- GENERIC NAME: AMOXICILLIN/CLAVULANIC ACID 875 MG/125 MG – ORAL (a-MOX-i-SIL-in/KLAV-you-lan-ik)
- Augmentin Side Effects
- For the Consumer
- For Healthcare Professionals
- Further information
- More about Augmentin (amoxicillin / clavulanate)
- Side effects
- How to Restore Your Gut Health After Antibiotics
- Antibiotics and How They Work in Your Gut
- Are There Side Effects of Antibiotics?
- How Long Does It Take to Restore Gut Health?
- What Can You Do to “Speed-Up” Restoration?
- What to do when your medication causes nausea
- Taking your pills with a light snack or at bedtime may help reduce the nausea.
- About nausea
- Side Effects of Antibiotics: What They Are and How to Manage Them
- About co-amoxiclav
- Before taking co-amoxiclav
- How to take co-amoxiclav
- Getting the most from your treatment
- Can co-amoxiclav cause problems?
- How to store co-amoxiclav
- Important information about all medicines
GENERIC NAME: AMOXICILLIN/CLAVULANIC ACID 875 MG/125 MG – ORAL (a-MOX-i-SIL-in/KLAV-you-lan-ik)
BRAND NAME(S): Augmentin
Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes | Missed Dose | Storage
USES: Amoxicillin/clavulanic acid is a penicillin-type antibiotic used to treat a wide variety of bacterial infections. It works by stopping the growth of bacteria.This antibiotic only treats bacterial infections. It will not work for viral infections (e.g., common cold, flu). Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness.
HOW TO USE: Take this medication by mouth with a meal or snack, usually every 12 hours, or as directed by your doctor.Antibiotics work best when the amount of medicine in your body is kept at a constant level. Therefore, take this drug at evenly spaced intervals.Continue to take this medication until the full prescribed amount is finished even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a relapse of the infection.Inform your doctor if your condition persists or worsens.
SIDE EFFECTS: Diarrhea, nausea, or vomiting may occur during the first few days as your body adjusts to the medication. Take with food to minimize stomach upset. If any of these effects persist or worsen, contact your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: easy bruising or bleeding, persistent sore throat or fever, dark urine, persistent nausea or vomiting, severe stomach/abdominal pain, yellowing eyes or skin.This medication may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a type of resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Do not use anti-diarrhea products or narcotic pain medications if you have any of the following symptoms because these products may make them worse. Tell your doctor immediately if you develop: persistent diarrhea, abdominal or stomach pain/cramping, or blood/mucus in your stool.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection (oral or vaginal fungal infection). Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge or other new symptoms.A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.The amoxicillin in this combination medication can commonly cause a mild rash that is usually not serious. However, you may not be able to tell it apart from a rare rash that could be a sign of a severe allergic reaction. Therefore, seek immediate medical attention if you develop any rash.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Augmentin Side Effects
Generic Name: amoxicillin / clavulanate
Medically reviewed by Drugs.com. Last updated on Jan 29, 2019.
- Side Effects
Note: This document contains side effect information about amoxicillin / clavulanate. Some of the dosage forms listed on this page may not apply to the brand name Augmentin.
For the Consumer
Applies to amoxicillin / clavulanate: oral powder for suspension, oral tablet, oral tablet chewable, oral tablet extended release
Along with its needed effects, amoxicillin/clavulanate may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking amoxicillin / clavulanate:
- Hives or welts
- itching of the vagina or genital area
- pain during sexual intercourse
- redness of the skin
- skin rash
- thick, white vaginal discharge with no odor or with a mild odor
- Bloody or cloudy urine
- greatly decreased frequency of urination or amount of urine
- swelling of the feet or lower legs
Incidence not known
- Abdominal or stomach cramps or tenderness
- back, leg, or stomach pains
- black, hairy tongue
- black, tarry stools
- bleeding gums
- blistering, peeling, or loosening of the skin
- blood in the stools
- bloody nose
- chest pain
- clay-colored stools
- cough or hoarseness
- cracks in the skin
- dark urine
- diarrhea, watery and severe, which may also be bloody
- difficulty with breathing
- difficulty with moving
- difficulty with swallowing
- fast heartbeat
- fever with or without chills
- general body swelling
- general feeling of tiredness or weakness
- heavier menstrual periods
- increased thirst
- joint or muscle pain
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- light-colored stools
- loss of appetite
- loss of heat from the body
- lower back or side pain
- muscle stiffness
- nausea or vomiting
- pain, swelling, or redness in the joints
- painful or difficult urination
- pale skin
- pinpoint red spots on the skin
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- red skin lesions, often with a purple center
- red, irritated eyes
- red, swollen skin
- scaly skin
- sore throat
- sores, ulcers, or white spots on the lips or in the mouth
- swollen glands
- tightness in the chest
- troubled breathing with exertion
- unpleasant breath odor
- unusual bleeding or bruising
- unusual tiredness or weakness
- unusual weight loss
- upper right abdominal or stomach pain
- vomiting of blood
- white patches in the mouth or throat or on the tongue
- white patches with diaper rash
- yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur while taking amoxicillin / clavulanate:
Symptoms of overdose
- Abdominal or stomach pain
- cloudy urine
- greatly decreased frequency of urination or amount of urine
Some side effects of amoxicillin / clavulanate may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- dry mouth
- irregular heartbeats
- tooth discoloration
- trouble sitting still
- trouble with sleeping
Incidence not known
- Burning feeling in the chest or stomach
- redness, swelling, or soreness of the tongue
- stomach upset
- swelling or inflammation of the mouth
For Healthcare Professionals
Applies to amoxicillin / clavulanate: oral powder for reconstitution, oral tablet, oral tablet chewable, oral tablet extended release
Gastrointestinal side effects have included diarrhea, nausea, abdominal pain, vomiting, indigestion, gastritis, generalized abdominal cramps, stomatitis, glossitis, mucocutaneous candidiasis, enterocolitis, black “hairy” tongue, small intestinal motor disturbances, hemorrhagic colitis, and pseudomembranous colitis. Colitis and Clostridium difficile pseudomembranous colitis have been reported with amoxicillin.
Amoxicillin has been associated with hemorrhagic, sometimes inflammatory colitis, which typically affects the ascending colon. In addition, C difficile pseudomembranous colitis should be considered in patients who develop severe or prolonged diarrhea during or following amoxicillin-clavulanate therapy.
The incidence of diarrhea appears to increase with higher doses, and to decrease with twice daily dosing regimens (of immediate release formulations).
Hypersensitivity reactions to amoxicillin are more likely in patients with a history of allergy, asthma, hay fever, or urticaria.
Hypersensitivity reactions have occurred in up to 10% of patients, and may present as a skin rash, urticaria, pruritus, angioedema, serum sickness-like reactions (urticaria or skin rash accompanied by arthritis, arthralgia, myalgia, and frequently fever), erythema multiforme, Stevens-Johnson syndrome (rarely), acute generalized exanthematous pustulosis, hypersensitivity vasculitis, exfoliative dermatitis, and toxic epidermal necrolysis. Anaphylaxis has been rarely reported (up to 0.2%). Hypersensitivity may play a role in some cases of amoxicillin-clavulanate-induced renal and hepatic toxicity. Urticarial rash, erythematous maculopapular rash, edema, hypotension, fever, eosinophilia, and dyspnea have been associated with hypersensitivity reactions to amoxicillin.
Three out of four patients with infectious mononucleosis and an amoxicillin-associated rash displayed hypersensitivity to amoxicillin and ampicillin by skin tests and lymphocyte transformation tests. Two of these patients had side-chain-specific sensitization.
Dermatologic side effects have included rash, fixed drug eruption, bullous pemphigoid, erythema multiforme, Stevens-Johnson syndrome, and exfoliative dermatitis. Amoxicillin rashes occur more frequently in patients with unrecognized infectious mononucleosis. This rash is not necessarily indicative of a lifelong amoxicillin hypersensitivity.
Hepatic side effects have included moderate elevations in serum transaminases (ALT and/or AST). Hepatic dysfunction (including cholestatic jaundice and hepatitis, increases in ALT and/or AST, serum bilirubin, and/or alkaline phosphatase) has been reported infrequently. Rare cases of jaundice, ductopenia, cholestatic hepatitis, granulomatous hepatitis, hepatic necrosis, and hepatocellular damage have also been reported. Less than 1 death per approximately 4 million prescriptions has been reported worldwide. Hepatic cholestasis and acute cytolytic hepatitis have been reported with amoxicillin use.
In cases of amoxicillin-clavulanate-induced hepatotoxicity, biopsy findings have typically revealed evidence of cholestatic injury. However, hepatocellular and mixed-type (cholestatic and hepatocellular) injury have also been documented. In many instances, hepatotoxicity may be due to a hypersensitivity. Onset of symptoms has been delayed in some patients, with presentation occurring after therapy has been discontinued. Prolonged treatment may increase the risk of hepatotoxicity. Elderly patients may be at increased risk of developing amoxicillin-clavulanate-induced jaundice. Fatalities are rare, but have been reported.
Rechallenge with amoxicillin alone has not been followed by a recurrence of hepatitis. However, rechallenge with amoxicillin-clavulanate has resulted in a relapse of liver injury. Therefore, the clavulanic acid may be the hepatotoxic part of the drug.
In patients with liver disease, frequent monitoring of liver function tests during amoxicillin-clavulanate therapy is recommended.
Renal side effects have rarely included crystalluria, hematuria, acute renal failure, and acute interstitial nephritis, often associated with fever, rash, and eosinophilia.
A 45-year-old female developed massive crystalluria, gross hematuria, and acute anuric renal failure after 12 days of intravenous amoxicillin-clavulanate at a dose of 2 g amoxicillin 3 times daily (not available in the United States). The crystals were composed of amoxicillin trihydrate. The renal failure and hematuria resolved over 6 days after discontinuation of the antibiotic.
Amoxicillin has been shown to induce hemolytic anemia in rare cases. A case of bone marrow “maturation arrest” resulting in neutropenia and of Henoch-Schonlein purpura syndrome has been associated with amoxicillin-clavulanate.
A patient undergoing dental extraction and receiving warfarin anticoagulation therapy had prolonged bleeding times (PT and INR), and decreased hemoglobin and hematocrit. The bleeding was felt due to vitamin K deficiency as a result of depletion of intrinsic vitamin K-producing gut flora from use of amoxicillin for prophylaxis of subacute bacterial endocarditis.
Hematologic side effects associated with penicillins have included thrombocytopenia, anemia, hemolytic anemia, thrombocytopenic purpura, eosinophilia, agranulocytosis, and leukopenia. These are believed to be due to hypersensitivity and are usually reversible when the drug is discontinued. Mild to moderate thrombocytosis has been reported in less than 1% of patients treated with amoxicillin-clavulanate and 3.6% of patients treated with the extended-release tablets. Purpura, pancytopenia, granulocytopenia, medullary aplasia, prolongation of prothrombin time, and transient neutropenia have also been reported.
Immunologic side effects associated with amoxicillin have included mucocutaneous candidiasis and vulvovaginal mycotic infection.
Nervous system side effects have rarely included agitation, anxiety, behavioral changes, confusion, convulsions, dizziness, headache, insomnia, and reversible hyperactivity. Rare cases of psychosis associated with amoxicillin therapy have been reported, but may have been due to underlying infection or concomitant medication. Rarely, somnolence and aseptic meningitis have been reported with amoxicillin.
Genitourinary side effects have included genital moniliasis (2.1%).
Amoxicillin-clavulanate may cause false-positive urine glucose tests in patients using Clinitest(R) tablets. Enzymatic glucose oxidase tests should be used during amoxicillin-clavulanate therapy.
Other side effects have rarely included brown, yellow, or gray tooth discoloration, primarily in pediatric patients. Brushing or dental cleaning reduced or eliminated the discoloration in most cases.
Respiratory side effects associated with amoxicillin have included cough and rhinorrhea.
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Augmentin is a brand name for an antibiotic, called co-amoxiclav, that is used to treat a wide range of conditions, from bronchitis to Lyme disease. It is one of the most commonly prescribed antibiotics for children, frequently dispensed for ear infections.
Antibiotics work by attacking the cell wall of bacteria that are harming the body, or they prevent the bacteria from replicating.
The drug is a combination of two active ingredients: amoxicillin and clavulanic acid. Together, the drugs fight bacteria that would ordinarily be resistant to amoxicillin alone.
The antibiotic can also be used on animals. Ruminants, swine, horses, dogs, cats and poultry are often prescribed Augmentin for various ailments.
Augmentin is typically taken orally, in pill form for adults, and in a liquid (often flavored) suspension for little children. Doctors prescribe the drug so often because it works against many types of disease-causing bacteria.
“When I travel I always have some Augmentin in my travel bag,” because it works against so many common infections, said Dr. Alasdair Geddes, an emeritus professor of infectious diseases at the University of Birmingham in England, who ran some of the first clinical trials of Augmentin.
Augmentin is one of the workhorses of the pediatrician’s office, prescribed for ear infections that are resistant to amoxicillin alone, sore throats and certain eye infections. The drug is also a powerful agent against bronchitis and tonsillitis caused by bacteria (though many cases of sore throat are viral in origin).
In addition, the drug can fight pneumonia, urinary tract infections, gonorrhea and skin infections. The drug has also been seen as a good potential candidate for treatment of Lyme disease, chlamydia, sinusitis, gastritis and peptic ulcers, according to a 2011 study in the International Journal of Pharmacy and Pharmaceutical Sciences.
Though Augmentin hasn’t been conclusively shown to be safe during pregnancy, some studies suggest it is unlikely to do harm to pregnant women or their fetuses, according to a 2004 study in the British Journal of Clinical Pharmacology. The Mayo Clinic also lists amoxicillin as a safe antibiotic for pregnancy. Women who are pregnant should check with their doctors before taking the drug, though. The Food and Drug Administration classifies Augmentin as a class B drug, meaning there is no evidence for harm.
The most common side effects for Augmentin are nausea, upset stomach, gas and diarrhea. Largely, this is because clavulanic acid can irritate the gut, Geddes said. In addition, like other antibiotics, Augmentin wipes out a broad class of bacteria, so it may also kill “good” bacteria that line the gut and help digest foods. Augmentin can also leave people more prone to yeast infections — again, because it wipes out good bacterial populations that normally inhibit the growth of yeast.
(Image credit: NIH.)
People who are allergic to penicillin-like drugs are often allergic to Augmentin as well, because it contains amoxicillin. To test for this drug allergy, doctors can do a skin-prick test called PrePen. In some instances, an allergy to Augmentin can lead to anaphylaxis, a deadly allergic response that can cause the narrowing of the airways, the swelling of the lips and tongue, and a deadly drop in blood pressure.
“It is in the penicillin family, so allergy is relatively common,” said Dr. Warren Hammert, a surgeon at the University of Rochester Medical Center in New York.
Rarely, the drug can cause problems with how the liver functions, which will lead to yellowing of the skin called jaundice.
“In rare cases, it can cause a condition where the colon is affected and result in serious long-term GI problems,” Hammert told Live Science.
And a few isolated cases of children reacting negatively to the clavulanic acid in Augmentin have also been reported. For instance, 10 children who tested negative for penicillin allergy, broke out into hives after taking Augmentin, according to a 2008 study in the journal Allergologia and Immunopathologia.
Humans gained their first powerful weapon in the war against bacteria in the 1920s. Scottish biologist Alexander Fleming was culturing a bacteria, when he noticed that a mold growing in one of his petri dishes had killed off the surrounding bacteria, according to the Nobel Prize website. After much work, he discovered that the active agent was what is now known as penicillin (named after the fungus, penicillium, which produces it.)
Though penicillin worked wonders, it had some side effects and was not effective against all that many bacteria. So, in the 1950s, scientists at Beecham Research Laboratories, which was created by the same company that produced Lucozade soft drinks and Brylcreem hair gel, began developing new antibiotics. Their strategy was simple and clever: they used the core chemical structure of penicillin, but added different side chains to it, Geddes said.
One of their early successful drugs was amoxicillin, a close relative to penicillin. Both amoxicillin and other penicillins have a key molecular structure that helps the kill bacteria: a chemical ring called a beta-lactam.
Beta-lactam rings bind to enzymes in bacterial cell membranes. These enzymes are responsible for cross-linking peptidoglycans, the building blocks used to form the bacterial cell wall. When drugs like amoxicillin disable these membrane enzymes, they prevent the bacteria from building up the cell wall, even as the bacteria continue to break down their old cell wall. The bacteria die as a result.
Amoxicillin was seen as a breakthrough because it was absorbed better than earlier antibiotics, had fewer of the side effects of antibiotics such as methicillin, and seemed to work against a broad class of bacteria.
However, it had one flaw: at least some resistant populations of bacteria had evolved an ability to fight amoxicillin and other antibiotics by making an enzyme called beta-lactamase, which essentially snipped the beta lactam ring open and disabled it.
But in 1972, Beecham Research Laboratories discovered that a certain bacteria called Streptomyces clavuligerus produced a chemical lookalike to penicillin, called clavulanic acid, as a byproduct of its fermentation, according to an article published in 2007 in the International Journal of Microbial Agents. Like other antibiotics, it had a beta-lactam ring, but on its own, wasn’t much good at killing bacteria.
However, when combined with amoxicillin, it created a superb antibiotic. Clavulanic acid was the ultimate decoy: when bacteria sent out its antibiotic-snipping enzyme, Beta-lactamase, it would bind to clavulanic acid instead. Once bound, clavulanic acid changed its shape and permanently deactivated Beta-lactamase. Clavulanic acid worked extremely well against several deadly bacteria, including Escherichia coli, Klebisella aerogens, Pseudomonas aeruginosa and Staphylococcus aureus, according to a 1977 article in the journal of the American Society for Microbiology.
“It was really the first broad-spectrum oral antibiotic which was remarkably free from side effects,” Geddes said. “At one stage, Augmentin was the largest selling oral antibacterial drug in the world.”
Additional reporting by Alina Bradford, Live Science contributor.
- National Library of Medicine: Augmentin
- Drugs.com: Amoxicillin/Clavulanate Pregnancy and Breastfeeding Warnings
- U.S. National Library of Medicine: Augmentin
How to Restore Your Gut Health After Antibiotics
Antibiotics have been nothing short of a miracle in modern medicine and have undoubtedly saved lives by eradicating and treating infections. However, many health professionals agree that antibiotics are over-prescribed, and attention is rarely given as to how to restore gut health after antibiotics.
In this article, we’ll look at what antibiotics are, their side effects on your gut health, and optimal forms of getting your GI health back in shape afterward.
Antibiotics and How They Work in Your Gut
Antibiotics are a type of antimicrobial drug used to prevent and treat bacterial infections. They work by both inhibiting and/or killing bacteria, but they are not quite smart enough to distinguish between beneficial and pathogenic bacteria. The killing of beneficial bacteria weakens the GI microbiome, which can lead to a long list of symptoms and problems in the long term.
The extent to which antibiotics can negatively impact gut health depends on the type of antibiotic, stage of life when they are used (for example, they could be more damaging to the gut of a small child), and the duration of use.
Are There Side Effects of Antibiotics?
Antibiotics can potentially cause diarrhea, soft stools, stomach upset, constipation, rash or allergic reaction. Damage to the gut is a well-known side effect of antibiotic use, and several new studies suggest that overuse of antibiotics could damage the immune system.
How Long Does It Take to Restore Gut Health?
The length of time it might take to restore gut health post-antibiotic depends on how long a person has been taking the antibiotics. A high-quality probiotic supplement is your first line of defense, as probiotics are the very beneficial bacteria that antibiotics destroy.
A common recommendation is one round of probiotics for each week that you have taken antibiotics. One round of probiotics could last from one to two weeks. This is up for debate, but there is likely no harm in taking probiotics at the same time you are taking antibiotics, preferably with a two-hour window before or after you take your antibiotic.
What Can You Do to “Speed-Up” Restoration?
Along with probiotics, there are several other steps you can take to speed up gut healing after antibiotics. According to the CDC, at least 30 percent of antibiotics used are prescribed unnecessarily. So first and foremost, be sure that the recommendation to use antibiotics is, in fact, called for. Most of this misuse takes place when antibiotics are prescribed for viruses (such as the common cold), which will not respond to antibiotics.
Opt for a wide spectrum probiotic (one that includes multiple strains) with at least 50 billion CFU (colony forming units) per dose.
If you are new to probiotic supplements, you might need to cut the recommended dose in half (or even in quarters) and work your dosage up over a few days if you experience digestive distress (gas, bloating, etc.).
Fermented foods are naturally rich in probiotics, and are an excellent way to maintain proper gut health post-antibiotic use. Combining them with a probiotic supplement after a round of antibiotics will help with healing, but fermented foods should ideally be included in your daily diet on a regular basis.
Some great and easy-to-find sources include raw sauerkraut, kimchi, plain yogurt, kefir and kombucha tea.
Colostrum is a nutrient-rich type of milk (a pre-milk) produced by all mammals to feed our newborns. It has been shown to improve overall GI health and help maintain and restore gut health.
Fruits and Vegetables
Fruits and veggies are naturally rich in prebiotics (also important for gut microbiome) and include foods you might already have in the kitchen, such as bananas, sweet potatoes, and other tubers.
By following these guidelines, you can work to restore your gut health after antibiotics as effectively and rapidly as possible.
Dr. McNatty is an assistant professor of pharmacy practice at Midwestern University College of Pharmacy, Glendale, Arizona.
Nausea is one of the most common medication side effects that patients report, as virtually all agents have the ability to cause stomach disturbances. Nausea can range from a slight annoyance to a debilitating condition causing disruption to a patient’s daily life.
Medication-related nausea can have a profound impact on patient outcomes because nonadherence to prescribed therapy can lead to treatment failure. A loss of appetite may occur, which can lead to poor nutrition. Nausea also can have psychological effects on patients, and they may become apprehensive about taking medications in the future. Patient education by pharmacists and other health care professionals can reduce substantially the likelihood of nausea as a side effect and help patients achieve optimum benefit from medication therapy.
Chemotherapy-induced nausea is the most studied type of medication-related nausea. Nausea and vomiting due to chemotherapy is a very common and debilitating event for patients undergoing this treatment, and guidelines written specifically for this side effect have been developed.1,2
Nausea and vomiting can cause dehydration, malnourishment, increased anxiety, and stress in a patient population already at high risk for medication-related complications. Nausea and vomiting are categorized as acute, delayed, anticipatory, breakthrough, and refractory; in the ambulatory care setting, delayed and anticipatory nausea are seen frequently.
When a patient who is not receiving chemotherapy presents with nausea, it is often difficult to determine the cause. In addition to medications, other causes (eg, migraine, emotional response, pregnancy, and gastrointestinal disorders) must be considered.
Nausea caused by medications is typically acute rather than chronic and usually is seen shortly after starting a medication.3 Medications can cause nausea via several mechanisms. Dopaminergic agonists, nicotine, digoxin, and opiates have been shown to act on the area postrema. Some agents (eg, nonsteroidal anti-inflammatory drugs and erythromycin) activate peripheral afferent pathways, stimulating the brainstem nuclei.3 Nausea also can be induced through stimulation and activation of the chemoreceptor trigger zone (CTZ). Stimuli cause the CTZ to recognize a substance as foreign and activate the vomiting center.
The most common substances to cause stimulation are chemotherapy drugs, opiates, and ipecac syrup. Many other drugs (eg, antibiotics, NSAIDs, selective serotonin reuptake inhibitors , and digoxin) also can cause the activation of the CTZ.4 The mechanism associated with a number of medication classes known to cause nausea remains unclear. Some of these include anti-arrhythmics, antihypertensives, diuretics, oral hypoglycemics, and oral contraceptives.3
Preventing nausea caused by medication often can be achieved with a few simple reminders. Unless an agent is meant to be taken on an empty stomach, patients can be advised to take their medications with food. This is an easy way to prevent nausea, especially with notorious offenders, such as antibiotics, NSAIDS, and multivitamins. The time of day a medication is taken may be an important consideration when preventing nausea caused by dizziness. Taking medications such as SSRIs at bedtime prevents the vomiting center from being activated by dizziness because the body is asleep.4
o n l i n e
A complete discussion of treatment guidelines for chemotherapy-related nausea can be accessed at www.nccn.org/patients/patient_gls.asp.
If these simple interventions are not effective, the next step is to identify any alternative agents that can be used to provide equal efficacy with less nausea for the patient. If the nausea is being caused by any of the excipients, a simple formulation switch may help. The patient can try either the same product from a different manufacturer or change formulations—from a tablet to a liquid, for example. If this is not possible or does not work, changing to an alternative agent with the same mechanism of action may alleviate the nausea. Finally, if this option is not possible or proves to be ineffective, changing to a medication with an entirely different mechanism of action may be warranted. These nonpharmacologic interventions are summarized in the Figure.
When nonpharmacologic recommendations do not work, patients can turn to pharmacologic agents to prevent and/or treat nausea caused by medication use. Dopamine antagonists, such as promethazine and prochlorperazine, are especially effective for opioid-induced nausea, but can be beneficial for nausea caused by other medications as well. They are a good choice for short-term offenders, such as antibiotics and NSAIDS. Long-term use may be limited by extrapyrimidal side effects. The use of serotonin receptor antagonists (eg, ondansetron and granisetron) may be beneficial for long-term prevention of nausea. The use of this class of agents is often limited by cost to the patient.
Many patients consider nausea to be a sign of an allergic reaction. This can have profound effects on future therapy. If an allergy is documented in a patient’s profile, it could lead to the choice of a less-than-optimal agent for future treatment.
Pharmacists can play a key role in making sure every patient understands the difference between an allergic reaction and an adverse reaction. An ideal time to do this is during the initial contact with the patient while getting a medication history. Verifying allergies and the specific reaction caused by the offending agents is the first step in identifying misinterpreted reactions. In addition, health care professionals should be vigilant about documenting new allergies/intolerances and counseling patients appropriately about these issues.
Nausea is a common medication-related side effect with many potential causes. Nausea can have a significant impact on a patient’s physical and psychological health. Proper counseling on prevention and treatment of nausea due to medication use can help patients better understand how to take their medications for optimum benefit with minimal side effects.
- Jordan K, Sippel C, Schmoll HJ. Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations. Oncologist. 2007;12:1143-1150.
- American Cancer Society and National Comprehensive Cancer Network. Nausea and Vomiting: Treatment Guidelines for Patients with Cancer (Version IV 2007). www.nccn.org/patients/patient_gls.asp.
- Quigley EM, Hasler WL, Parkman HP. AGA technical review on nausea and vomiting. Gastroenterology. 2001;120:263-286.
- Garrett K, Tsuruta K, Walker S, Jackson S, Sweat M. Managing nausea and vomiting. Current strategies. Crit Care Nurse. 2003;23(1):31-50.
What to do when your medication causes nausea
Taking your pills with a light snack or at bedtime may help reduce the nausea.
Updated: July 31, 2019Published: May, 2017
You take medication hoping it will make you feel better. But sometimes it makes you feel worse. “Nausea is one of the most common side effects of medications we hear about,” says Joanne Doyle Petrongolo, a pharmacist at Harvard-affiliated Massachusetts General Hospital.
Nausea is a queasy feeling in your stomach — you may feel seasick, or you may feel you’re about to vomit. Medications that commonly cause nausea as a side effect include antibiotics, such as erythromycin (Erythrocin); aspirin; nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve); and some blood pressure drugs, such as the calcium-channel blocker nifedipine (Nifedical, Procardia).
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Side Effects of Antibiotics: What They Are and How to Manage Them
Serious side effects from antibiotics aren’t common, but they can occur. Some of the main serious side effects include:
Allergic reactions are possible with any medication, including antibiotics. Some allergic reactions can be mild, but others can be serious and need medical attention.
If you’re allergic to a certain antibiotic, you’ll have symptoms right after taking the drug. These symptoms can include trouble breathing, hives, and swelling of your tongue and throat.
When to call your doctor
If you have hives, stop taking the drug and call your doctor. If you have swelling or trouble breathing, stop taking the drug and call 911 right away.
Stevens-Johnson syndrome (SJS) is a rare, but serious, disorder of the skin and mucous membranes. Mucous membranes are the moist linings of certain parts of your body, such as your nose, mouth, throat, and lungs.
SJS is a reaction that can happen with any medication, including antibiotics. It occurs more often with antibiotics such as beta-lactams and sulfamethoxazole.
Typically, SJS begins with flu-like symptoms, such as a fever or sore throat. These symptoms may be followed by blisters and a painful rash that spreads. Following that, the top layer of your skin can shed. Other symptoms can include:
- skin pain
- swelling of your face or tongue
- pain in your mouth and throat
What to do
You can’t prevent this condition, but you can try to reduce your risk.
You’re at increased risk for SJS if you have a weakened immune system, have had SJS in the past, or have a family history of SJS.
If you believe any of these conditions apply to you, talk to your doctor before taking an antibiotic.
When to call your doctor
Call 911 or go to the nearest emergency room right away if you have symptoms of SJS and think you have the condition.
Some antibiotics can cause changes to your blood.
For example, leukopenia is a decrease in the number of white blood cells. It can lead to increased infections.
Another change is thrombocytopenia, which is a low level of platelets. This can cause bleeding, bruising, and slowed blood clotting.
Beta-lactam antibiotics and sulfamethoxazole cause these side effects more often.
What to do
You can’t prevent these reactions. However, you’re at higher risk if you have a weakened immune system. If your immune system is weak, discuss it with your doctor before you take an antibiotic.
When to call your doctor
Call your doctor if you have a new infection or one that appears abruptly after taking an antibiotic.
Call 911 or go to the nearest emergency room right away if you:
- have serious bleeding that doesn’t stop
- have bleeding from your rectum
- cough up a substance like coffee grounds
In rare cases, certain antibiotics can cause heart problems such as an irregular heartbeat or low blood pressure.
The antibiotics most often linked with these side effects are erythromycin and some fluoroquinolones such as ciprofloxacin. The antifungal terbinafine can also cause this problem.
What to do
If you have an existing heart condition, tell your doctor before you start taking any kind of antibiotic. This information will help your doctor choose the right antibiotic for you.
When to call your doctor
Call your doctor if you have new or worsening heart pain, an irregular heart rhythm, or trouble breathing. If your symptoms are severe, call 911 or go to the nearest emergency room.
Tendonitis is inflammation or irritation of a tendon. Tendons are thick cords that attach bone to muscle, and they can be found throughout your body.
Antibiotics such as ciprofloxacin have been reported to cause tendonitis or tendon rupture. This is when the tendon tears or rips.
All people are at risk for tendon problems when taking certain antibiotics. However, certain people are at increased risk of tendon rupture. These include people who:
- have existing kidney failure
- have had a kidney, heart, or lung transplant
- have had past tendon problems
- are taking steroids
- are older than 60 years
What to do
Talk to your doctor before starting a new antibiotic if you meet any of the increased risk factors. This information will help your doctor choose the correct antibiotic for you.
When to call your doctor
If you have new or worsening tendon pain after taking your antibiotic, call your doctor. If the pain is severe, go to the nearest emergency room.
It’s rare for antibiotics to cause seizures, but it can happen. Seizures are more common with ciprofloxacin, imipenem, and cephalosporin antibiotics such as cefixime and cephalexin.
What to do
If you have epilepsy or a history of seizures, be sure to tell your doctor before you start taking any kind of antibiotic. That way, your doctor can choose an antibiotic that won’t make your condition worse or interact with your seizure medications.
When to call your doctor
Call your doctor if you have new seizures or your seizures get worse when you take an antibiotic.
|Type of medicine||Penicillin antibiotic|
|Used for||Infections (in adults and children)|
|Available as||Tablets, oral liquid medicine and injection|
Co-amoxiclav is given to treat bacterial infections. It is prescribed for sinus infections, urine infections, skin infections, joint infections and some dental infections. It is also given before some surgical operations, to prevent an infection from developing.
Co-amoxiclav contains two ingredients, amoxicillin and clavulanic acid. The first ingredient, amoxicillin, is a penicillin antibiotic which treats infection by killing the bacteria responsible for the infection. Some bacteria are able to produce a chemical which makes amoxicillin less effective. The second ingredient, clavulanic acid, stops this from happening. Clavulanic acid stops the chemical produced by the bacteria from working, and this allows the amoxicillin to kill the bacteria.
Before taking co-amoxiclav
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking co-amoxiclav it is important that your doctor knows:
- If you suspect you may have glandular fever.
- If you have an allergic condition, or if you have ever had an allergic reaction to a medicine. This is especially important if you have ever had a bad reaction to any penicillin antibiotic.
- If you are pregnant or breastfeeding. Co-amoxiclav is not known to be harmful to babies; however, it is still important that you tell your doctor if you are expecting or breastfeeding a baby.
- If you have any problems with the way your liver works, or problems with the way your kidneys work.
- If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
How to take co-amoxiclav
- Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about co-amoxiclav and will provide you with a full list of the side-effects which you may experience from taking it.
- Take co-amoxiclav exactly as your doctor tells you to. It is usually taken three times daily, every eight hours. It is important that you space out the doses evenly during the day. Your doctor or pharmacist will tell you how many tablets (or how much liquid medicine) to take for each dose, and this information will be printed on the label of the pack to remind you. If you have been given liquid medicine for a child, read the directions carefully to make sure you measure out the correct amount of medicine.
- Try to drink plenty of water while you are taking co-amoxiclav, to help keep your kidneys working well. You can take your doses before or after food.
- If you forget to take a dose, take one as soon as you remember. Try to take the correct number of doses each day, but do not take two doses at the same time to make up for a forgotten dose.
Getting the most from your treatment
- If you (or your child) have been prescribed the oral liquid medicine, you may find that it causes some staining of the teeth. This will disappear soon after the course of antibiotics is finished.
- Even if you feel your infection has cleared up, keep taking the antibiotic until the course is finished, unless you are told to stop. This is to prevent the infection from coming back. Your doctor will tell you how long your course of treatment will last – this is not usually for longer than 14 days. If you still feel unwell after finishing the course, go back to see your doctor.
- Some people develop redness and itching in the mouth or vagina (thrush) after taking a course of antibiotics. If this happens to you, speak with your doctor or pharmacist for advice.
- If you are taking the contraceptive ‘pill’ at the same time as this antibiotic, the effectiveness of the ‘pill’ can be reduced if you have a bout of being sick (vomiting) or diarrhoea which lasts for more than 24 hours. If this should happen, ask your doctor or pharmacist for advice about what additional contraceptive precautions to use over the next few days. There is no need to use additional precautions for any bouts of sickness or diarrhoea which last for less than 24 hours.
- Co-amoxiclav may stop the oral typhoid vaccine from working. If you are having any vaccinations, make sure the person treating you knows that you are taking this antibiotic.
Can co-amoxiclav cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with co-amoxiclav. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Very common co-amoxiclav side-effects (these affect more than 1 in 10 people)||What can I do if I experience this?|
|Diarrhoea||Drink plenty of water to replace any lost fluids. If the diarrhoea continues, becomes severe, or contains blood, let your doctor know straightaway|
|Common co-amoxiclav side-effects (these affect less than 1 in 10 people)||What can I do if I experience this?|
|Feeling sick (nausea) or being sick (vomiting)||You can reduce this by taking your doses at a mealtime|
|Redness and itching in the mouth or vagina (thrush)||Speak with your doctor for advice about treatment|
Important: if you develop an itchy rash, swollen face or mouth, or have difficulty breathing, these may be signs that you are allergic to a penicillin antibiotic. Do not take any more co-amoxiclav and speak with your doctor or go to your local accident and emergency department straightaway.
If you experience any other symptoms which you think may be due to the antibiotic, speak with your doctor or pharmacist for further advice.
How to store co-amoxiclav
- Keep all medicines out of the reach and sight of children.
- Keep co-amoxiclav liquid medicine in a refrigerator, and do not use it after the expiry date on the bottle. It will have been made up by the pharmacy and it is important you do not store or use it for longer than seven days since the date it was made up.
- Store co-amoxiclav tablets in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
If you buy any medicines, check with a pharmacist that they are safe to take with your other medicines.
If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.