Consumer medicine information

Amiloxyn

Amoxicillin

BRAND INFORMATION

Brand name

Amiloxyn

Active ingredient

Amoxicillin

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Amiloxyn.

SUMMARY CMI

AMILOXYN

Consumer Medicine Information (CMI) summary

The full CMI on the next page has more details. If you are worried about using this medicine, speak to your doctor or pharmacist.

1. Why am I taking AMILOXYN?

AMILOXYN contains a penicillin called amoxicillin (as trihydrate) as the active ingredient.

AMILOXYN belongs to the penicillin group of antibiotics.

AMILOXYN is used to treat a range of infections caused by bacteria. These may be infections of the chest (pneumonia), tonsils (tonsillitis), sinuses (sinusitis), urinary and genital tract, skin and fleshy tissue.

For more information, see Section 1. Why am I taking AMILOXYN? in the full CMI.

2. What should I know before I take AMILOXYN?

Do not take if you are allergic to penicillin or similar types of antibiotics (such as cephalosporins), or any of the ingredients listed at the end of the CMI. If you have ever had an allergic reaction (such as a rash) when taking an antibiotic you should tell your doctor before you take AMILOXYN.

Talk to your doctor if you have any other medical conditions, take any other medicines, or are pregnant or plan to become pregnant or are breastfeeding.

For more information, see Section 2. What should I know before I take AMILOXYN? in the full CMI.

3. What if I am taking other medicines?

Some medicines may interfere with AMILOXYN and affect how it works.

A list of these medicines is in Section 3. What if I am taking other medicines? in the full CMI.

4. How do I take AMILOXYN?

  • Follow the directions given to you by your doctor and pharmacist. Their directions may differ from the information contained in this leaflet.

More instructions can be found in Section 4. How do I take AMILOXYN? in the full CMI.

5. What should I know while taking AMILOXYN?

Things you should do
  • Take AMILOXYN exactly as your doctor has prescribed.
  • Tell your doctor if, for any reason, you have not taken your medicine exactly as directed.
  • Remind any doctor, dentist or pharmacist you visit that you are taking AMILOXYN.
  • Tell your doctor if the symptoms of your infection become worse, or do not improve within a few days of starting AMILOXYN.
Things you should not do
  • Do not give AMILOXYN to anyone else, even if their symptoms seem similar to yours.
  • Do not take AMILOXYN to treat any other complaints unless your doctor says to.
Driving or using machines
  • Be careful before you drive or use any machines or tools until you know how AMILOXYN affects you.
Looking after your medicine
  • Keep your capsules in the original pack until it is time to take them.
  • Store it in a cool dry place, away from moisture where the temperature stays below 25°C.

For more information, see Section 5. What should I know while taking AMILOXYN? in the full CMI.

6. Are there any side effects?

Less serious side effects are diarrhoea, indigestion, feeling sick (nausea), vomiting. White furry, sore tongue and mouth (oral thrush). Soreness or itching of the vagina or vaginal discharge (vaginal thrush). Headache, dizziness, tiredness. Teeth discolouration. Unusually active (hyperactivity).

For more information, including what to do if you have any side effects, see Section 6. Are there any side effects? in the full CMI.



FULL CMI

AMILOXYN

Active ingredient: amoxicillin (as trihydrate)


Consumer Medicine Information (CMI)

This leaflet provides important information about taking AMILOXYN. You should also speak to your doctor or pharmacist if you would like further information or if you have any concerns or questions about taking AMILOXYN.

Where to find information in this leaflet:

1. Why am I taking AMILOXYN?
2. What should I know before I take AMILOXYN?
3. What if I am taking other medicines?
4. How do I take AMILOXYN?
5. What should I know while taking AMILOXYN?
6. Are there any side effects?
7. Product details

1. Why am I taking AMILOXYN?

AMILOXYN contains the active ingredient amoxicillin (as trihydrate).

AMILOXYN belongs to the penicillin group of antibiotics.

AMILOXYN is used to treat a range of infections caused by bacteria. These infections may affect the chest (e.g. pneumonia), tonsils (e.g. tonsilitis), sinuses (e.g. sinusitis), urinary and genital tract, skin and fleshy tissues.

AMILOXYN works by killing the bacteria that causes infections. AMILOXYN can also be used to prevent infection.

Your doctor may prescribe AMILOXYN for another use. If you want more information, ask your doctor.

There is no evidence that AMILOXYN is addictive.

2. What should I know before I take AMILOXYN?

Warnings

Do not take AMILOXYN if:

  • you are allergic to amoxicillin (as trihydrate), penicillin or similar types of antibiotics (such as cephalosporins), or any of the ingredients listed at the end of this leaflet.
    Some of the symptoms of an allergic reaction may include skin rash, itching, difficulty in breathing and swelling of the face or tongue.
  • the expiry date (EXP) printed on the pack has passed.
  • the packaging is torn or shows signs of tampering.

Always check the ingredients to make sure you can take AMILOXYN.

Do not give AMILOXYN to anyone else, your doctor has prescribed it specifically for you and your condition.

Check with your doctor if you:

  • have ever had an allergic reaction (such as a rash) to antibiotics or other substances in the past.
  • are allergic to foods, dyes, preservatives or any other medicines.
  • have glandular fever (mononucleosis) or lymphatic leukaemia.
  • have any kidney or liver problems.
    The dosage of AMILOXYN may need to be changed or you may need to be given an alternative medicine.
  • have to test your urine for sugar.
    AMILOXYN may affect the results of these tests.

During treatment, you may be at risk of developing certain side effects. It is important you understand these risks and how to monitor them. See additional information under Section 6. Are there any side effects?

Pregnancy and breastfeeding

Check with your doctor if you are pregnant or intend to become pregnant.

Talk to your doctor if you are breastfeeding or intend to breastfeed.

Your doctor will discuss with you the possible risks and benefits of taking AMILOXYN during pregnancy or while you are breastfeeding. AMILOXYN passes to your baby from breast milk.

3. What if I am taking other medicines?

Tell your doctor or pharmacist if you are taking any other medicines, including any medicines, vitamins or supplements that you buy without a prescription from your pharmacy, supermarket or health food shop.

In particular, tell your doctor or pharmacist if you are taking any of the following:

  • acenocoumarol, warfarin or other medicines used to prevent blood clots.
  • medicines used to treat gout (e.g. probenecid or allopurinol).
  • other antibiotics (e.g. tetracyclines). These may interfere with the actions of AMILOXYN.
  • methotrexate (a medicine used to treat cancer or rheumatic diseases).
  • contraceptive pill. As with other antibiotics, you may need to use extra birth control methods (e.g. condoms) while taking AMILOXYN.

Some medicines may interfere with AMILOXYN and affect how it works. Check with your doctor or pharmacist if you are not sure about what medicines, vitamins or supplements you are taking and if these affect AMILOXYN.

4. How do I take AMILOXYN?

Follow the directions given to you by your doctor and pharmacist. Their directions may differ from the information contained in this leaflet.

Please read the direction label carefully. If you have any concerns about how to take AMILOXYN, talk to your doctor or pharmacist.

How much to take

Your doctor will tell you the dose of AMILOXYN you will need to take each day. This depends on the condition being treated and whether other medicines are being taken.

When to take it

Space the doses as evenly as possible throughout the day. For example, if you are taking AMILOXYN three times a day, take a dose about every eight hours.

How to take it

AMILOXYN can be taken with or without food. The effects of AMILOYXN are not changed by food.

Swallow AMILOXYN capsule whole with a full glass of water.

How long to take it for

Keep taking AMILOXYN until the course is finished or for as long as your doctor tells you.

Do not stop taking AMILOXYN just because you feel better as the infection can return.

Do not stop taking AMILOXYN, or change the dose, without first checking with your doctor.

If you forget to take AMILOXYN

If it is almost time for your next dose, skip the dose you missed and take your next dose at the normal time. Otherwise, take the missed dose as soon as you remember and then go back to taking AMILOXYN as directed by your doctor.

Do not take a double dose to make up for the dose you missed. Taking more than the prescribed dose can increase the chance of unwanted side-effects.

If you take too much AMILOXYN

If you think that you have taken too much AMILOXYN, you may need urgent medical attention.

You should immediately:

  • drink plenty of water
  • phone the Poisons Information Centre
    (by calling 13 11 26), or
  • contact your doctor, or
  • go to the Emergency Department at your nearest hospital.

Symptoms of overdose include mild to severe nausea, vomiting, cramps and diarrhoea.

You should do this even if there are no signs of discomfort or poisoning.

5. What should I know while taking AMILOXYN?

Things you should do

  • Take AMILOXYN exactly as your doctor has prescribed.
  • Tell your doctor if, for any reason, you have not taken AMILOXYN exactly as directed. Otherwise your doctor may think that it was not working as it should and change your treatment unnecessarily.
  • Tell your doctor if the symptoms of your infection become worse, or do not improve within a few days of starting AMILOXYN.
  • Tell your doctor if you develop itching, swelling or a skin rash when taking AMILOXYN, do not take any more AMILOYXN and tell your doctor immediately.
  • Tell your doctor if you develop severe diarrhoea either when taking AMILOXYN or within several weeks after treatment, tell your doctor immediately. Diarrhoea may mean you have a serious condition affecting your bowel. You may need urgent medical care. Do not take any medication to stop the diarrhoea (e.g. Lomotil® or Imodium®).
  • Tell your doctor if you get a sore white mouth or tongue while taking or soon after stopping AMILOXYN.
  • Tell your doctor if you have vaginal itching or discharge. This may mean you have a fungal infection called vaginal thrush. Sometimes taking AMILOXYN allows fungi to grow and the above symptoms occur.
  • If you have to test your urine for sugar while you are taking AMILOXYN, ensure your doctor knows which type of test you use. AMILOXYN may affect the results of some of these tests.
  • Remind any doctor, dentist or pharmacist you visit that you are taking AMILOXYN before starting any other medicines. Some medicines may affect the way other medicines work.

Things you should not do

  • Do not stop taking AMILOXYN because you are feeling better, unless advised by your doctor. If you do not complete the full course prescribed by your doctor, all of the bacteria causing your infection may not be killed. These bacteria may continue to grow and multiply so that your infection may not clear completely or it may return.
  • Do not give AMILOXYN to anyone else, even if their symptoms seem similar to yours.
  • Do not take AMILOXYN to treat any other complaints unless your doctor says to.

Driving or using machines

Be careful before you drive or use any machines or tools until you know how AMILOXYN affects you.

Generally, this medicine does not cause any problems with your ability to drive a car or operate machinery. However, as with many other medicines, AMILOXYN may cause dizziness or tiredness in some people.

Looking after your medicine

Keep your capsules in the original pack until it is time to take them. If you take the capsules out of its original pack it may not keep well.

Store in a cool dry place, away from moisture where the temperature stays below 25°C. Do not store it:

  • in the bathroom or near a sink, or
  • in the car or on window sills.

Keep it where young children cannot reach it.

Getting rid of any unwanted medicine

If you no longer need to take AMILOXYN or it is out of date, take it to any pharmacy for safe disposal.

Do not take AMILOXYN after the expiry date.

6. Are there any side effects?

All medicines can have side effects. If you do experience any side effects, most of them are minor and temporary. However, some side effects may need medical attention.

See the information below and, if you need to, ask your doctor or pharmacist if you have any further questions about side effects.

Less serious side effects

Less serious side effectsWhat to do
  • Diarrhoea, indigestion.
  • Feeling sick (nausea), vomiting.
  • White, furry, sore tongue and mouth (oral thrush).
  • Soreness or itching of the vagina or vaginal discharge (vaginal thrush).
  • Headache, dizziness, tiredness.
  • Teeth discolouration.
  • Unusually active (hyperactivity).
Speak to your doctor if you have any of these less serious side effects and they worry you.

Serious side effects

Serious side effectsWhat to do
  • Itching, rash.
  • Dark urine or pale stools.
  • Difficulty or pain in passing urine, decreased amount of urine.
  • Yellowing of the skin or eyes (jaundice).
  • Severe stomach cramps.
  • Severe watery or bloody diarrhoea, which may also be bloody.
  • Unusual bleeding or bruising.
  • A red rash commonly seen on both sides of buttocks, upper inner thighs, armpits, neck.
Tell your doctor immediately if you notice any of these symptoms during or after taking AMILOXYN.
Allergic Reactions:
  • Wheezing, hives, severe skin reaction, fainting, swelling of limbs, face, lips, mouth or throat, difficulty swallowing or breathing, joint discomfort or swelling, swollen lymph glands, nausea and vomiting or fever.
Stop taking AMILOXYN and call your doctor immediately, or go straight to the Emergency Department at your nearest hospital if you notice any of these serious side effects.

Remember, you should tell your doctor or pharmacist as soon as possible if any of these, or any other unusual events or problems occur during or after treatment with AMILOXYN.

This is not a complete list of all possible side-effects. Others may occur in some people and there may be some side-effects not yet known.

Tell your doctor or pharmacist if you notice any side-effects from your medicine which are not mentioned here.

Do not be alarmed by this list of possible side-effects. You may not experience any of them.

Reporting side effects

After you have received medical advice for any side effects you experience, you can report side effects to the Therapeutic Goods Administration online at www.tga.gov.au/reporting-problems. By reporting side effects, you can help provide more information on the safety of this medicine.

Always make sure you speak to your doctor or pharmacist before you decide to stop taking any of your medicines.

7. Product details

AMILOXYN is only available with a doctor's prescription.

What AMILOXYN contains

Active ingredient
(main ingredient)
  • 250 mg or 500 mg amoxicillin (as trihydrate)
Other ingredients
(inactive ingredients)
  • Magnesium stearate
  • Microcrystalline cellulose
The capsule shells contain gelatin, carmoisine, iron oxide yellow, patent blue V, titanium dioxide, sodium lauryl sulfate, purified water.
Potential allergensMay contain sulfites.

Do not take AMILOXYN if you are allergic to any of these ingredients.

What AMILOXYN looks like

AMILOXYN 250 mg Capsule

Maroon/yellow size ‘1’ hard gelatin capsule filled with white to off white granular powder and imprinted with ‘A’ on maroon cap and ‘85’ on yellow body with black ink.

(AUST R 185793). Available in pack size of 20 capsules.

AMILOXYN 500 mg Capsule

Maroon/yellow size ‘0EL’ hard gelatin capsule filled with white to off white granular powder and imprinted with ‘A’ on maroon cap and ‘86’ on yellow body with black ink.

(AUST R 185798). Available in pack size of 20 capsules.

Who distributes AMILOXYN

Arrotex Pharmaceuticals Pty Ltd
15-17 Chapel St,
Cremorne VIC 3121
www.arrotex.com.au

This leaflet was prepared in September 2024.

Published by MIMS November 2024

BRAND INFORMATION

Brand name

Amiloxyn

Active ingredient

Amoxicillin

Schedule

S4

 

1 Name of Medicine

Amoxicillin trihydrate.

2 Qualitative and Quantitative Composition

Amiloxyn is available as capsules containing 250 mg and 500 mg amoxicillin as trihydrate.
Amoxicillin is a white or almost white, crystalline powder.

Excipients with known effect.

May contain traces of sulfites.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Amiloxyn 250 mg.

Maroon/yellow size '1' hard gelatin capsule filled with white to off-white granular powder and imprinted with 'A' on maroon cap and '85' on yellow body with black ink.

Amiloxyn 500 mg.

Maroon/yellow size '0EL' hard gelatin capsule filled with white to off-white granular powder and imprinted with 'A' on maroon cap and '86' on yellow body with black ink.

4 Clinical Particulars

4.1 Therapeutic Indications

It is indicated for the treatment of the following infections due to susceptible strains of sensitive organisms:

Note.

Therapy should be guided by bacteriological studies, including sensitivity tests, and by clinical response. However, in emergency cases where the causative organism has not been identified, therapy with amoxicillin may be useful. Clinical judgement will decide whether combination with another antibiotic would provide a sufficiently broad spectrum of activity pending sensitivity test results.

Skin and skin structure.

Staphylococcus, nonpenicillinase producing; Streptococcus; E. coli (see Section 5.1 Pharmacodynamic Properties, Microbiology).

Respiratory (acute and chronic).

H. influenzae, Streptococcus; S. pneumoniae; staphylococcus, non-penicillinase-producing; E. coli (see Section 5.1 Pharmacodynamic Properties, Microbiology).

Genitourinary tract (complicated and uncomplicated, acute and chronic).

E. coli (see Section 5.1 Pharmacodynamic Properties, Microbiology), P. mirabilis and S. faecalis.

Gonorrhoea.

N. gonorrhoeae (non-penicillinase producing).

Prophylaxis of endocarditis.

Amiloxyn may be used for the prophylaxis of bacterial endocarditis in individuals at particular risk, such as those with a prosthetic heart valve or those who have previously had endocarditis.

4.2 Dose and Method of Administration

Normal renal function.

Upper respiratory tract infections; genito-urinary tract infections; skin and soft tissue infections.

Adults.

250 mg every eight hours.

Children (under 20 kg).

20 mg/kg/day in equally divided doses every eight hours.
In severe infections or those caused by less susceptible organisms, 500 mg every eight hours for adults and 40 mg/kg/day in equally divided doses every eight hours for children may be needed.
Lower respiratory tract infections.

Adults.

500 mg every eight hours.

Children (under 20 kg).

40 mg/kg/day in equally divided doses every eight hours.
Urethritis, gonococcal.

Adults.

3 g as single dose. Cases of gonorrhoea with a suspected lesion of syphilis should have darkfield examinations before receiving amoxicillin and monthly serological tests for a minimum of four months.
Acute, uncomplicated lower urinary tract infections in non-pregnant adult female.

Adults.

3 g as single dose.

Note.

Experience in neonates is too limited to make any recommendations regarding dosage or the appropriateness of the oral route.
The children's dosage is intended for individuals whose weight will not cause dosage to be calculated greater than that recommended for adults. Children weighing more than 20 kg should be dosed according to the adult recommendations.
As the manufacturer does not market dose strengths and forms for paediatric dosing requirements, an alternative brand name should be sought.

Renal impairment.

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.
In patients receiving peritoneal dialysis, the maximum recommended dose is 500 mg/day. Amoxicillin may be removed from the circulation by haemodialysis.
It should be recognised that in the treatment of chronic urinary tract infections, frequent bacteriological and clinical appraisals are necessary. Smaller doses than those recommended above should not be used. In stubborn infections, therapy may be required for several weeks. It may be necessary to continue clinical and/or bacteriological follow-up for several months after cessation of therapy.
Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. It is recommended that there be at least ten days treatment for any infection caused by haemolytic streptococci to prevent the occurrence of acute rheumatic fever or glomerulonephritis.

Prophylaxis of endocarditis.

(See Table 1.)

4.3 Contraindications

Amoxicillin is a penicillin and should not be given to patients with a history of hypersensitivity to beta-lactam antibiotics (e.g. penicillins, cephalosporins).

4.4 Special Warnings and Precautions for Use

Serious, and occasionally fatal, hypersensitivity reactions (including anaphylaxis, anaphylactoid and severe cutaneous reaction) have been reported in patients receiving beta-lactam antibiotics. Hypersensitivity reactions can also progress to Kounis syndrome, a serious allergic reaction that can result in myocardial infarction (see Section 4.8 Adverse Effects (Undesirable Effects)). These reactions are more likely to occur in individuals with a history of penicillin hypersensitivity and in atopic individuals. Before commencing therapy with any penicillin careful enquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins or other allergens. If an allergic reaction occurs, appropriate therapy should be instituted and amoxicillin therapy discontinued.
Serious anaphylactic reactions require immediate emergency treatment with adrenaline. Oxygen, intravenous steroids and airway management, including intubation should also be administered as indicated.
Drug induced enterocolitis syndrome (DIES) has been reported mainly in children receiving amoxicillin (see Section 4.8 Adverse Effects (Undesirable Effects)). DIES is an allergic reaction with the leading symptom of protracted vomiting (1-4 hours after administration of amoxicillin) in the absence of allergic skin or respiratory symptoms. Further symptoms could comprise abdominal pain, diarrhoea, hypotension, or leucocytosis with neutrophilia. There have been severe cases including progression to shock.
Although anaphylaxis is more frequent following parenteral therapy, it has occurred in patients on oral therapy. Before commencing therapy with any penicillin careful enquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins or other allergens. If an allergic reaction occurs, appropriate therapy should be instituted and amoxicillin therapy discontinued.
Serious anaphylactic reactions require immediate emergency treatment with adrenaline. Oxygen, intravenous steroids and airway management, including intubation, should also be administered as indicated.
Antibiotic associated pseudomembranous colitis has been reported with many antibiotics including amoxicillin. A toxin produced with Clostridium difficile appears to be the primary cause. The severity of the colitis may range from mild to life threatening. Clostridium difficile associated diarrhoea (CDAD) has been reported with the use of nearly all antibacterial agents and may range in severity from mild diarrhoea to fatal colitis. It is important to consider this diagnosis in patients who develop diarrhoea or colitis in association with antibiotic use (this may occur up to several weeks after cessation of antibiotic therapy). If prolonged or significant diarrhea occurs or the patient experiences abdominal cramps, treatment should be discontinued immediately, and the patient investigated further. Mild cases usually respond to drug discontinuation alone. However, in moderate to severe cases, appropriate therapy with a suitable oral antibiotic agent effective against Clostridium difficile should be considered. Fluids, electrolytes and protein replacement should be provided when indicated. Drugs which delay peristalsis, e.g. opiates and diphenoxylate with atropine (Lomotil) may prolong and/or worsen the condition and should not be used.
Adequate fluid intake and urinary output must be maintained in patients receiving high doses of amoxicillin.
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 concurrently. Adjustments in the dose of oral anticoagulants may be necessary to maintain the desired level of anticoagulation.
Amoxicillin should be avoided if infectious mononucleosis is suspected since the occurrence of a morbilliform rash has been associated with this condition following the use of amoxicillin.
Prolonged use may occasionally result in overgrowth of non-susceptible organisms.
As with any potent drug, periodic assessment of renal, hepatic and haematopoietic function should be made during prolonged therapy. The possibility of superinfections with mycotic or bacterial pathogens should be kept in mind during therapy. If superinfections occur (usually involving Aerobacter, Pseudomonas or Candida), the drug should be discontinued and/or appropriate therapy instituted.
Amoxicillin, an aminopenicillin, is not the treatment of choice in patients presenting with sore throat or pharyngitis because of the possibility that the underlying cause is infectious mononucleosis, in the presence of which there is a high incidence of rash if amoxicillin is used.
Amoxicillin should be given with caution to patients with lymphatic leukaemia since they are especially susceptible to ampicillin-induced skin rashes.
Following single dose therapy of acute lower urinary tract infections, the urine should be cultured. A positive culture may be evidence of a complicated or upper urinary tract infection and call for longer or larger course of therapy.
Adequate fluid intake and urinary output must be maintained in patients receiving high doses of amoxicillin.

Use in renal impairment.

Dosage should be adjusted in patients with renal impairment (see Section 4.2 Dose and Method of Administration).
In patients with reduced urine output, crystalluria (including acute renal injury) 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. In patients with bladder catheters, a regular check of patency should be maintained (see Section 4.8 Adverse Effects (Undesirable Effects); Section 4.9 Overdose).

Use in the elderly.

No data available.

Paediatric use.

No data available.

Effects on laboratory tests.

Oral administration of amoxicillin will result in high urine concentrations of amoxicillin. Since high urine concentrations of amoxicillin may result in false positive reactions when testing for the presence of glucose in urine using Clinitest, Benedict's solution or Fehling's solution, it is recommended that glucose tests based on enzymatic glucose oxidase reactions (such as Clinistix, or Testape) be used.
Following administration of ampicillin to pregnant women, a transient decrease in plasma concentration of total conjugated oestriol, oestriol glucuronide, conjugated oestrone and oestradiol has been noted. This effect may also occur with amoxicillin.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Probenecid decreases the renal tubular secretion of amoxicillin. Concurrent use with amoxicillin may result in increased and prolonged blood levels of amoxicillin.
The concurrent administration of allopurinol and ampicillin increases substantially the incidence of rashes in patients receiving both drugs as compared to patients receiving ampicillin alone. It is not known whether this potentiation of ampicillin rashes is due to allopurinol or the hyperuricemia present in these patients. Similar reactions can be expected with amoxicillin.
In common with other antibiotics, amoxicillin may affect the gut flora, leading to lower oestrogen reabsorption and reduced efficacy of combined oral contraceptives.
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 coadministration is necessary, the prothrombin time or international normalised ratio should be carefully monitored with the addition or withdrawal of amoxicillin.
Tetracyclines and other bacteriostatic drugs may interfere with the bactericidal effects of amoxicillin.

Methotrexate.

Penicillins may reduce the excretion of methotrexate causing a potential increase in toxicity.
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.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

No data available.
(Category A)
Animal studies with amoxicillin 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.
Amoxicillin may be used in pregnancy when the potential benefits outweigh the potential risks associated with treatment.
Australian categorisation definition of Category A: Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus having been observed.

Use in labour and delivery.

Oral ampicillin class antibiotics are generally poorly absorbed during labour. Studies in guinea pigs have shown that intravenous administration of ampicillin decreased the uterine tone, frequency of contractions, height of contractions and duration of contractions. However, it is not known whether the use of amoxicillin in humans during labour or delivery has immediate or delayed adverse effects on the foetus, prolongs the duration of labour or increases the likelihood that forceps delivery or other obstetrical intervention or resuscitation of the newborn will be necessary.
Ampicillin class antibiotics are excreted in the milk; therefore, caution should be exercised when amoxicillin is administered to a nursing woman.

4.7 Effects on Ability to Drive and Use Machines

The effects of this medicine on a person's ability to drive and use machines were not assessed as part of its registration.

4.8 Adverse Effects (Undesirable Effects)

As with other penicillins, it may be expected that untoward reactions will be essentially limited to sensitivity phenomena. They are more likely to occur in individuals who have previously demonstrated hypersensitivity to penicillins.
The following adverse reactions have been reported as associated with the use of amoxicillin.

Cardiac disorders.

Kounis syndrome: not known.

Infections and infestations.

Mucocutaneous candidiasis have been reported very rarely.

Gastrointestinal.

Nausea, vomiting, diarrhoea. Intestinal candidiasis and antibiotic associated colitis (including pseudomembranous colitis and haemorrhagic colitis) have been reported rarely. Black hairy tongue has been reported very rarely. Drug induced enterocolitis syndrome: not known (see Section 4.4 Special Warnings and Precautions for Use).

Skin and subcutaneous tissue disorders.

Linear IgA disease: not known.

Hypersensitivity reactions.

Erythematous maculopapular rash, pruritus and urticaria have been reported occasionally. Rarely, skin reactions such as erythema multiforme and Stevens-Johnson syndrome, toxic epidermal necrolysis and bullous, exfoliative dermatitis and acute generalised exanthematous pustulosis (AGEP) and drug reaction with eosinophilia and systemic symptoms (DRESS), and symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) (baboon syndrome) have been reported. As with other antibiotics, severe allergic reactions including angioneurotic oedema, anaphylaxis, serum sickness, hypersensitivity vasculitis and interstitial nephritis have been reported rarely.
Whenever such reactions occur, amoxicillin should be discontinued. (Note: urticaria, other skin rashes and serum sickness-like reactions may be controlled with antihistamines and, if necessary, systemic corticosteroids.) Anaphylaxis is the most serious reaction experienced (see Section 4.4 Special Warnings and Precautions for Use).

Liver.

A moderate rise in AST and/or ALT has occasionally been noted, but the significance of this finding is unknown. As with other beta-lactam antibiotics, hepatitis and cholestatic jaundice have been reported rarely.

Haemic and lymphatic systems.

Reactions such as anaemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia and leucopenia (including severe neutropenia or agranulocytosis) have been reported during therapy with other penicillins. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena. Prolongation of bleeding time and prothrombin time have also been reported rarely.

Renal and urinary tract disorders.

Interstitial nephritis, crystalluria (including acute renal injury): not known (see Section 4.9 Overdose).

CNS effects.

CNS effects have been seen rarely. They include aseptic meningitis, hyperkinesia, dizziness and convulsions. Convulsions may occur in patients with impaired renal function or in those receiving high doses.

Miscellaneous.

Superficial tooth discolouration has been reported very rarely in children. Good oral hygiene may help to prevent tooth discolouration as it can usually be removed by brushing.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.9 Overdose

Gastrointestinal effects such as nausea, vomiting and diarrhoea may be evident and symptoms of water/ electrolyte imbalance should be treated symptomatically. During the administration of high doses of amoxicillin, adequate fluid intake and urinary output must be maintained to minimize the possibility of amoxicillin crystalluria. Amoxicillin crystalluria, in some cases leading to renal failure, has been observed (see Section 4.4 Special Warnings and Precautions for Use).
Amoxicillin can be removed from the circulation by haemodialysis.
For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

Microbiology. Amoxicillin is similar to ampicillin in its bactericidal action against Gram-positive and Gram-negative susceptible organisms during the stage of active multiplication. It acts through the inhibition of biosynthesis of the cell wall mucopeptide.
It is active in vitro against most strains of Haemophilus influenzae*, Neisseria gonorrhoeae*, Neisseria meningitidis, Escherichia coli*, Proteus mirabilis* and Salmonellae. Because amoxicillin does not resist destruction by penicillinase, it is not active against penicillinase-producing organisms, particularly penicillinase producing staphylococci. All strains of Pseudomonas species, Klebsiella species, Enterobacter species, indole-positive Proteus species, Serratia marcescens, Citrobacter species, penicillinase-producing N. gonorrhoeae and penicillinase-producing H. influenzae are resistant. In vitro studies have demonstrated the susceptibility of most strains of the following Gram-positive bacteria: alpha- and beta-haemolytic streptococci, Diplococcus pneumoniae, non-penicillinase producing staphylococci and Streptococcus faecalis. These organisms are susceptible to amoxicillin at serum concentrations, which may be expected following the recommended doses. However, some of the organisms were susceptible to amoxicillin only at concentrations achieved in the urine (see Section 4.1 Therapeutic Indications).
* Activity refers only to beta-lactamase negative strains.
Escherichia coli isolates are becoming increasingly resistant to amoxicillin in vitro due to the presence of penicillinase-producing strains.
Strains of gonococci which are relatively resistant to benzylpenicillin may be sensitive to amoxicillin.
The following in vitro data are available, but their clinical significance is unknown. See Table 2.
A positive β-lactamase test predicts resistance to penicillin, ampicillin and amoxicillin. See Table 3.
Breakpoints. Streptococcus pneumoniae: S ≤ -2 microgram/mL; I = 4 microgram/mL; R ≥ 8 microgram/mL.

Note.

Because amoxicillin has greater in vitro activity against S. pneumoniae than does ampicillin, the majority of S. pneumoniae strains with intermediate susceptibility to ampicillin are fully susceptible to amoxicillin.
Susceptibility tests. Dilution or diffusion techniques - either quantitative (MIC) or breakpoint, should be used following a regularly updated, recognised and standardised method (e.g. NCCLS). Standardised susceptibility test procedures require the use of laboratory control microorganisms to control the technical aspects of the laboratory procedures.
A report of "Susceptible" indicates that the pathogen is likely to be inhibited if the antimicrobial compound in the blood reaches the concentrations usually achievable. A report of "Intermediate" indicates that the result should be considered equivocal, and if the microorganism is not fully susceptible to alternative, clinically feasible drugs, the test should be repeated. This category implies possible clinical applicability in body sites where the drug is physiologically concentrated or in situations where high dosage of drug can be used. This category also provides a buffer zone, which prevents small uncontrolled technical factors from causing major discrepancies in interpretation. A report of "Resistant" indicates that the pathogen is not likely to be inhibited if the antimicrobial compound in the blood reaches the concentrations usually achievable; other therapy should be selected.

Note.

The prevalence of resistance may vary geographically for selected species and local information on resistance is desirable, particularly when treating severe infections. This information gives only an approximate guidance on probabilities whether organisms will be susceptible to amoxicillin.
Susceptibility to amoxicillin will vary with geography and time and local susceptibility data should be consulted where available and microbiological sampling and susceptibility testing performed where necessary.

Cross resistance.

Other β-lactams, β-lactam/ β-lactamase inhibitor combinations and cephalosporins.

Resistance mechanisms.

Production of penicillinase, altered penicillin binding proteins.

Clinical trials.

No data available.

5.2 Pharmacokinetic Properties

Absorption.

Amoxicillin is stable in the presence of gastric acid and is rapidly and well absorbed after oral administration, even in the presence of food.

Distribution.

Amoxicillin diffuses rapidly into most body tissues and fluids, with the exception of brain and spinal fluid except when meninges are inflamed.
Amoxicillin has been shown to diffuse into sputum and saliva and is excreted mainly via the urine where it exists in a high concentration.
The amount to be found in the bile is variable depending on normal biliary secretory function.

Excretion.

The half-life of amoxicillin is 61.3 minutes with normal renal function and in the absence of renal function 16-20 hours.
Amoxicillin is excreted in the urine both unchanged and as penicilloic acid. About 75% of a 1 g dose is excreted in the urine in 6 hours in the presence of normal renal function (60% is biologically active and 15% is penicilloic acid). However, about 32% of a 3 g dose is excreted via the urine as the biologically active component in 8 hours (by which time most of the urinary excretion is complete). This proportional difference in the amount excreted from the different doses reflects a lack of linearity between doses and extent of absorption with a levelling off at higher doses of oral amoxicillin.
Excretion of amoxicillin can be delayed by concurrent administration of probenecid thus prolonging its therapeutic effect.
Amoxicillin is not highly protein bound, being only 17% protein bound in serum as measured by ultrafiltration or equilibrium dialysis.
Orally administered doses of 250 mg and 500 mg amoxicillin result in average peak serum levels one to two hours after administration of 5.0 microgram/mL and 6.6-10.8 microgram/mL, respectively. Detectable serum levels of amoxicillin are present 8 hours after ingestion of a single dose.

5.3 Preclinical Safety Data

Genotoxicity.

No data available.

Carcinogenicity.

No data available.

6 Pharmaceutical Particulars

6.1 List of Excipients

Each capsule contains following inactive ingredients: microcrystalline cellulose, magnesium stearate.
The capsule shells contain gelatin, carmoisine (E122), iron oxide yellow (E172), patent blue V (E131), titanium dioxide (E171), sodium lauryl sulfate.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C.

6.5 Nature and Contents of Container

Amiloxyn 250 mg and 500 mg (250 and 500 mg amoxicillin as trihydrate) are supplied in PVC/Aclar-Aluminium foil blister packs containing 20 capsules. Each blister strip contains 10 capsules.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of in accordance with local requirements.

6.7 Physicochemical Properties

Chemical structure.


Chemical name: (2S,5R,6R)-6-[[(2R)-2-amino-2-(4-hydroxyphenyl) acetyl]amino]-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo [3.2.0]heptane-2-carboxylic acid.
Molecular formula: C16H19N3O5S.3H2O.
Molecular weight: 419.4.
Slightly soluble in water, very slightly soluble in alcohol, practically insoluble in fatty oils. It dissolves in dilute acids and dilute solutions of alkali hydroxides.

CAS number.

[61336-70-7].

7 Medicine Schedule (Poisons Standard)

Schedule 4 (Prescription only medicine).

Summary Table of Changes