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Alclav Neo 625 mg/Alclav Hospi: Oral anticoagulants: Oral anticoagulants and penicillin antibiotics have been widely used in practice without reports of interaction. However, in the literature there are cases of increased international normalised ratio in patients maintained on acenocoumarol or warfarin and prescribed a course of amoxicillin. If coadministration is necessary, the prothrombin time or international normalised ratio should be carefully monitored with the addition or withdrawal of amoxicillin. Moreover, adjustments in the dose of oral anticoagulants may be necessary.
Methotrexate: Penicillins may reduce the excretion of methotrexate causing a potential increase in toxicity.
Probenecid: Concomitant use of probenecid is not recommended. Probenecid decreases the renal tubular secretion of amoxicillin. Concomitant use of probenecid may result in increased and prolonged blood levels of amoxicillin but not of clavulanic acid.
Mycophenolate mofetil: In patients receiving mycophenolate mofetil, reduction in predose concentration of the active metabolite mycophenolic acid (MPA) of approximately 50% has been reported following commencement of oral amoxicillin plus clavulanic acid. The change in pre-dose level may not accurately represent changes in overall MPA exposure. Therefore, a change in the dose of mycophenolate mofetil should not normally be necessary in the absence of clinical evidence of graft dysfunction. However, close clinical monitoring should be performed during the combination and shortly after antibiotic treatment.
Alclav Neo 1g: Following administration of ampicillin to pregnant women a transient decrease in plasma concentration of total conjugated estriol, estradiol has been noted. This effect may also occur with amoxicillin and therefore with co-amoxiclav. Probenecid decreases the renal tubular secretion of amoxicillin but does not affect clavulanic acid excretion. Concurrent use with co-amoxiclav may result in increased and prolonged blood levels of amoxicillin but not for clavulanic acid. The concurrent administration of allopurinol and ampicillin increases substantially the incidence of rashes in patients receiving both medicines as compared to patients receiving ampicillin alone. It is not known whether this potentiation of ampicillin rashes is due to allopurinol or the hyperuricaemia present in these patients. No information is available about the concurrent use of co-amoxiclav and alcohol. However, the ingestion of alcohol whilst being treated with the beta-lactam antibiotics latamoxef, cefoperazone and cephamandole has precipitated a disulfiram (antabuse) like reaction in some patients. Therefore, the ingestion of alcohol should be avoided during and for several days after treatment with co-amoxiclav.
