beta-hemolytic streptococci (Groups A, B, C and G )
Listeria monocytogenes
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Species for which acquired resistance may be a problem
Gram-negative aerobes:
Escherichia coli
Haemophilus influenza
Helicobacter pylori
Proteus mirabilis
Salmonella typhi
Salmonella paratyphi
Pasteurella multocida
Gram-positive aerobes:
Coagulase negative staphylococcus
Staphylococcus aureus£
Streptococcus pneumoniae
Viridans group streptococcus
Gram-positive aerobes:
Clostridium spp.
Gram-negative aerobes:
Fusobactrium spp.
Other:
Borrelia burgdorferi
Inherently resistant organisms†
Gram-positive aerobes:
Enterococcus faecium†
Gram-negative aerobes:
Acinetobacter spp.
Enterobacter spp.
Klebsiella spp.
Pseudomonas spp.
Gram-negative anaerobes:
Bacteroids spp. (many strains of Bacteroides fragilis are
resistant)
Others:
Chlamydia spp.
Mycoplasma spp.
Legionella spp.
†
Natural intermediate susceptibility in the absence of acquired
mechanism of resistance.
£
Almost all S.aureus are resistant to amoxicillin due to production
of penicillinase. In addition, all methicillin-resistant strains are
resistant to amoxicillin.
5.2 Pharmacokinetic properties
Absorption
Amoxicillin fully dissociates in aqueous solution
at physiological pH. Amoxicillin is stable in the
acid gastric secretion and is rapidly absorbed
from the gastrointestinal tract after oral
administration. Following oral administration,
amoxicillin is approximately 70% bioavailable.
The time to peak plasma concentration (Tmax) is
approximately one hour.
The pharmacokinetic results for a study, in
which an amoxicillin dose of 250 mg three times
daily was administered in the fasting state to
groups of healthy volunteers are presented
below.
Cmax Tmax* AUC(0-24h) T ½
(µg/ml) (h) (µg.h/ml) (h)
3.3 ±
1.12
1.5 (1.0-2.0) 26.7 ± 4.56 1.36 ± 0.56
*Median (range)
In the range 250 to 3000 the bioavailability is
linear in proportion to dose (measured as
Cmax and AUC). The absorption is not influenced
by simultaneous food intake.
Haemodialysis can be used for elimination of
amoxicillin.
Distribution
About 18% of total plasma amoxicillin is bound
to protein and the apparent volume of
distribution is around 0.3 to 0.41/kg. Following
intravenous administration, amoxicillin has been
found in gall bladder, abdominal tissue, skin, fat,
muscle tissue, synovial and peritoneal fluids,
bile and pus. Amoxicillin does not adequately
distribute into the cerebrospinal fluid.
From animal studies there is no evidence for
significant tissue retention of drug-derived
material. Amoxicillin, like most penicillins, can
be detected in breast milk (see section 4.6)
Amoxicillin has been shown to cross the
placental barrier (see section 4.6).
Biotransformation
Amoxicillin is partly excreted in the urine as the
inactive penicilloic acid in quantities equivalent
to up to 10 to 25% of the initial dose.
Elimination
The major route of elimination for amoxicillin is
via the kidney.
Amoxicillin has a mean elimination half-life of
approximately one hour and a mean total
clearance of approximately 25 l/hour in healthy
subjects. Approximately 60 to 70% of an orally
administered dose is excreted unchanged in the
Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals
Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
urine during the first 6 hours after administration
of a single 250mg or 500mg dose of amoxicillin.
Various studies have found the urinary excretion
to be 50-85% for amoxicillin over a 24 hour
period.
Concomitant use of probenecid delays
amoxicillin excretion (see section 4.5)
Age
The elimination half-life of amoxicillin is
similar for children aged around 3 months to 2
years and older children and adults. For very
young children (including preterm newborns) in
the first week of life the interval of
administration should not exceed twice daily
administration due to immaturity of the renal
pathway of elimination. In preterm infants with
gestational age 26-33 weeks, the total body
clearance after intravenous dosing of
amoxicillin, day 3 of life, ranged between 0.75 –
2 ml/min, very similar to the inuline clearance
(GFR) in this population. Following oral
administration, the absorption pattern and the
bioavailability of amoxicillin in small children
may be different to that of adults. Because
elderly patients are more likely to have
decreased renal function, care should be taken in
dose selection, and it may be useful to monitor
renal function.
Gender
Following oral administration of amoxicillin to
healthy males and female subjects, gender has
no significant impact on the pharmacokinetics of
amoxicillin.
Renal impairment
The total serum clearance of amoxicillin
decreases proportionately with decreasing renal
function (see section 4.2 and 4.4).
Hepatic impairment
Hepatically impaired patients should be dosed
with caution and hepatic function monitored at
regular intervals.
5.3 Preclinical safety data
There are no pre-clinical data of relevance to the
prescriber which are additional to that already
included in other sections of the SPC.
6. PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Indigo Carmine (E132)
Erythrosine (E127)
Titanium Dioxide (E171)
To 100% Gelatin
Composition of Ink
Shellac
Dehydrated Alcohol
Isopropyl Alcohol
Butyl Alcohol
Propylene Glycol
Strong Ammonia Solution
Potassium Hydroxide
Black Iron Oxide (E172)
6.2 Incompatibilities
Not applicable.
6.3 Shelf life
3 years: Polypropylene/polyethylene containers.
2 years: Blister strips
6.4 Special precautions for storage
Do not store above 25°C. Store in the original
package and keep containers tightly closed.
6.5 Nature and contents of container
Polypropylene/polyethylene containers and
tamper evident closures/ 1000, 500, 100, 21, 20
and 15 capsules.
Blister strips: 15 and 21 capsules.
Not all pack sizes may be marketed.
6.6 Special precautions for disposal and other
handling
Not applicable.
Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals
Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
7. MANUFACTURER:
Manufactured in India by:
TAJ PHARMACEUTICALS LTD.
Mumbai, India
At:388/34, Changodar Industrial Estate
Changodar- 382 210
Dist- Ahmedabad. Gujarat (India)
MFG. LIC NO: G/25A/4795-A

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  • 1. Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad. RX AMOXYCILLIN CAPSULES 500MG 1.NAME OF THE MEDICINAL PRODUCT Amoxicillin 500 mg Capsules 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Amoxicillin trihydrate equivalent to 500mg Amoxycillin per capsule. For a full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Hard Capsules. White to off-white granular powder filled in hard gelatine capsule shells size '0'. Scarlet colour cap, buff colour body. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications Amoxicillin is indicated for the treatment of the following infections in adults and children (see section 4.2, 4.4 and 5.1). • Acute bacterial sinusitis • Acute streptococcal tonsillitis and pharyngitis • Acute exacerbations of chronic bronchitis • Community acquired pneumonia • Acute otitis media • Acute cystitis • Acute pyelonephritis • Asymptomatic Bacteriuria in pregnancy • Typhoid and paratyphoid fevers • Dental abscess with spreading cellulitis • Prosthetic joint infections • Helicobacter pylori eradication • Lyme disease Amoxicillin is also indicated for the prophylaxis of endocarditis. Consideration should be given to official guidance on the appropriate use of antibacterial agents. 4.2 Posology and method of administration The dose of Amoxicillin that is selected to treat an individual infection should take into account: • The expected pathogens and their likely susceptibility to antibacterial agents (see section 4.4) • The severity and the site of infection • The age, weight and renal function of the patient; as shown below The duration of therapy should be determined by the type of infection and the response of the patient, and should generally be as short as possible. Some infections require longer periods of treatment (see section 4.4 regarding prolonged therapy). Adults and children ≥40 kg Indication* Dose* Acute bacterial sinusitis 250mg to 500mg every 8 hours or 750mg to 1g every 12 hours For severe infections 750mg to 1g every 8 hours Acute cystitis may be treated with 3g twice daily for one day Asymptomatic bacteriuria in pregnancy Acute pyelonephritis Dental abscess with spreading cellulitis Acute cystitis Acute otitis media 500mg every 8 hours, 750mg to 1g every 12 hours For severe infections 750mg to 1g every 8 hours for 10 days Acute streptococcal tonsillitis and pharyngitis Acute exacerbations of chronic bronchitis Community acquired pneumonia 500mg to 1g every 8 hours Typhoid and paratyphoid fever 500mg to 2g every 8 hours Prosthetic joint infections 500mg to 1g every 8 hours Prophylaxis of endocarditis 2g orally, single dose 30 to 60 minutes before procedure Helicobacter pylori eradication 750mg to 1g twice daily in combination with a proton pump inhibitor (e.g. omeprazole, lansoprazole) and another antibiotic (e.g. clarithromycin, metronidazole) for 7 days
  • 2. Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad. Lyme disease (see section 4.4) Early stage: 500mg to 1g every 8 hours up to a maximum of 4 g/day in divided doses for 14 days (10 to 21 days) Late stage (systemic involvement): 500mg to 2g every 8 hours up to a maximum of 6 g/day in divided doses for 10 to 30 days *Consideration should be given to the official treatment guidelines for each indication Children <40 kg Children may be treated with Amoxicillin capsules, dispersible tablets, suspensions or sachets. Amoxicillin Paediatric Suspension is recommended for children under six months of age. Children weighing 40kg or more should be prescribed the adult dosage. Recommended doses: Indication+ Dose+ Acute bacterial sinusitis 20 to 90 mg/kg/day in divided doses* Acute otitis media Community acquired pneumonia Acute cystitis Acute pyelonephritis Dental abscess with spreading cellulitis Acute streptococcal tonsillitis and pharyngitis 40 to 90 mg/kg/day in divided doses* Typhoid and paratyphoid fever 100 mg/kg/day in three divided doses Prophylaxis of endocarditis 50 mg/kg orally, single dose 30 to 60 minutes before procedure Lyme disease (see section 4.4) Early stage: 25 to 50 mg/kg/day in three divided doses for 10 to 21 days Late stage (systemic involvement): 100 mg/kg/day in three divided doses for 10 to 30 days + Consideration should be given to the official treatment guidelines for each indication. *Twice daily dosing regimens should only be considered when the dose is in the upper range. Elderly No dose adjustment is considered necessary. Renal impairment GFR (ml/min) Adults and children ≥ 40kg Children < 40 kg# greater than 30 No adjustment necessary No adjustment necessary 10 to 30 Maximum 500mg twice daily 15 mg/kg given twice daily (maximum 500mg twice daily) less than 10 Maximum 500 mg/day 15 mg/kg given as a single dose (maximum 500 mg) # In the majority of cases, parenteral therapy is preferred In patients receiving haemodialysis Amoxicillin may be removed from the circulation by haemodialysis Haemodialysis Adults and children over 40kg 500mg every 24h Prior to haemodialysis one additional dose of 500mg should be administered. In order to restore circulating blood levels, another dose of 500mg should be administered after haemodialysis Children under 40kg 15 mg/kg/day given as a single daily dose (maximum 500mg). Prior to haemodialysis one additional dose of 15 mg/kg should be administered. In order to restore circulating blood levels, another dose of 15 mg/kg should be administered after haemodialysis In patients receiving peritoneal dialysis Amoxicillin maximum 500mg/day Hepatic impairment Dose with caution and monitor hepatic function at regular intervals (see section 4.4 and 4.8). Method of administration Amoxicillin is for oral use. Absorption of amoxicillin is impaired by food. Therapy can be started parenterally according to the dosing recommendations of the intravenous formulation and continued with an oral preparation. Swallow with water without opening capsule. 4.3 Contraindications Hypersensitivity to the active substance, to any
  • 3. Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad. of the penicillins or to any of the excipients listed in section 6.1. History of a severe immediate hypersensitivity reaction (e.g. anaphylaxis) to another beta- lactam agent (e.g. a cephalosporin, carbapenem or monobactam). 4.4 Special Warnings and precautions for use Hypersensitivity reactions Before initiating therapy with amoxicillin, careful enquiry should be made concerning previous hypersensitivity reactions to penicillin and cephalosporins or other beta-lactam agents (see sections 4.3 and 4.8). Serious and occasionally fatal hypersensitivity reactions (including anaphylactoid and severe cutaneous adverse reactions) have been reported in patients on penicillin therapy. These reactions are more likely to occur in individuals with a history of penicillin hypersensitivity and in atopic individuals. If an allergic reaction occurs, amoxicillin therapy must be discontinued and appropriate alternative therapy instituted. Non-susceptible microorganisms Amoxicillin is not suitable for the treatment of some types of infection unless the pathogen is already documented and known to be susceptible or there is a very high likelihood that the pathogen would be suitable for treatment with amoxicillin (see section 5.1). This particularly applies when considering the treatment of patients with urinary tract infections and severe infections of the ear, nose and throat. Convulsions Convulsions may occur in patients with impaired renal function or in those receiving high doses or in patients with predisposing factors (e.g. history of seizures, treated epilepsy or meningeal disorders (see section 4.8). Renal impairment In patients with renal impairment, the dose should be adjusted according to the degree of impairment (see section 4.2). Skin reactions The occurrence at the treatment initiation of a feverish generalised erythema associated with pustula may be a symptom of acute generalised exanthemous pustulosis (AGEP, see section 4.8). This reaction requires amoxicillin discontinuation and contra-indicates any subsequent administration. Amoxicillin should be avoided if infectious mononucleosis is suspected since the occurrence of a morbilliform rash has been associated with this condition following the use of amoxicillin. Patients with lymphatic leukaemia and possibly with HIV infection are particularly prone to developing erythematous rashes with amoxicillin. Amoxicillin should be discontinued if a skin rash occurs. Jarisch-Herxheimer reaction The Jarisch-Herxheimer reaction has been seen following amoxicillin treatment of Lyme disease (see section 4.8). It results directly from the bactericidal activity of amoxicillin on the causative bacteria of Lyme disease, the spirochaete Borrelia burgdorferi. Patients should be reassured that this is a common and usually self-limiting consequence of antibiotic treatment of Lyme disease. Overgrowth of non-susceptible microorganisms Prolonged use of an anti-infective may result in the overgrowth of non-susceptible organisms (superinfection). Antibiotic-associated colitis has been reported with nearly all antibacterial agents and may range in severity from mild to life threatening (see section 4.8). Therefore, it is important to consider this diagnosis in patients who present with diarrhoea during, or subsequent to, the administration of any antibiotics. Should antibiotic-associated colitis occur, amoxicillin should immediately be discontinued, a physician consulted and an appropriate therapy initiated. Anti-peristaltic medicinal products are contra- indicated in this situation. Prolonged therapy Periodic assessment of organ system functions; including renal, hepatic and haematopoietic function is advisable during prolonged therapy.
  • 4. Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad. Elevated liver enzymes and changes in blood counts have been reported (see section 4.8) Crystalluria In patients with reduced urine output, crystalluria has been observed very rarely, predominantly with parenteral therapy. During the administration of high doses of amoxicillin, it is advisable to maintain adequate fluid intake and urinary output in order to reduce the possibility of amoxicillin crystalluria. In patients with bladder catheters, a regular check of patency should be maintained (see section 4.8 and 4.9). Anticoagulants Prolongation of prothrombin time has been reported rarely in patients receiving amoxicillin. Appropriate monitoring should be undertaken when anticoagulants are prescribed concomitantly. Adjustments in the dose of oral anticoagulants may be necessary to maintain the desired level of anticoagulation (see section 4.5 and 4.8) Interference with diagnostic tests Elevated serum and urinary levels of amoxicillin are likely to affect certain laboratory tests. Due to high urinary concentrations of amoxicillin, false positive readings are common with chemical methods. It is recommended that when testing for the presence of glucose in urine during amoxicillin treatment, enzymatic glucose oxidase methods should be used. The presence of amoxicillin may distort assay results for oestriol in pregnant women. 4.5 Interaction with other medicinal products and other forms of interaction Oral anticoagulants Oral anticoagulants and penicillin antibiotics have been widely used in practice without reports of interaction. However, in the literature there are rare cases of increased international normalised ratio in patients maintained on acenocoumarol or warfarin and prescribed a course of amoxicillin. If co-administration is necessary, the prothrombin time or international normalised ratio should be carefully monitored with the addition or withdrawal of amoxicillin (see sections 4.4 and 4.8). Probenecid Concomitant use of probenecid is not recommended. Probencid decreases the renal tubular secretion of amoxicilin. Concurrent use with amoxicillin may result in increased and prolonged blood levels of amoxicillin Allopurinol Concurrent administration of allopurinol during treatment with amoxicillin can increase the likelihood of allergic skin reactions. Tetracyclines Tetracyclines and other bacteriostatic drugs may interfere with the bactericidal effects of amoxicillin. Methotrexate Penicillins may reduce the excretion of methotrexate causing potential increase in toxicity. 4.6 Fertility, Pregnancy and lactation Pregnancy: Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. Limited data on the use of amoxicillin during pregnancy in humans do not indicate an increased risk of congenital malformations. Amoxicillin may be used in pregnancy when the potential benefits outweigh the potential risks associated with treatment. Breastfeeding: Amoxicillin is excreted into breast milk in small quantities with the possible risk of sensitisation. Consequently, diarrhoea and fungus infection of the mucous membranes are possible in the breast-fed infant, so that breast-feeding might have to be discontinued. Amoxicillin should only be used during breast-feeding after benefit/risk assessment by the physician in charge. Fertility:
  • 5. Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad. There are no data on the effects of amoxicillin on fertility in humans. Reproductive studies in animals have shown no effects on fertility. 4.7 Effects on ability to drive and use machines No studies on the effects on the ability to drive and use machines have been performed. However, undesirable effects may occur (e.g. allergic reactions, dizziness, convulsions), which may influence the ability to drive and use machines (see section 4.8). 4.8 Undesirable Effects The following convention has been utilised for the classification of undesirable effects: Very common (≥1/10), Common (≥1/100 to <1/10), Uncommon (≥1/1000 to <1/100), Rare (≥1/10,000 to <1/1000), Very rare (<1/10,000), Not known (cannot be estimated from the available data) The majority of side effects listed below are not unique to amoxicillin and may occur when using other penicillins. The most commonly reported adverse drug reactions (ADRs) are diarrhoea, nausea and skin rash. Unless otherwise stated, the frequency of adverse events has been derived from more than 30 years of post-marketing reports. Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. 4.9 Overdose Symptoms and signs of overdose Problems of overdosage with amoxicillin are unlikely to occur. Gastrointestinal symptoms (such as nausea, vomiting and diarrhoea) and disturbances of the fluid and electrolyte balances may be evident. Amoxicillin crystalluria, in some cases leading to renal failure, has been observed (see Section 4.4). Convulsions may occur in patients with impaired renal function or in those receiving high doses (see section 4.4 and 4.8). Treatment of intoxication Gastrointestinal symptoms may be treated symptomatically, with attention to the water/electrolyte balance. Infections and infestations Very Rare: Muco-cutaneous candidiasis Blood and lymphatic system disorders Very rare: Reversible leucopenia (including severe neutropenia or agranulocytosis), reversible thrombocytopenia and haemolytic anaemia. Prolonged prothrombin and bleeding times (see section 4.4 - Special Warnings and Precautions for Use) Immune system disorders Very rare: As with other antibiotics, severe allergic reactions, including angioneurotic oedema, anaphylaxis (see Section 4.4 - Special Warnings and Precautions for Use), serum sickness and hypersensitivity vasculitis Not known: Jarisch-Herxheimer reaction (see section 4.4) If any hypersensitivity reaction occurs the treatment should be discontinued (See also Skin and subcutaneous tissue disorders). Nervous system disorders Very rare: Hyperkinesia, dizziness and convulsions. Convulsions may occur in patients with impaired renal function or in those receiving high doses. Gastrointestinal disorders Clinical Trial Data *Common: Diarrhoea and nausea. *Uncommon: Vomiting. Post-marketing Data Very rare: Antibiotic associated colitis (including pseudomembraneous colitis and haemorrhagic colitis see section 4.4). Black hairy tongue Hepato-biliary disorders Very rare: Hepatitis and cholestatic jaundice. A moderate rise in AST and/or ALT. The significance of a rise in AST and/or ALT is unclear. Skin and subcutaneous tissue disorders Clinical Trial Data *Common: Skin rash *Uncommon: Urticaria and pruritus Post-marketing Data Very rare: Skin reactions such as erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, bullous and exfoliative dermatitis, acute generalised exanthematous pustulosis (AGEP) (see section 4.4) and drug reaction with eosinophilia and systemic symptoms (DRESS). (See also Immune system disorders). Renal and urinary tract disorders Very rare: Interstitial nephritis. Very rare: Crystalluria (see Sections 4.4 and 4.9 Overdose). *The incidence of these AEs was derived from clinical studies involving a total of approximately 6,000 adult and paediatric patients taking amoxicillin.
  • 6. Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad. Amoxicillin can be removed from the circulation by haemodialysis. 5. PHARMACOLOGICAL PROPERTIES 5.1 Pharmacodynamic properties Pharmacotherapeutic group: penicillins with extended spectrum Mechanism of action Amoxicillin is a semisynthetic penicillin (beta- lactam antibiotic) that inhibits one or more enzymes (often referred to as penicillin-binding proteins, PBPs) in the biosynthetic pathway of bactericidal peptidoglycan, which is an integral structural component of the bacterial cell wall. Inhibition of peptidoglycan synthesis leads to weakening of the cell wall, which is usually followed by cell lysis and death. Amoxicillin is susceptible to degradation by beta-lactamases produced by resistant bacteria and therefore the spectrum of activity of amoxicillin alone does not include organisms which produce these enzymes. Pharmacokinetic/ pharmacodynamic relationship The time above the minimum inhibitory concentration (T>MIC) is considered to be the major determinant of efficacy for amoxicillin. Mechanisms of resistance The main mechanisms of resistance to amoxicillin are: • Inactivation by bacterial beta-lactamases • Alteration of PBPs, which reduce the affinity of the antibacterial agent for the target. Impermeability of bacteria or efflux pump mechanisms may cause or contribute to bacterial resistance, particularly in Gram-negative bacteria. Breakpoints MIC breakpoints for amoxicillin are those of the European Committee on Antimicrobial Susceptibility Testing (EUCASAT) version 5.0. Organism MIC breakpoint (mg/L) Susceptible ≤ Resistant > Enterobacteriaceae 81 8 Staphylococcus spp. Note2 Note2 Enterococcus spp.3 4 8 Streptococcus groups A, B, C and G Note4 Note4 Streptococcus pneumoniae Note5 Note5 Viridans group steprococci 0.5 2 Haemophilus influenza 26 26 Moraxella catarrhalis Note7 Note7 Neisseria meningitides 0.125 1 Gram positive anaerobes except Clostridium difficile8 4 8 Gram negative anaerobes8 0.5 2 Helicobacter pylori 0.1259 0.1259 Pasteurella multocida 1 1 Non-species related breakpoints10 2 8 1 Wild type enterobacteriaceae are categorised as susceptible to aminopenicillins. Some countries prefer to categorise wild type isolates of E. coli and P. mirabilis as intermediate. When this is the case, use the MIC breakpoint S≤ 0.5 mg/L 2 Most staphylococci are penicillinase producers, which are resistant to amoxicillin. Methicillin resistant isolates are, with few exceptions, resistant to all beta-lactam agents. 3 Susceptibility to amoxicillin can be inferred from ampicillin 4 The susceptibility of streptococcus groups A, B, C and G to penicillins is inferred from the benzylpenicillin susceptibility 5 Breakpoints relate only to non-meningitis isolates. For isolates categorised as intermediate to ampicillin avoid oral treatment with amoxicillin. Susceptibility inferred from the MIC of ampicillin 6 Breakpoints are based on intravenous administration. Beta- lactamase positive isolates should be reported resistant 7 Beta lactamase producers should be reported resistant 8 Susceptibility to amoxicillin can be inferred from benzylpenicillin. 9 The breakpoints are based on epidemiological cut-off values (ECOFFs), which distinguish wild-type isolates from those with reduced susceptibility. 10 The non-species related breakpoints are based on doses of at least 0.5g x 3 or 4 doses daily (1.5 to 2 g/day). The prevalence of resistance may vary geographically and with time for selected species, and local information on resistance is desirable, particularly when treating severe infections. As necessary, expert advice should be sought when the local prevalence of resistance is such that the utility of the agent in at least some types of infections is questionable. In vitro susceptibility of micro-organisms to Amoxicillin Commonly Susceptible Species Gram-positive aerobes: Enterococcus faecalis Beta-hemolytic streptococci (Groups A, B, C and G ) Listeria monocytogenes
  • 7. Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad. Species for which acquired resistance may be a problem Gram-negative aerobes: Escherichia coli Haemophilus influenza Helicobacter pylori Proteus mirabilis Salmonella typhi Salmonella paratyphi Pasteurella multocida Gram-positive aerobes: Coagulase negative staphylococcus Staphylococcus aureus£ Streptococcus pneumoniae Viridans group streptococcus Gram-positive aerobes: Clostridium spp. Gram-negative aerobes: Fusobactrium spp. Other: Borrelia burgdorferi Inherently resistant organisms† Gram-positive aerobes: Enterococcus faecium† Gram-negative aerobes: Acinetobacter spp. Enterobacter spp. Klebsiella spp. Pseudomonas spp. Gram-negative anaerobes: Bacteroids spp. (many strains of Bacteroides fragilis are resistant) Others: Chlamydia spp. Mycoplasma spp. Legionella spp. † Natural intermediate susceptibility in the absence of acquired mechanism of resistance. £ Almost all S.aureus are resistant to amoxicillin due to production of penicillinase. In addition, all methicillin-resistant strains are resistant to amoxicillin. 5.2 Pharmacokinetic properties Absorption Amoxicillin fully dissociates in aqueous solution at physiological pH. Amoxicillin is stable in the acid gastric secretion and is rapidly absorbed from the gastrointestinal tract after oral administration. Following oral administration, amoxicillin is approximately 70% bioavailable. The time to peak plasma concentration (Tmax) is approximately one hour. The pharmacokinetic results for a study, in which an amoxicillin dose of 250 mg three times daily was administered in the fasting state to groups of healthy volunteers are presented below. Cmax Tmax* AUC(0-24h) T ½ (µg/ml) (h) (µg.h/ml) (h) 3.3 ± 1.12 1.5 (1.0-2.0) 26.7 ± 4.56 1.36 ± 0.56 *Median (range) In the range 250 to 3000 the bioavailability is linear in proportion to dose (measured as Cmax and AUC). The absorption is not influenced by simultaneous food intake. Haemodialysis can be used for elimination of amoxicillin. Distribution About 18% of total plasma amoxicillin is bound to protein and the apparent volume of distribution is around 0.3 to 0.41/kg. Following intravenous administration, amoxicillin has been found in gall bladder, abdominal tissue, skin, fat, muscle tissue, synovial and peritoneal fluids, bile and pus. Amoxicillin does not adequately distribute into the cerebrospinal fluid. From animal studies there is no evidence for significant tissue retention of drug-derived material. Amoxicillin, like most penicillins, can be detected in breast milk (see section 4.6) Amoxicillin has been shown to cross the placental barrier (see section 4.6). Biotransformation Amoxicillin is partly excreted in the urine as the inactive penicilloic acid in quantities equivalent to up to 10 to 25% of the initial dose. Elimination The major route of elimination for amoxicillin is via the kidney. Amoxicillin has a mean elimination half-life of approximately one hour and a mean total clearance of approximately 25 l/hour in healthy subjects. Approximately 60 to 70% of an orally administered dose is excreted unchanged in the
  • 8. Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad. urine during the first 6 hours after administration of a single 250mg or 500mg dose of amoxicillin. Various studies have found the urinary excretion to be 50-85% for amoxicillin over a 24 hour period. Concomitant use of probenecid delays amoxicillin excretion (see section 4.5) Age The elimination half-life of amoxicillin is similar for children aged around 3 months to 2 years and older children and adults. For very young children (including preterm newborns) in the first week of life the interval of administration should not exceed twice daily administration due to immaturity of the renal pathway of elimination. In preterm infants with gestational age 26-33 weeks, the total body clearance after intravenous dosing of amoxicillin, day 3 of life, ranged between 0.75 – 2 ml/min, very similar to the inuline clearance (GFR) in this population. Following oral administration, the absorption pattern and the bioavailability of amoxicillin in small children may be different to that of adults. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Gender Following oral administration of amoxicillin to healthy males and female subjects, gender has no significant impact on the pharmacokinetics of amoxicillin. Renal impairment The total serum clearance of amoxicillin decreases proportionately with decreasing renal function (see section 4.2 and 4.4). Hepatic impairment Hepatically impaired patients should be dosed with caution and hepatic function monitored at regular intervals. 5.3 Preclinical safety data There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC. 6. PHARMACEUTICAL PARTICULARS 6.1 List of excipients Indigo Carmine (E132) Erythrosine (E127) Titanium Dioxide (E171) To 100% Gelatin Composition of Ink Shellac Dehydrated Alcohol Isopropyl Alcohol Butyl Alcohol Propylene Glycol Strong Ammonia Solution Potassium Hydroxide Black Iron Oxide (E172) 6.2 Incompatibilities Not applicable. 6.3 Shelf life 3 years: Polypropylene/polyethylene containers. 2 years: Blister strips 6.4 Special precautions for storage Do not store above 25°C. Store in the original package and keep containers tightly closed. 6.5 Nature and contents of container Polypropylene/polyethylene containers and tamper evident closures/ 1000, 500, 100, 21, 20 and 15 capsules. Blister strips: 15 and 21 capsules. Not all pack sizes may be marketed. 6.6 Special precautions for disposal and other handling Not applicable.
  • 9. Amoxycillin (Trihydrate) 500mg Capsules SMPC, Taj Pharmaceuticals Amoxycillin (Trihydrate) 500mg Capsules Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warning s, Amoxycillin Dosage & Rx Info | Amoxycillin Uses, Side Effects - Amoxycillin : Indications, Side Effects, Warnings, Amoxycillin - Drug Information - Taj Pharma, Amoxycillin dose Taj pharmaceuticals Amoxycillin interactions, Taj Pharmaceutical Amoxycillin contraindications, Amoxy cillin price, A moxycillin Taj Pharma Antibiotic Amoxycillin (Trihydrate) 500mg Capsules SMPC- Taj Pharma . Stay connected to all updated on Amoxy cillin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad. 7. MANUFACTURER: Manufactured in India by: TAJ PHARMACEUTICALS LTD. Mumbai, India At:388/34, Changodar Industrial Estate Changodar- 382 210 Dist- Ahmedabad. Gujarat (India) MFG. LIC NO: G/25A/4795-A