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AMOXICILLIN/CLAVULANIC ACID SANDOZ 1000 mg/200 mg POWDER FOR INJECTION AND INFUSION SOLUTION

AMOXICILLIN/CLAVULANIC ACID SANDOZ 1000 mg/200 mg POWDER FOR INJECTION AND INFUSION SOLUTION

Ask a doctor about a prescription for AMOXICILLIN/CLAVULANIC ACID SANDOZ 1000 mg/200 mg POWDER FOR INJECTION AND INFUSION SOLUTION

This page is for general information. Consult a doctor for personal advice. Call emergency services if symptoms are severe.
About the medicine

How to use AMOXICILLIN/CLAVULANIC ACID SANDOZ 1000 mg/200 mg POWDER FOR INJECTION AND INFUSION SOLUTION

Introduction

Package Leaflet: Information for the User

Amoxicillin/Clavulanic Acid Sandoz 1000 mg/200 mg Powder for Solution for Injection and Infusion EFG

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

  • Keep this leaflet, you may need to read it again.
  • If you have any further questions, ask your doctor, pharmacist, or nurse.
  • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
  • If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the Package Leaflet

  1. What is Amoxicillin/Clavulanic Acid Sandoz and what is it used for
  2. What you need to know before you use Amoxicillin/Clavulanic Acid Sandoz
  3. How to use Amoxicillin/Clavulanic Acid Sandoz
  4. Possible side effects
  5. Storage of Amoxicillin/Clavulanic Acid Sandoz
  6. Contents of the pack and other information

1. What is Amoxicillin/Clavulanic Acid Sandoz and what is it used for

Amoxicillin/clavulanic acid is an antibiotic that eliminates the bacteria that cause infections. It contains two different medicines called amoxicillin and clavulanic acid. Amoxicillin belongs to a group of medicines known as "penicillins" which can sometimes lose their effectiveness (become inactivated). The other component (clavulanic acid) prevents this from happening.

Antibiotics are used to treat bacterial infections and are not effective against viral infections such as the flu or the common cold.

It is important that you follow the instructions regarding dosage, administration, and duration of treatment as indicated by your doctor.

Do not store or reuse this medicine. If you have any leftover antibiotic after completing your treatment, return it to the pharmacy for proper disposal. Do not throw medicines down the drain or in the trash.

Amoxicillin/clavulanic acid is used in adults and children to treat the following infections:

  • acute ear, nose, and throat infections,
  • respiratory tract infections,
  • urinary tract infections,
  • skin and soft tissue infections including dental infections,
  • bone and skin infections,
  • intra-abdominal infections,
  • genital infections in women.

Amoxicillin/clavulanic acid is used in adults to prevent infections associated with major surgical procedures.

2. What you need to know before you use Amoxicillin/Clavulanic Acid Sandoz

Do not use Amoxicillin/Clavulanic Acid Sandoz:

  • if you are allergic to the active substances or to any of the other ingredients of this medicine (listed in section 6),
  • if you have ever had a severe allergic reaction (hypersensitivity) to any other antibiotic. This could include a skin rash or swelling of the face or neck,
  • if you have ever had liver problems or jaundice (yellowing of the skin) when taking an antibiotic.

Do not receive Amoxicillin/Clavulanic Acid Sandoz if any of the above applies to you.If you are not sure, consult your doctor, pharmacist, or nurse.

Warnings and Precautions

Consult your doctor, pharmacist, or nurse before starting to use amoxicillin/clavulanic acid if:

  • you have infectious mononucleosis,
  • you are receiving treatment for liver or kidney problems,
  • you do not urinate regularly.

If you are not sure if any of the above symptoms affect you, inform your doctor, pharmacist, or nurse before receiving amoxicillin/clavulanic acid.

In some cases, your doctor may investigate the type of bacteria causing your infection. Depending on the results, you may be prescribed a different formulation of amoxicillin/clavulanic acid or another medicine.

Symptoms to be aware of

Amoxicillin/clavulanic acid can worsen certain existing conditions or cause serious side effects. These include allergic reactions, seizures, and inflammation of the large intestine. You should be aware of certain symptoms while being administered amoxicillin/clavulanic acid to reduce the risk of problems. See "Symptoms to be aware of" in section4.

Blood and urine tests

If you are having blood tests (such as red blood cell status or liver function studies) or urine tests (to check glucose levels), inform your doctor or nurse that you are being administered amoxicillin/clavulanic acid. This is because amoxicillin/clavulanic acid can alter the results of these types of tests.

Using Amoxicillin/Clavulanic Acid Sandoz with other medicines

Tell your doctor or pharmacist if you are using or have recently used or might use any other medicines, including those obtained without a prescription and herbal medicines.

If you are taking allopurinol (used for gout) with amoxicillin/clavulanic acid, you may be more likely to have a skin allergic reaction.

Probenecid (used to treat gout), concomitant use of probenecid may reduce the excretion of amoxicillin and is not recommended.

If you are taking anticoagulants (such as warfarin) with amoxicillin/clavulanic acid, more blood tests will be needed.

Methotrexate (a medicine used to treat cancer and severe psoriasis), penicillins may reduce the excretion of methotrexate and cause a potential increase in side effects.

Amoxicillin/clavulanic acid may affect how mycophenolate mofetil (a medicine used to prevent organ rejection in transplant patients) works.

Pregnancy and Breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor, pharmacist, or nurse before using this medicine.

Amoxicillin/Clavulanic Acid Sandoz contains sodium and potassium

This medicine contains 59.3 mg of sodium per vial, equivalent to 2.9% of the maximum daily intake of 2 g of sodium recommended by the WHO for an adult.

This medicine contains less than 39 mg (1 mmol) of potassium per vial, and is therefore considered "essentially potassium-free".

3. How to use Amoxicillin/Clavulanic Acid Sandoz

You will never administer this medicine to yourself. A qualified person, such as a doctor or nurse, will administer it to you.

The usual doses are:

Adults and children weighing 40 kg or more

Standard dose

1000 mg/200 mg every 8 hours.

To prevent infections during and after surgery.

1000 mg/200 mg before surgery when you are given your anesthetic.

The dose may vary depending on the type of surgery you are having. Your doctor may repeat the dose if the surgery lasts more than one hour.

Children weighing less than 40 kg

  • All doses are calculated based on the child's body weight in kilograms.

Children 3 months or older:

25 mg/5 mg per kilogram of body weight every 8 hours.

Children under 3 months and weighing less than 4 kg

25 mg/5 mg per kilogram of body weight every 12 hours.

Patients with kidney and liver problems

How Amoxicillin/Clavulanic Acid Sandoz will be administered to you

  • amoxicillin/clavulanic acid will be administered to you as an injection into a vein or by intravenous infusion,
  • make sure you drink plenty of liquid while receiving amoxicillin/clavulanic acid,
  • amoxicillin/clavulanic acid will not be administered to you for more than two weeks without your doctor reviewing your treatment.

If you use more Amoxicillin/Clavulanic Acid Sandoz than you should

It is very unlikely that you will be given too much amoxicillin/clavulanic acid, but if you think you have been given too much, tell your doctor, pharmacist, or nurse immediately. The symptoms may be stomach upset (nausea, vomiting, or diarrhea) or seizures.

If you have any further questions on how this product is administered, ask your doctor, pharmacist, or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

The following side effects may occur with this medicine.

Symptoms to be aware of

Allergic reactions:

  • skin rash,
  • inflammation of blood vessels (vasculitis) which can appear as red or purple spots on the skin, but can affect other parts of the body,
  • fever, joint pain, swollen glands in the neck, armpits, or groin,
  • swelling sometimes of the face or mouth (angioedema), which can cause difficulty breathing,
  • collapse,
  • chest pain in the context of allergic reactions, which can be a symptom of allergy-induced heart attack (Kounis syndrome).
  • Drug-induced enterocolitis syndrome (DIES): DIES has been reported mainly in children receiving amoxicillin. It is a certain type of allergic reaction with the main symptom of repeated vomiting (1-4 hours after administering the medicine). Other symptoms may include abdominal pain, lethargy, diarrhea, and low blood pressure.

Contact your doctor immediatelyif you experience any of these symptoms. Stop using Amoxicillin/Clavulanic Acid Sandoz.

Inflammation of the large intestine

Inflammation of the large intestine, which causes watery diarrhea normally with blood and mucus, stomach pain, and/or fever.

Contact your doctor as soon as possiblefor advice if you have these symptoms.

Common side effects (may affect up to 1 in 10 people)

  • thrush (candida - fungal infection of the vagina, mouth, or mucous membranes),
  • diarrhea.

Uncommon side effects (may affect up to 1 in 100 people)

  • skin rash, itching,
  • increased pruritic rash (urticarial rash),
  • nausea, especially when high doses are administered,
  • vomiting,
  • indigestion,
  • dizziness,
  • headache.

Uncommon side effects that may appear in your blood tests:

  • increase in some substances (enzymes) produced by the liver.

Rare side effects (may affect up to 1 in 1,000 people)

  • skin rash, which can form blisters that look like small targets (central dark spot surrounded by a paler area, with a dark ring around the edge - erythema multiforme),
  • swelling and redness along the vein, which is extremely sensitive to touch.

Rare side effects that may appear in your blood tests:

  • low count of cells involved in blood clotting,
  • low count of white blood cells.

Other side effects

Other side effects that have occurred in a very small number of patients and whose exact frequency is unknown:

  • allergic reactions (see above),
  • severe skin reactions:
  • widespread rash with blisters and peeling of the skin, particularly around the mouth, nose, eyes, and genitals (Stevens-Johnson syndrome), and in its most severe form, causing widespread peeling of the skin (more than 30% of the body surface - toxic epidermal necrolysis),
  • widespread rash with small blisters containing pus (bullous exfoliative dermatitis),
  • red rash with bumps under the skin and blisters (pustular exanthematous rash),
  • flu-like symptoms with skin rash, fever, gland inflammation, and abnormal blood test results (such as elevated white blood cell count and liver enzymes) (drug reaction with eosinophilia and systemic symptoms - DRESS),
  • rash with blisters arranged in a circle with a central crust or like a string of pearls (linear IgA disease).
  • inflammation of the liver (hepatitis),
  • acute inflammation of the pancreas (acute pancreatitis); if you have severe and persistent stomach pain, this could be a sign of acute pancreatitis,
  • jaundice, caused by an increase in bilirubin in the blood (a substance produced by the liver), which can cause the skin and the whites of the eyes to turn yellow,
  • delayed blood clotting,
  • seizures (in patients taking high doses of amoxicillin/clavulanic acid or with kidney problems).

Side effects that may appear in your blood or urine tests:

  • significant decrease in the number of white blood cells,
  • low count of red blood cells (hemolytic anemia),
  • crystals in the urine that cause acute kidney injury.

Reporting of side effects

If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Amoxicillin/Clavulanic Acid Sandoz

The expiration date and storage instructions on the label are for the information of the doctor or nurse. The doctor, pharmacist, or nurse will reconstitute your medicine, which must be used within 15 minutes of reconstitution.

Do not store above 25°C.

Keep this medicine out of the sight and reach of children.

Do not use Amoxicillin/Clavulanic Acid Sandoz after the expiration date stated on the pack. The expiration date is the last day of the month indicated.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Container Content and Additional Information

Composition of Amoxicillin/Clavulanic Acid Sandoz

Each vial contains as active ingredients 1,000 mg of amoxicillin (as amoxicillin sodium) and 200 mg of clavulanic acid (as potassium clavulanate).

It does not contain excipients.

Product Appearance and Container Content

Vials containing a sterile white to off-white powder.

Packaging of 1 vial, 10 vials, or 100 vials of 20 ml.

Marketing Authorization Holder and Manufacturer

Marketing Authorization Holder

Sandoz Pharmaceutical, S.A.

Business Center Parque Norte

Edificio Roble

C/ Serrano Galvache, 56

28033 Madrid

Spain

Manufacturer

Sandoz GmbH

Biochemiestrasse, 10

A-6250 Kundl

Austria

Date of the Last Revision of this Prospectus:July 2020

Detailed and updated information about this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/

--------------------------------------------------------------------------------------------------------------------

This information is intended only for doctors or healthcare professionals:

Please see the Technical Sheet for additional information

Administration

Amoxicillin/Clavulanic Acid Sandoz can be administered by slow intravenous injection over a period of 3 to 4 minutes directly into a vein or by a drip infusion over 30-40 minutes. Amoxicillin/Clavulanic Acid Sandoz is not suitable for intramuscular administration.

Reconstitution

For single use. Any unused solution must be discarded.

Reconstitution/dilution must be performed under aseptic conditions. The solution must be visually inspected before administration to detect any foreign particles and discoloration. The solution should only be used if it is clear and free of particles. Reconstitution of the solution for intravenous injection or reconstitution and dilution of the solution for infusion must be performed at the time of administration.

Preparation of Solutions for Intravenous Injection

The usual solvent is water for injectable preparations. Amoxicillin/Clavulanic Acid Sandoz 1,000 mg/200 mg must be dissolved in 20 ml of solvent. This results in approximately 20.9 ml of solution for single-dose use. A pale pink coloration may be observed during reconstitution. Reconstituted solutions are normally colorless or pale straw-colored.

Amoxicillin/Clavulanic Acid Sandoz must be administered within 15 minutes after reconstitution.

Preparation of Solutions for Intravenous Infusion

Amoxicillin/Clavulanic Acid Sandoz must be reconstituted as described above for injection.

Immediately, the reconstituted solution must be added to 100 ml of infusion fluid using a minibag or in-line burette.

Glucose (dextrose) injectable solutions, sodium bicarbonate, or dextran must not be used as solvents.

In general, it is recommended not to mix it with any other product in the same syringe or infusion bottle. The combination of amoxicillin and clavulanic acid is incompatible with: blood and plasma, hydrocortisone succinate, amino acid solutions, protein hydrolysates, lipid emulsions, phenylephrine HCl, mannitol solutions.

Amoxicillin/Clavulanic Acid Sandoz must not be mixed in the same syringe with aminoglycoside antibiotics, as this may result in a loss of aminoglycoside activity under these conditions.

The vials of Amoxicillin/Clavulanic Acid Sandoz are not suitable for multiple-dose use.

Stability of Prepared Solutions

Reconstituted Vials (for Intravenous Injection or before Dilution for Infusion)

The solution obtained after reconstitution of the vial (1 vial with 20 ml of water for injectables Ph. Eur.) has been shown to be stable from a chemical and physical point of view for 15 minutes at 25 °C ± 2°C/ 60% ±5% HR.

Reconstituted and Diluted Vials for Infusion

The solution obtained by diluting immediatelythe reconstituted vial with 100 ml of water for injectables Ph. Eur. or NaCl 0.9% or sodium lactate 1/6M or Ringer's solution or Hartmann's solution has been shown to be stable from a chemical and physical point of view for 60 minutes at 25°C ± 2°C/ 60% ±5% HR.

Any unused antibiotic solution must be discarded.

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