lansoprazole / amoxicillin / clarithromycin
Prevpac is a pre-packed treatment containing three medications: lansoprazole capsules, amoxicillin capsules, and clarithromycin tablets. All three medications are taken together to treat adults with a type of stomach infection called H. pylori. The treatment regimen consists of a proton pump inhibitor or PPI (lansoprazole) and two types of antibiotics (amoxicillin and clarithromycin). The medications are taken by mouth twice per day for 10 or 14 days. The brand name Prevpac is discontinued, but the pre-packed set of medications is still available as a lower-cost generic. Side effects include diarrhea, changes in taste, and headache.
What is Prevpac?
What is Prevpac used for?
Helicobacter pylori (H. pylori) stomach infection in adults
How Prevpac works
Prevpac is a combination of three medications that treat stomach infections caused by the bacteria Helicobacter pylori (H. pylori).
Lansoprazole is a proton pump inhibitor (PPI). It stops the production of acid in your stomach. This makes your stomach less acidic, which weakens the H. pylori bacteria and allows antibiotics to work well at getting rid of the infection.
Amoxicillin is a penicillin antibiotic. It kills bacteria by preventing them from making their outer covering that protects them from harm.
Clarithromycin is a macrolide antibiotic. It stops bacteria from making proteins that they need for growth and survival.
Drug Facts
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What are the side effects of Prevpac?
Common Side Effects
- Diarrhea (7%)
- Headache (6%)
- Changes in taste (5%)
Other Side Effects
- Stomach pain
- Nausea
- Dry mouth
- Dark stools
- Muscle pain
- Dizziness
Serious Side Effects
- Serious allergic reaction or skin reaction: hives, rash, blisters, skin peeling, skin reddening, fever, swelling of the lips or tongue, trouble breathing
- Infectious diarrhea (C. difficile-related diarrhea): rapid heart rate, fever, nausea, foul-smelling diarrhea, frequent bowel movements (even up to 15 times per day)
- Liver problems: swelling of the stomach, yellowing of the skin or whites of the eyes, dark or brown urine, confusion
- Kidney problems: not urinating as much as usual
- Abnormal heart rhythm: chest pounding, chest pain, trouble breathing, feeling faint or lightheaded
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low magnesium level—muscle pain or cramps, unusual weakness or fatigue, fast or irregular heartbeat, tremors
- Lupus-like syndrome—joint pain, swelling, or stiffness, butterfly-shaped rash on the face, rashes that get worse in the sun, fever, unusual weakness or fatigue
- Rash, fever, and swollen lymph nodes
- Severe diarrhea, fever
- Severe or prolonged vomiting or diarrhea
- Unusual vaginal discharge, itching, or odor
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Change in taste
- Diarrhea
- Headache
Pros and cons of Prevpac
Pros
First-choice treatment option for treating a H. pylori infection
Comes as pre-packed cards (each card has all the pills you need to take for the day in it)
Only taken for 10 or 14 days
Available as a lower-cost generic
Cons
Need to take 4 pills twice per day
Doesn't come in a liquid form
Contains amoxicillin, which might not be a good choice for people with a serious penicillin allergy
Contains clarithromycin, which can interact with many medications, including some blood pressure medications and statins
Pharmacist tips for Prevpac
Each pre-packed card of Prevpac contains the total dose of lansoprazole, amoxicillin, and clarithromycin that you need to take each day. Take 1 capsule of lanzoprazole, 2 capsules of amoxillicin, and 1 tablet of clarithromycin together twice each day of treatment.
Take Prevpac for 10 or 14 days, depending on your prescriber's instructions. Make sure to finish the entire course of treatment, even if you start to feel better. Stopping the treatment regimen earlier than prescribed can make your infection come back and become harder to treat.
You can take Prevpac with or without food. But since the antibiotics in the kit typically cause stomach upset, taking your pills with food can help prevent or ease this side effect.
Be sure to drink plenty of fluids to prevent dehydration if you have diarrhea while you're taking Prevpac. Ask a healthcare professional whether it's helpful to take a probiotic to help lessen this side effect. If so, take the probiotic at least 2 hours before or after you take your Prevpac dose to prevent the antibiotics from killing the "good" bacteria in the probiotic, which can make the probiotic work less well.
Contact your prescriber you develop severe diarrhea with symptoms such as stomach cramps, fever, and tiredness. This might be a symptom of infectious diarrhea – a rare, but serious side effect of Prevpac that needs immediate medical attention. Keep in mind that it's possible for infectious diarrhea to develop a few months after treatment ends.
Clarithromycin and amoxicillin, which are the antibiotics in the Prevpac kit, can cause changes in taste. This should get better and eventually go away after you finish your treatment.
It's possible for clarithromycin in the Prevpac kit to cause dizziness, confusion, and vertigo. Don't drive or operate heavy machinery until you know how this medication affects you.
Tell your care team about all of the medications you're taking or planning to take. Since Prevpac interacts with many medications, your care team can make sure all your medications are safe to take together.
Let your prescriber know if you're pregnant or breastfeeding before you start Prevpac. They'll review the risks and benefits of each medication in the Prevpac kit with you. They might consider other options that might be safer for you.
Frequently asked questions about Prevpac
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What are the risks and warnings for Prevpac?
Prevpac can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Severe allergic reactions and skin reactions
Risk factors: Allergy to penicillin or macrolides
Severe allergic reactions to Prevpac are possible, including life-threatening reactions like facial swelling, hives, and anaphylaxis (e.g., closing of the throat). Prevpac can also cause serious skin reactions. These skin reactions can include Stevens-Johnson syndrome (SJS), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, and toxic epidermal necrolysis (TEN).
Call 911 as soon as possible if you notice any signs of a severe allergic reaction or skin reaction after you take a dose of Prevpac. Watch out for swelling of the face or lips, trouble breathing, blisters, hives, skin redness, or a red-purple rash. Sometimes, severe allergic reactions can start off with body aches, fever, sore throat, or a burning sensation in the eyes.
Liver problems
Although rare, some people who took clarithromycin (a medication in the Prevpac kit) had liver problems. These liver problems are usually reversible. But they can sometimes be very serious, like with liver failure. Get medical help right away if you notice swelling of your stomach, stomach pain, yellowing of your skin or the whites of your eyes, clay-colored stools, nausea, vomiting, confusion, or dark or brown urine. You might need to stop using the medication to prevent further liver damage.
Kidney problems
Although rare, some people who take proton pump inhibitors, like the lansoprazole packaged in the Prevpac kit, can have kidney damage. This damage can happen at any time while you're taking lansoprazole and can make your kidneys work less well. Contact your prescriber if you notice that you're urinating less than usual, feel tired or sick, or have swelling in your hands or feet. These can be symptoms of kidney damage.
Infectious diarrhea
Taking Prevpac can put you at higher risk for getting infected with a bacteria called Clostridioides difficile (C. difficile). Like many other bacteria, C. difficile naturally lives in your gut and normally don’t cause any problems. But taking antibiotics, like amoxicillin that's included in the Prevpac kit, can cause C. difficile to grow out of control. This can lead to infectious diarrhea, which can range in severity from mild to life-threatening.
C. difficile-related diarrhea is a medical emergency. Get medical attention right away if you have any symptoms of infectious diarrhea, including rapid heart rate, fever, nausea, foul-smelling diarrhea, and frequent bowel movements (even up to 15 times per day). You'll get tested for infectious diarrhea. Your prescriber might ask you to stop Prevpac.
Life-threatening heart rhythm problems (QT prolongation)
Risk factors: Older adults | Heart rhythm problems | Taking other medications that affect your heart rhythm | Electrolyte problems
Although rare, the clarithromycin in the Prevpac kit can raise your risk for an abnormal heart rhythm condition called QT prolongation. The risk is higher for people who take other medications that can affect your heart rhythm, such as amiodarone (Pacerone) or certain antipsychotic medications.
Make sure to tell your prescriber about all the medications you take before you start Prevpac. Call 911 right away if you feel symptoms of heart rhythm problems, such as a pounding chest, trouble breathing, lightheadedness, or chest pain, while you're taking Prevpac.
Worsening of myasthenia gravis
Let your prescriber know if you have myasthenia gravis. The clarithromycin in the Prevpac kit can worsen symptoms of myasthenia gravis, like muscle weakness and trouble breathing. Ask your prescriber if you're concerned about this risk.
Lupus
Some people who've taken proton pump inhibitors like lansoprazole (a medication in the Prevpac kit) reported new or worsening symptoms related to lupus. Lupus is a condition that happens when your body’s immune system attacks itself. Contact your prescriber and stop taking Prevpac if you notice a butterfly-like rash on your face, tiredness, joint pain or swelling, or sores on your skin. These can be symptoms of lupus.
Interactions with other medications
The clarithromycin antibiotic that's included in the Prevpac kit can interact with many common prescription and over-the-counter medications. These drug interactions can either make certain medications work less well or raise your risk for side effects from other medications. Examples of medications that interact with clarithromycin include colchicine, amlodipine (Norvasc), warfarin (Coumadin), and certain statins, among others.
Tell your prescriber about all of the medications you're taking before you start Prevpac. Your prescriber can check to see whether you need any dose adjustments to any of your medications or whether you need to stop taking any of them while you take Prevpac. Don't start any new medications without talking to your care team first so they can make sure that all your medications are safe for you to take together.
Avoid use during pregnancy
Prevpac contains clarithromycin, which is a medication that's generally not recommended during pregnancy. It isn't completely clear whether clarithromycin is safe to take while pregnant. A 2021 study found that there wasn't a link between taking clarithromycin during the first trimester of pregnancy and major birth defects. But animal studies have shown a risk of harm, like heart problems and cleft palate, to babies when given during pregnancy at higher doses than those for humans. Talk to your prescriber about the risks and benefits of taking Prevpac while pregnant. Ask your prescriber if there are any safer options.
Prevpac dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 14 day | 1 package | $241.47 | $241.47 |
Typical dosing for Prevpac
Each card of Prevpac contains the total daily dose of all the medications you need to take. Each card has two capsules of lansoprazole 30 mg, four capsules of amoxicillin 500 mg, and two tablets of clarithromycin 500 mg.
The typical dose is 1 capsule of lansoprazole, 2 capsules of amoxicillin, and 1 tablet of clarithromycin taken together by mouth twice each day for 10 or 14 days.
How much does Prevpac cost?
Prevpac contraindications
Severe allergy to macrolide antibiotics, penicillins, or beta-lactam antibiotics
History of cholestatic jaundice or liver problems related to previous treatment with clarithromycin
History of heart rhythm problems (e.g., QT prolongation, ventricular arrhythmia)
Take pimozide, ergotamine, dihydroergotamine (Migranal), or lurasidone (Latuda)
Take medications containing rilpivirine
Take lovastatin or simvastatin (Zocor)
Kidney or liver problems and also take colchicine
What are alternatives to Prevpac?
Helicobacter pylori (H. pylori) stomach infection in adults
Duodenal (gut) ulcer associated with Helicobacter pylori (H. pylori) infection
Helicobacter pylori (H. pylori) stomach infection in adults
Prevpac images
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References
Best studies we foundAmerican Kidney Fund. (2024). Interstitial nephritis.
Andersson, N. W., et al. (2020). Association between use of macrolides in pregnancy and risk of major birth defects: Nationwide, register based cohort study. The British Medical Journal.
Centers for Disease Control and Prevention. (2024). Cleft lip/cleft palate.
Drugs@FDA: FDA-Approved Drugs. (n.d.). Prevpac (copackaged). U.S. Food and Drug Administration.
Farzam, K., et al. (2023). QT prolonging drugs. StatPearls.
Ierardi, E., et al. (2019). Optimizing proton pump inhibitors in Helicobacter pylori treatment: Old and new tricks to improve effectiveness. World Journal of Gastroenterology.
National Heart, Lung, and Blood Syndrome. (2022). Arrhythmias: Types.
National Heart, Lung, and Blood Syndrome. (2022). Long QT syndrome.
Randel, A., et al. (2018). H. pylori infection: ACG updates treatment recommendations. American Family Physician.
Rising Pharma Holdings, Inc. (2024). Lansoprazole, amoxicillin, clarithromycin kit [package insert]. DailyMed.
Rising Pharma Holdings, Inc. (2024). Lansoprazole, amoxicillin, clarithromycin- lansoprazole, amoxicillin, clarithromycin [package insert]. DailyMed.
Tholey, D. (2023). Cholestasis. Merck Manual Consumer Version.
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