1. Name Of The Medicinal Product
Amoxil® Vials for Injection 500 Mg
2. Qualitative And Quantitative Composition
Amoxil Vials for Injection 500 mg contain 500 mg amoxicillin
The amoxicillin is present as the sodium salt in Amoxil injections (each 1 g vial contains approximately 3.3 mmol of sodium).
3. Pharmaceutical Form
Amoxil Vials: vials containing sterile powder for reconstitution.
4. Clinical Particulars
4.1 Therapeutic Indications
Treatment of Infection: Amoxil is a broad spectrum antibiotic indicated for the treatment of commonly occurring bacterial infections such as:
Upper respiratory tract infections
Otitis media
Acute and chronic bronchitis
Chronic bronchial sepsis
Lobar and bronchopneumonia
Cystitis, urethritis, pyelonephritis
Bacteriuria in pregnancy
Gynaecological infections including puerperal sepsis and septic abortion
Gonorrhoea
Peritonitis
Intra-abdominal sepsis
Septicaemia
Bacterial endocarditis
Typhoid and paratyphoid fever
Skin and soft tissue infections
In children with urinary tract infection the need for investigation should be considered.
Prophylaxis of endocarditis: Amoxil may be used for the prevention of bacteraemia, associated with procedures such as dental extraction, in patients at risk of developing bacterial endocarditis.
The wide range of organisms sensitive to the bactericidal action of Amoxil include:
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4.2 Posology And Method Of Administration
Treatment of infection:
Adult dosage (including elderly patients):
Injectable:
500 mg IM eight hourly (or more frequently if necessary) in moderate infections. (This dose may be given by slow IV injection if more convenient.)
1 g IV six hourly in severe infections.
Children's dosage (up to 10 years of age):
Injectable:
50-100 mg/kg body weight a day, in divided doses.
Parenteral therapy is indicated if the oral route is considered impracticable or unsuitable, and particularly for the urgent treatment of severe infection.
In renal impairment the excretion of the antibiotic will be delayed and, depending on the degree of impairment, it may be necessary to reduce the total daily dosage.
Prophylaxis of endocarditis: see table on next page.
Prophylaxis of endocarditis:
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Administration:
Intravenous Injection, Intravenous Infusion, Intramuscular:
Using vials for injection (See Section 6.6)
4.3 Contraindications
Amoxil is a penicillin and should not be given to penicillin-hypersensitive patients. Attention should be paid to possible cross-sensitivity with other beta-lactam antibiotics, e.g. cephalosporins.
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 more likely to occur in individuals with a history of hypersensitivity to beta-lactam antibiotics (see Section 4.3).
Erythematous (morbilliform) rashes have been associated with glandular fever in patients receiving amoxicillin.
Prolonged use may also occasionally result in overgrowth of non-susceptible organisms.
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 (see Section 4.9 Overdose). Amoxicillin has been reported to precipitate in bladder catheters after intravenous administration of large doses. A regular check of patency should be maintained.
Dosage should be adjusted in patients with renal impairment (see Section 4.2).
Abnormal prolongation of prothrombin time (increased INR) has been reported rarely in patients receiving amoxicillin and oral anticoagulants. 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 sections 4.5 and 4.8).
When prepared for intramuscular or direct intravenous injection, Amoxil should be administered immediately after reconstitution. The stability of Amoxil in various infusion fluids is given in the Package Enclosure Leaflet.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
Probenecid decreases the renal tubular secretion of amoxicillin. Concurrent use with Amoxil may result in increased and prolonged blood levels of amoxicillin.
In common with other antibiotics, amoxicillin may affect the gut flora, leading to lower oestrogen reabsorption and reduced efficacy of combined oral contraceptives.
Concurrent administration of allopurinol during treatment with amoxicillin can increase the likelihood of allergic skin reactions.
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).
It is recommended that when testing for the presence of glucose in urine during amoxicillin treatment, enzymatic glucose oxidase methods should be used. Due to the high urinary concentrations of amoxicillin, false positive readings are common with chemical methods.
4.6 Pregnancy And Lactation
Use in pregnancy
Animal studies with Amoxil have shown no teratogenic effects. The product has been in extensive clinical use since 1972 and its suitability in human pregnancy has been well documented in clinical studies. When antibiotic therapy is required during pregnancy, Amoxil may be considered appropriate when the potential benefits outweigh the potential risks associated with treatment.
Use in lactation:
Amoxicillin may be given during lactation. With the exception of the risk of sensitisation associated with the excretion of trace quantities of amoxicillin in breast milk, there are no known detrimental effects for the breast-fed infant.
4.7 Effects On Ability To Drive And Use Machines
Adverse effects on the ability to drive or operate machinery have not been observed.
4.8 Undesirable Effects
The following convention has been utilised for the classification of undesirable effects:-
Very common (>1/10), common (>1/100, <1/10), uncommon (>1/1000,<1/100), rare (>1/10,000, <1/1000), very rare (<1/10,000)
The majority of side effects listed below are not unique to amoxicillin and may occur when using other penicillins.
Unless otherwise stated, the frequency of adverse events has been derived from more than 30 years of post-marketing reports.
Infections and infestations
Very Rare: Mucocutaneous candidiasis
Blood and lymphatic system disorders
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Immune system disorders
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If a hypersensitivity reaction is reported, the treatment must be discontinued. (See also Skin and subcutaneous tissue disorders).
Nervous system disorders
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Gastrointestinal disorders
Clinical Trial Data
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Post-marketing Data
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Hepato-biliary disorders
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The significance of a rise in AST and/or ALT is unclear.
Skin and subcutaneous tissue disorders
Clinical Trial Data
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Post-marketing Data
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(See also Immune system disorders).
Renal and urinary tract disorders
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The incidence of these AEs was derived from clinical studies involving a total of approximately 6,000 adult and paediatric patients taking amoxicillin.
4.9 Overdose
Gastrointestinal effects such as nausea, vomiting and diarrhoea may be evident and should be treated symptomatically with attention to the water/electrolyte balance. Amoxicillin crystalluria, in some cases leading to renal failure, has been observed (see Section 4.4 Special warnings and special precautions for use).
Amoxicillin may be removed from the circulation by haemodialysis.
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
Amoxil is a broad spectrum antibiotic.
It is rapidly bactericidal and possesses the safety profile of a penicillin.
5.2 Pharmacokinetic Properties
Amoxil is well absorbed by the oral and parenteral routes. Amoxil gives good penetration into bronchial secretions and high urinary concentrations of unchanged antibiotic.
5.3 Preclinical Safety Data
Not applicable.
6. Pharmaceutical Particulars
6.1 List Of Excipients
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6.2 Incompatibilities
Amoxil should not be mixed with blood products, other proteinaceous fluids such as protein hydrolysates, or with intravenous lipid emulsions.
If Amoxil is prescribed concurrently with an aminoglycoside, the antibiotics should not be mixed in the syringe, intravenous fluid container or giving set because loss of activity of the aminoglycoside can occur under these conditions.
6.3 Shelf Life
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6.4 Special Precautions For Storage
Amoxil Vials for Injection should be stored in a cool, dry place.
When prepared for intramuscular or direct intravenous injection, Amoxil should be administered immediately after reconstitution. The stability of Amoxil in various infusion fluids is dependent upon the concentration and temperature: stability times are given in the Package Enclosure Leaflet.
6.5 Nature And Contents Of Container
Amoxil Vials for Injection: Clear Type I glass vials fitted with a chlorobutyl rubber bung and an aluminium overseal. 500 mg: packs of 5 or 10. Each pack carries instructions for use.
6.6 Special Precautions For Disposal And Other Handling
Intravenous Injection:
Dissolve 500 mg in 10 ml Water for Injections BP (Final volume=10.4 ml).
Amoxil injection, suitably diluted, may be injected directly into a vein or the infusion line over a period of three to four minutes.
Intravenous Infusion:
Solutions may be prepared as described for intravenous injections and then added to an intravenous solution in a minibag or in-line burette and administered over a period of half to one hour. Alternatively, using a suitable reconstitution device, the appropriate volume of intravenous fluid may be transferred from the infusion bag into the vial and then drawn back into the bag after dissolution.
Intramuscular:
500 mg: Add 2.5 ml Water for Injections BP † and shake vigorously (Final volume=2.9 ml).
If pain is experienced on intramuscular injection, a sterile 1% solution of lidocaine hydrochloride or 0.5% solution of procaine hydrochloride may be used in place of Water for Injections.
A transient pink colouration or slight opalescence may appear during reconstitution. Reconstituted solutions are normally a pale straw colour.
ADMINISTRATIVE DATA
7. Marketing Authorisation Holder
Beecham Group plc
Great West Road, Brentford, Middlesex TW8 9GS
Trading as GlaxoSmithKline UK Stockley Park West, Uxbridge, Middlesex UB11 1BT
And/or
Bencard or SmithKline Beecham Pharmaceuticals at Mundells Welwyn Garden City, Hertfordshire AL7 1 EY
8. Marketing Authorisation Number(S)
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9. Date Of First Authorisation/Renewal Of The Authorisation
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10. Date Of Revision Of The Text
1st March 2010
11. Legal Status
POM
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