Magnapen Capsules

1. Name Of The Medicinal Product

Magnapen^® Hard Capsules or Co-fluampicil 250mg/250mg Hard Capsules

2. Qualitative And Quantitative Composition

Co-fluampicil Capsules contain 250mg ampicillin as ampicillin trihydrate with 250mg flucloxacillin as flucloxacillin sodium (co-fluampicil 250/250).

3. Pharmaceutical Form

Capsules

Black and turquoise capsules overprinted Magnapen/Magnapen or CF500/CP

4. Clinical Particulars

4.1 Therapeutic Indications

Co-fluampicil is indicated for the treatment of severe infections where the causative organism is unknown, and for mixed infections involving β-lactamase-producing staphylococci. Typical indications include:

In general practice: Chest infections, ENT infections, skin and soft tissue infections, and infections in patients whose underlying pathology places them at special risk.

In hospital (prior to laboratory results being available): severe respiratory tract infections, post-operative chest and wound infections, septic abortion, puerperal fever; septicaemia, prophylaxis in major surgery, infections in patients receiving immuno-suppressive therapy.

The spectrum of activity of co-fluampicil also makes it suitable for the treatment of many mixed infections, particularly those where β-lactamase-producing staphylococci are suspected or confirmed.

Parenteral usage is indicated where oral dosage is inappropriate.

4.2 Posology And Method Of Administration

Usual adult dosage (including elderly patients and children over 10 years):

Oral: 1 capsule four times a day.

Usual children's dosage:

Oral: Under 10 years: half adult dose, using Co-fluampicil Syrup.

The above dosages for adults and children may be doubled where necessary.

Oral doses should be administered half to one hour before meals.

4.3 Contraindications

Co-fluampicil contains ampicillin and flucloxacillin which are penicillins, and should not be given to patients with a history of hypersensitivity to β-lactam antibiotics (e.g. penicillins, cephalosporins).

Co-fluampicil is contraindicated in patients with a history of flucloxacillin-associated jaundice/hepatic dysfunction.

4.4 Special Warnings And Precautions For Use

Before initiating therapy with co-fluampicil careful enquiries should be made concerning previous hypersensitivity reactions to β-lactam antibiotics.

Serious and occasionally fatal hypersensitivity reactions (anaphylaxis) have been reported in patients receiving β-lactam antibiotics. Although anaphylaxis is more frequent following parenteral therapy, it has occurred in patients on oral therapy. These reactions are more likely to occur in individuals with a hypersensitivity to β-lactam antibiotics.

Co-fluampicil contains ampicillin and should be avoided if infectious mononucleosis and/or acute or chronic leukaemia of lymphoid origin are suspected. The occurrence of a skin rash has been associated with these conditions following the administration of ampicillin.

Co-fluampicil should be used with caution in patients with evidence of hepatic dysfunction (see Section 4.8).

During prolonged treatments (e.g. osteomyelitis, endocarditis), regular monitoring of hepatic and renal functions is recommended.

Prolonged use may occasionally result in the selection of resistant strains of organisms.

Sodium Content: Co-fluampicil Capsules contain 13.0mg sodium per capsule. This should be included in the daily allowance of patients on sodium restricted diets.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

Bacteriostatic drugs may interfere with the bactericidal action of ampicillin and flucloxacillin.

In common with other oral broad-spectrum antibiotics, co-fluampicil may reduce the efficacy of oral contraceptives and patients should be warned accordingly.

Probenecid decreases the renal tubular secretion of co-fluampicil. Concurrent use with co-fluampicil may result in increased and prolonged blood levels of both ampicillin and flucloxacillin.

Concurrent administration of allopurinol during treatment with ampicillin can increase the likelihood of allergic skin reactions.

Co-fluampicil contains ampicillin. It is recommended that when testing for the presence of glucose in urine during ampicillin treatment, enzymatic glucose oxidase methods should be used because false positive readings are common with chemical methods due to the high urinary concentrations of ampicillin.

4.6 Pregnancy And Lactation

Pregnancy: Animal studies with co-fluampicil have shown no teratogenic effects. The product has been in clinical use since 1971 and the limited number of reported cases of use in human pregnancy have shown no evidence of untoward effects. The decision to administer any drug during pregnancy should be taken with the utmost care. Therefore co-fluampicil should only be used in pregnancy when the potential benefits outweigh the potential risks associated with treatment.

Lactation: Trace quantities of ampicillin and flucloxacillin can be detected in breast milk. The possibility of hypersensitivity reactions must be considered in breast-fed infants. Therefore co-fluampicil should only be administered to a breast-feeding mother when the potential benefit outweigh the potential risks associated with treatment.

4.7 Effects On Ability To Drive And Use Machines

Adverse effects on the ability to drive or operate machinery have not been observed.

4.8 Undesirable Effects

Hypersensitivity reactions:

If any hypersensitivity reaction occurs, the treatment should be discontinued.

Skin rash, puritis and urticaria have been reported occasionally. The incidence of rash is higher in patients suffering from infectious mononucleosis and acute or chronic leukaemia of lymphoid origin. Purpura, fever, eosinophilia and sometimes angioneurotic oedema have also been reported. Rarely, skin reactions such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis have been reported. Reactions such as fever, arthralgia, and myalgia can develop more than 48 hours after the start of the treatment.

Anaphylaxis (see Item 4.4-Warnings) has been reported rarely.

Gastrointestinal reactions:

Minor gastrointestinal disturbances, including occasionally nausea, vomiting and diarrhoea may occur during treatment. Pseudomembranous colitis has been reported rarely.

Hepatic effects:

Hepatitis and cholestatic jaundice have been reported rarely. These may be delayed for up to two months after withdrawal of treatment. In some cases the course of these conditions has been protracted and lasted for several months. Very rarely deaths have been reported from hepatic effects but are mostly limited to patients with serious underlying disease.

As with most other antibiotics, a moderate transient increase in transaminases has been reported.

Renal effects:

Interstitial nephritis may occur.

Haematological effects:

As with other β-lactam antibiotic, haematological effects including reversible leucopenia, reversible thrombocytopenia and haemolytic anaemia have been reported rarely.

4.9 Overdose

Gastrointestinal effects such as nausea, vomiting and diarrhoea may be evident and should be treated symptomatically.

Co-fluampicil contains flucloxacillin. Haemodialysis does not lower the serum levels of flucloxacillin.

Co-fluampicil contains ampicillin, which may be removed from the circulation by haemodialysis.

5. Pharmacological Properties

5.1 Pharmacodynamic Properties

Infections encountered in medical practice can involve mixed strains of bacteria and may include β-lactamase-producing strains. Co-fluampicil provides broad spectrum activity.

5.2 Pharmacokinetic Properties

Co-fluampicil is excreted via the kidneys with a plasma half-life of approximately one hour.

5.3 Preclinical Safety Data

Not relevant

6. Pharmaceutical Particulars

6.1 List Of Excipients

Capsules: Magnesium Stearate:

Capsule Shells: Gelatin, Black Iron Oxide (E172), Titanium Dioxide (E171), Patent Blue V (E131), Quinoline Yellow (E104).

6.2 Incompatibilities

None known

6.3 Shelf Life

Two years

6.4 Special Precautions For Storage

Do not store above 25°C

Store in the original package

6.5 Nature And Contents Of Container

Capsules: Standard polypropylene tube with a polythene closure or standard aluminium canisters or glass bottles fitted with a screw cap with a waxed pulpboard wad. Pack sizes of 20, 50, 100 or 500.

Aluminium foil pack. Pack size 12 capsules.

Aluminium/PVDC blister pack with aluminium overseal. Pack size 20, 28 and 100 capsules.

6.6 Special Precautions For Disposal And Other Handling

None

7. Marketing Authorisation Holder

Wockhardt UK Ltd

Ash Road North

Wrexham

LL13 9UF

United Kingdom.

8. Marketing Authorisation Number(S)

PL 29831/0052

9. Date Of First Authorisation/Renewal Of The Authorisation

18^th June 2007

10. Date Of Revision Of The Text

September 2009