Amoxicillin 250 Mg Capsules
Out of date information, search anotherSUMMARY OF PRODUCT CHARACTERISTICS
1 NAME OF THE MEDICINAL PRODUCT
Amoxicillin 250 mg Capsules
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
Amoxicillin trihydrate equivalent to 250mg amoxicillin 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 ‘2’. Scarlet colour cap, buff colour body printed with ‘AMOXY’ on cap and ‘250’ on body.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
The treatment of bacterial infections caused by amoxicillin-susceptible organisms.
It is principally indicated for respiratory, middle ear and urinary tract infections.
Respiratory tract - pneumonia, bronchitis ENT - otitis media
Urinary tract - cystitis, pyelonephritis
Biliary and intra-abdominal infections
Gynaecological infections
Gonorrhoea
Septicaemia
Bacterial endocarditis
Skin and soft tissue infections
Meningitis (seek expert advice)
Enteric fevers (typhoid and paratyphoid fevers - seek expert advice)
Dental abscess (as an adjunct to surgical management)
The prevention of bacteraemia, associated with procedures (e.g. dental), in patients at risk of developing bacterial endocarditis
4.2 Posology and method of administration
Route of administration: Oral
Adults: 250mg every 8 hours, increasing to 500mg every 8 hours in severe infections.
Amoxicillin Capsules BP 250mg, Amoxicillin Oral Suspension BP 125mg/5ml or Amoxicillin Oral Suspension BP 250mg/5ml may be required to achieve the recommended dose.
In those with severely impaired renal function dose reduction may be necessary.
Prophylaxis of Endocarditis
Dental procedures under local or no anaesthesia:
Patients who have not received more than a single dose of a penicillin in the previous month, including those with a prosthetic valve (but not those who have had endocarditis): oral amoxicillin 3g 1 hour before procedure.
Patients who have had endocarditis, amoxicillin + gentamicin, as under general anaesthesia.
Dental procedures under general anaesthesia:
No special risk (including patients who have not received more than a single dose of a penicillin in the previous month): either i/m or i/v amoxicillin 1g at induction, then oral amoxicillin 500mg 6 hours later. Children under 5 years: quarter the adult dose, 5-10 years: half the adult dose
Or oral amoxicillin 3g 4 hours before induction then oral amoxicillin 3g as soon as possible after procedure. Children under 5 years: quarter adult dose, 5-10 years: half adult dose.
Or oral amoxicillin 3g+oral probenecid 1g 4 hours before procedure.
Special risk (patients with a prosthetic valve or who have had endocarditis): i/v amoxicillin 1g+i/v gentamicin 120mg at induction, then oral amoxicillin 500mg 6 hours later. Children under 5 years: amoxicillin quarter adult dose, gentamicin 2mg/kg.
This product should not be used in patients who have received more than a single dose of penicillin in the previous month, or whom are allergic to penicillin.
Upper respiratory-tract procedures:
As for dental procedures: post-operative dose may be given parenterally if swallowing is painful.
Genito-urinary procedures:
As for special risk patients undergoing dental procedures under general anaesthesia. If urine infected, prophylaxis should also cover infective organism.
Obstetric, gynaecological and gastro-intestinalprocedures:
(prophylaxis required for patients with prosthetic valves or those who have had endocarditis only) As for genito-urinary procedures.
Children’s
Children weighing < 40 kg
The daily dosage for children is 40 - 90 mg/kg/day in two to three divided doses* (not exceeding 3 g/day) depending on the indication, severity of the disease and the susceptibility of the pathogen (see special dosage recommendations below and sections 4.4, 5.1 and 5.2).
*PK/PD data indicate that dosing three times daily is associated with enhanced efficacy, thus twice daily dosing is only recommended when the dose is in the upper range.
Children weighing more than 40 kg should be given the usual adult dosage.
Special dosage recommendation Tonsillitis: 50 mg/kg/day in two divided doses.
Acute otitis media
In areas with high prevalence of pneumococci with reduced susceptibility to penicillins, dosage regimens should be guided by national/local recommendations.
Early Lyme disease (isolated erythema migrans) 50 mg/kg/day in three divided doses, over 14-21days.
Prophylaxis for endocarditis
50 mg amoxicillin/kg body weight given as a single dose one hour preceding the surgical procedure.
Dosage in impaired renal function
The dose should be reduced in patients with severe renal function impairment. In patients with a creatinine clearance of less than 30 ml/min an increase in the dosage interval and a reduction in the total daily dose is recommended (see section 4.4 and 5.2).
Renal impairment in children under 40 kg:
|
Creatinine clearance ml/min |
Dose |
Interval between administration |
|
> 30 |
Usual dose |
No adjustment necessary |
|
10 - 30 |
Usual dose |
12 h (corresponding to 2/3 of the dose) |
|
< 10 |
Usual dose |
24 h (corresponding to 1/3 of the dose) |
4.3 Contraindications
Amoxicillin is contra-indicated in patients with hypersensitivity to penicillins.
Attention should also be paid to possible cross-reactivity with other beta-lactam antibiotics e.g. cephalosporins.
It should not be given to patients with infectious mononucleosis (glandular fever) since they are especially susceptible to amoxicillin-induced skin rashes.
4.4 Special warnings and precautions for use
Serious and occasionally fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy. These reactions are most likely in those with a history of hypersensitivity to beta-lactam antibiotics.
Amoxicillin should be used with caution in those with impaired renal function and dose reduction may be necessary in severe impairment.
Patients with infectious mononucleosis (glandular fever), 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.
Prolonged use of an anti-infective may result in the overgrowth of non-susceptible organisms (superinfection).
Precaution should be taken in premature children and during the neonatal period: renal, hepatic and haematological functions should be monitored.
4.5 Interaction with other medicinal products and other forms of interaction
Prolongation of prothrombin time has been reported in patients taking amoxicillin. Appropriate monitoring should be undertaken when anticoagulants are prescribed concurrently.
In common with other broad spectrum antibiotics Amoxicillin may reduce the efficacy of the oral contraceptive pill and patients should be warned appropriately, and extra precautions taken.
Excretion of penicillins is reduced by probenecid
4.6 Pregnancy and lactation
Use in pregnancy:
There is no evidence that amoxicillin is teratogenic or foetotoxic in humans. The product has been in extensive clinical use form any years and is considered safe in pregnancy.
Use in lactation:
Amoxicillin is considered safe in lactation. However it should be noted that amoxicillin is excreted in breast milk in small quantities with the possible risk of sensitisation and subsequent allergic reactions in a sensitised infant.
4.7 Effects on ability to drive and use machines
Not applicable.
4.8 Undesirable effects
Hypersensitivity reactions:
When amoxicillin is administered to a hypersensitive patient anaphylactic shock with collapse and sometimes death may occur within minutes.
If any hypersensitivity reaction occurs the treatment should be discontinued.
Skin rashes are the most common side effects with pruritus and urticaria. Rarely skin reactions such as erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis and bullous and exfoliative dermatitis have been reported.
Severe allergic reactions including angioneurotic oedema, anaphylaxis, serum sickness and vasculitis have been reported rarely.
Interstitial nephritis can occur rarely Gastrointestinal reactions:
Mild gastrointestinal upsets: nausea, vomiting diarrhoea. Muco-cutaneous candidiasis. Antibiotic-associated colitis (including pseudo-membranous colitis).
Hepatic effects:
Transiently raised liver enzymes (AST and/or ALT) has been noted. As with other beta-lactam antibiotics, hepatitis and cholestatic jaundice have been reported rarely.
Haematological effects:
As with other beta-lactams reversible leucopenia (including agranulocytosis), thrombocytopenia and haemolytic anaemia, and coagulation disorders (prolonged prothrombin and bleeding times) have been reported rarely.
CNS effects:
Rare effects include dizziness, convulsions and paraesthesia. Convulsions may occur in patients with impaired renal function or in those receiving high doses.
4.9 Overdose
Problems of overdosage with amoxicillin are unlikely to occur. If encountered, gastrointestinal effects such as nausea, vomiting and diarrhoea may be evident and should be treated symptomatically.
5.1 Pharmacodynamic properties
Amoxicillin is bactericidal. Like all penicillins it acts by interfering with the synthesis of the cell wall of the bacterium.
Amoxicillin is inactivated by penicillinase. Penicillinase-producing strains of Staphylococcus aureus and Gram negative organisms (e.g. Escherichia coli, Proteus, Klebsiella) are resistant.
Complete cross-resistance occurs with ampicillin and amoxicillin.
5.2 Pharmacokinetic properties
Amoxicillin is stable in the acid gastric secretion and is rapidly absorbed from the gastrointestinal tract after oral administration. The presence of food does not interfere with this process. Peak plasma concentrations are obtained in about two hours, producing around 2.5 times the peak concentration resulting from comparable doses of ampicillin.
Protein binding is similar to that of ampicillin: up to 25%.
Effective levels in the cerebrospinal fluid are obtained only in the presence of inflammation and then irregularly. About 60% of an orally administered dose is excreted unchanged in the urine. It penetrates well in to purulent and mucoid sputum.
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. Consequently, due to the decreased CL, the exposure is expected to be elevated in this group of patients, although this increase in exposure may in part be diminished by decreased bioavailability when given orally.
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
Magnesium Stearate (E572)
Silica Colloidal Anhydrous
Capsule shell components: Body:
Iron Oxide Red (E172)
Iron Oxide Yellow (E172) Titanium Dioxide (El71)
To 100% Gelatin
Cap:
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 original package and keep containers tightly closed.
6.5 Nature and contents of container
Polypropylene/polyethylene containers and tamper evident closures/ 1000, 500, 100, 50, 21, 20 and 15 capsules.
Blister strips: 15 and 21 capsules.
Not all pack sizes may be marketed.
6.6 Special precautions for disposal
Not applicable.
7 MARKETING AUTHORISATION HOLDER
Milpharm Limited,
Ares,
Odyssey Business Park,
West End Road,
South Ruislip HA4 6QD,
United Kingdom
8 MARKETING AUTHORISATION NUMBER(S)
PL 16363/0044
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE
AUTHORISATION
08/04/2002 / 04/02/2009
10 DATE OF REVISION OF THE TEXT
13/12/2012