Augmentin XR or Augmentin ?

[T_Mom]

Our younger d has been on Augmentin (500 mg twice a day) for about two months now--some improvement but not consistent.

 

I am wondering if anyone knows whether or not the Augmentin XR 1000 mg (Sammy used the XR--"extended release" tabs) are truly different from the "regular" Augmentin. There is a difference in the Clavulanic (sp?) amount in these tablets. Does anyone know if this balance might affect the efficacy of the Augmentin dosage?

[memom]

Alex who sometimes posts mentioned that the XR is actually different in how it keeps the blood levels up more consistantly with a rapid release portion of the pill and then the sustained release portion. Can't break these in half. There may also be a different level of the second med in the Augmentin (don't remember how to spell the Clavi.....).

 

Ellie

[MomWithOCDSon]

Our younger d has been on Augmentin (500 mg twice a day) for about two months now--some improvement but not consistent.

 

I am wondering if anyone knows whether or not the Augmentin XR 1000 mg (Sammy used the XR--"extended release" tabs) are truly different from the "regular" Augmentin. There is a difference in the Clavulanic (sp?) amount in these tablets. Does anyone know if this balance might affect the efficacy of the Augmentin dosage?

 

We have tried both regular Augmentin and Augmentin XR. Our best results were with the XR, but our son was taking that 1,000 mg. dose not once each day but twice, so he was actually getting 2,000 mg. XR while on the dosage.

 

Not only were his symptoms improved on the XR versus twice daily dosing of regular Augmentin at 875 mg., but the XR did not seem to upset his stomach or gut nearly as much.

 

Interestingly enough, the prescription of Augmentin XR we were given did have a "split line" down the middle of the enormous horse pill, and no one warned us against breaking them in half. So once we'd completed 10 days on the full dosage, we did try cutting him back to what we thought would be 500 mg. Augmentin XR twice daily. Didn't seem to be any negative side effects of breaking the pill, but now I'm wondering if it was completely ineffective because by doing so, we'd breached the special outside coating?

[CZL]

Our younger d has been on Augmentin (500 mg twice a day) for about two months now--some improvement but not consistent.

 

I am wondering if anyone knows whether or not the Augmentin XR 1000 mg (Sammy used the XR--"extended release" tabs) are truly different from the "regular" Augmentin. There is a difference in the Clavulanic (sp?) amount in these tablets. Does anyone know if this balance might affect the efficacy of the Augmentin dosage?

 

We have tried both regular Augmentin and Augmentin XR. Our best results were with the XR, but our son was taking that 1,000 mg. dose not once each day but twice, so he was actually getting 2,000 mg. XR while on the dosage.

 

Not only were his symptoms improved on the XR versus twice daily dosing of regular Augmentin at 875 mg., but the XR did not seem to upset his stomach or gut nearly as much.

 

Interestingly enough, the prescription of Augmentin XR we were given did have a "split line" down the middle of the enormous horse pill, and no one warned us against breaking them in half. So once we'd completed 10 days on the full dosage, we did try cutting him back to what we thought would be 500 mg. Augmentin XR twice daily. Didn't seem to be any negative side effects of breaking the pill, but now I'm wondering if it was completely ineffective because by doing so, we'd breached the special outside coating?

So, when taking sammy dose, only takes Augmentin XR, any dose below that should be regular Augmentin? Any more input about this?

[memom]

Folks here on this forum have taken it many different ways. Anywhere from 500mg twice daily, to 875mg twice daily to 1000mg twice daily to Augmentin XR twice daily (that is also 1000mg but timed release and a different ratio of meds in it).

 

The Saving Sammy dose is XR twice daily (the strongest dose, he was about 120 lbs). My daughter started on 500 twice daily for a month, saw no appreciable change, went up to 875mg twice daily, not sure if it is helping, would like to try a month on XR. If that is not enough I would consider Azithromycin 500 daily (we live on the East coast where there is reported a form of resistant strep).

 

Ellie

[MomWithOCDSon]

Our younger d has been on Augmentin (500 mg twice a day) for about two months now--some improvement but not consistent.

 

I am wondering if anyone knows whether or not the Augmentin XR 1000 mg (Sammy used the XR--"extended release" tabs) are truly different from the "regular" Augmentin. There is a difference in the Clavulanic (sp?) amount in these tablets. Does anyone know if this balance might affect the efficacy of the Augmentin dosage?

 

We have tried both regular Augmentin and Augmentin XR. Our best results were with the XR, but our son was taking that 1,000 mg. dose not once each day but twice, so he was actually getting 2,000 mg. XR while on the dosage.

 

Not only were his symptoms improved on the XR versus twice daily dosing of regular Augmentin at 875 mg., but the XR did not seem to upset his stomach or gut nearly as much.

 

Interestingly enough, the prescription of Augmentin XR we were given did have a "split line" down the middle of the enormous horse pill, and no one warned us against breaking them in half. So once we'd completed 10 days on the full dosage, we did try cutting him back to what we thought would be 500 mg. Augmentin XR twice daily. Didn't seem to be any negative side effects of breaking the pill, but now I'm wondering if it was completely ineffective because by doing so, we'd breached the special outside coating?

So, when taking sammy dose, only takes Augmentin XR, any dose below that should be regular Augmentin? Any more input about this?

 

Personally, I cannot recommend a regular Augmentin 875 dose twice daily because it really seemed to do a number on my son's digestive tract. But more to the point, I think, to some extent, you're limited by the dosage available via the manufacturers. I'm not sure what increments the XR form comes in beyond the 1,000 mg., but I know that regular Augmentin tops out at the 875 mg. level, at least according to my ped and pharmacy.

[monarchcat]

My son (8, around 95lbs) is on 1000mg of augmentin twice a day (so 2000mg/day total). He takes two 500mg tablets in the morning and again at night. Our ped's office said that most likely insurance wouldn't cover the XR version so that is why they prescribed the regular version. I think we are seeing results (it's been 2-3 weeks now) but he is starting to get some intestinal trouble. I am thinking that when this Rx runs out I will ask for XR and just pay out of pocket if insurance won't pay for it.

 

I also wonder about the amox-clav ratio in the regular since I've seen that mentioned here. I think I will go back and re-read that to be sure his current dose is safe.

 

Has anyone had trouble with insurance covering the XR?

[T_Mom]

My son (8, around 95lbs) is on 1000mg of augmentin twice a day (so 2000mg/day total). He takes two 500mg tablets in the morning and again at night. Our ped's office said that most likely insurance wouldn't cover the XR version so that is why they prescribed the regular version. I think we are seeing results (it's been 2-3 weeks now) but he is starting to get some intestinal trouble. I am thinking that when this Rx runs out I will ask for XR and just pay out of pocket if insurance won't pay for it.

 

I also wonder about the amox-clav ratio in the regular since I've seen that mentioned here. I think I will go back and re-read that to be sure his current dose is safe.

 

Has anyone had trouble with insurance covering the XR?

 

 

Hi Monarchcat--You need to check this -- Our pharmacist was very concerned and it appears you must be careful, there is an apparent concern with the amount of clav. in the Augmentin pills. Anyone using this needs to be sure the ratio is OK for their child. Apparently that is why the Augmentin XR (extended release) is given, so the clav. is kept in a safe dosage level !!!

 

Wikipedia, I believe, had the info. on this even--age-based as I remember. It was my understanding that it was NOT safe to just raise the regular dose as the clav. dosage then went TOO high.

 

(This is a different issue then the generic vs. name-brand issue. And yes, our insurance covers the generic only. We are paying $85 a month for the regular Augmentin.)

All the best,

TMom

[Joan Pandas Mom]

Folks here on this forum have taken it many different ways. Anywhere from 500mg twice daily, to 875mg twice daily to 1000mg twice daily to Augmentin XR twice daily (that is also 1000mg but timed release and a different ratio of meds in it).

 

The Saving Sammy dose is XR twice daily (the strongest dose, he was about 120 lbs). My daughter started on 500 twice daily for a month, saw no appreciable change, went up to 875mg twice daily, not sure if it is helping, would like to try a month on XR. If that is not enough I would consider Azithromycin 500 daily (we live on the East coast where there is reported a form of resistant strep).

 

Ellie

I am switching to Azithro. My son is on Clindomycin 20 days post tonsillectomy and it is working great but I have been hearing so much about C diff and how tough it is on the gut. His pedi wants to put him on 500 mg Mon, Tues Weds., then off until the following Mond. Are many doing Azith daily?

[Alex]

Hi all,

 

I have done a couple of posts on the forum regarding the Augmentin XR vs. the regular Augmentin. The main point I tried to make was that for Sammy Maloney from 'Saving Sammy', augmentin was not really effective until he was on 2000mg a day of the extended release version. So for anyone trying Augmentin as a PANDAS treatment, you don't really know if it is an effective treatment for your child until you try what worked for Sammy.

 

I have done a little reading on the Augmentin XR and found out a few things. First, you can break the pill in half, but you have to take both halves at the same time. Not sure why but it could be that the clavulinic acid is not distributed evently between the two halves.

 

Second, adult dosing of Augmentin XR is up to 4000mg a day. So the Saving Sammy dose is not really that high at all. In fact, pediatric dosing for amoxicillin allows for up to 90 mg/kg per day. So my 70lb son could take 2700mg per day per pediatric dosing guidlines. So again, the 2000mg dosing is really an ordinary dose. Two 1000mg augmentin XR combined contain 125mg of clavulinic acid, half the amount you get from any standard two augmentin pills, be it the 500mg or 875 variety. So it would take the full adult dose of 4000mg per day to equal the clavulinic acid in just two 500mg regualar augmentin pills.

 

The augmenitn XR consists of an outer layer of immediate release augmentin with an inner portion of controlled release amoxicillin resulting in sustained blood plasma levels of amoxicillin compared to regular augmentin.

 

My own layperson's theory on why the XR may have worked better for Sammy and for others on this forum who have tried it is that if a strep inefection is ongoing, or intracellular, and you are not curing it through antibioitics but instead managing it long term, then a more continuous presence of antibioitic would let the immune system back off, allowing the dreaded antibodies to dissapate over time.

 

So, Augmentin XR has less clavulinic acid, sustains the antibioitic level in the blood plasma longer and seems to work better then regular augmentin for those who have tried it. We are seeing Dr. Bouboulis today and I am going to make my case that we should give it a try for my son.

 

Alex

[monarchcat]

I stopped by CVS to ask about the clav. ratio in regular augmentin vs. XR and didn't get any real answers. The pharmacist is a twit. He said the only concern with the level of clav would be eventual resistance and maybe an increased risk of diarrhea and that I would not find anything written about a safe upper limit doseage of clav.

 

He looked it up and said that it would cost $300/month for the XR (which would almost certainly not be covered by insurance). My feeling is that if there IS an unsafe dose of clav in the regular augmentin then insurance would have to cover the XR, but of course that would be in a perfect world. Which this is not. LOL

[MomWithOCDSon]

Hi all,

 

I have done a couple of posts on the forum regarding the Augmentin XR vs. the regular Augmentin. The main point I tried to make was that for Sammy Maloney from 'Saving Sammy', augmentin was not really effective until he was on 2000mg a day of the extended release version. So for anyone trying Augmentin as a PANDAS treatment, you don't really know if it is an effective treatment for your child until you try what worked for Sammy.

 

I have done a little reading on the Augmentin XR and found out a few things. First, you can break the pill in half, but you have to take both halves at the same time. Not sure why but it could be that the clavulinic acid is not distributed evently between the two halves.

 

Second, adult dosing of Augmentin XR is up to 4000mg a day. So the Saving Sammy dose is not really that high at all. In fact, pediatric dosing for amoxicillin allows for up to 90 mg/kg per day. So my 70lb son could take 2700mg per day per pediatric dosing guidlines. So again, the 2000mg dosing is really an ordinary dose. Two 1000mg augmentin XR combined contain 125mg of clavulinic acid, half the amount you get from any standard two augmentin pills, be it the 500mg or 875 variety. So it would take the full adult dose of 4000mg per day to equal the clavulinic acid in just two 500mg regualar augmentin pills.

 

The augmenitn XR consists of an outer layer of immediate release augmentin with an inner portion of controlled release amoxicillin resulting in sustained blood plasma levels of amoxicillin compared to regular augmentin.

 

My own layperson's theory on why the XR may have worked better for Sammy and for others on this forum who have tried it is that if a strep inefection is ongoing, or intracellular, and you are not curing it through antibioitics but instead managing it long term, then a more continuous presence of antibioitic would let the immune system back off, allowing the dreaded antibodies to dissapate over time.

 

So, Augmentin XR has less clavulinic acid, sustains the antibioitic level in the blood plasma longer and seems to work better then regular augmentin for those who have tried it. We are seeing Dr. Bouboulis today and I am going to make my case that we should give it a try for my son.

 

Alex

 

Thanks, Alex. That's great info, and something I hadn't been able to get a clear answer on before. Do you by any chance have an article or reference for the information regarding the XR? I'd like to be able to take it with me to the next ped appointment if so. Thanks again!

[Alex]

Hi all,

 

Thanks, Alex. That's great info, and something I hadn't been able to get a clear answer on before. Do you by any chance have an article or reference for the information regarding the XR? I'd like to be able to take it with me to the next ped appointment if so. Thanks again!

 

 

Here is a link to a GlaxoSmithKline press release on Augmentin XR from 2002

http://www.gsk.com/press_archive/press_09262002.htm

 

Here are a couple of quotes from the article.

 

"Augmentin XR employs a unique extended release formulation—bi-layer tablets that provide an immediate release of amoxicillin and clavulanate potassium and an extended release of amoxicillin. This enhanced formulation prolongs the time that the bacterium is exposed to the antibiotic and promotes coverage of tough-to-treat S. pneumoniae. "

 

"Augmentin® Tablets (250 mg or 500 mg) cannot be used to provide the same dosages as Augmentin XR Extended Release Tablets. This is because Augmentin XR contains 62.5 mg of clavulanate, while the Augmentin 250 mg and 500 mg tablets each contain 125 mg of clavulanate. In addition, the Extended Release Tablets provide an extended time course of plasma amoxicillin concentrations compared to immediate release Tablets. Thus two Augmentin 500 mg tablets are not equivalent to one Augmentin XR tablet."

 

Here is the link to a Drugs.com artilce on Augmentin XR saying you can break the pill in half.

http://www.drugs.com/augmentin.html

 

Here is the quote from the article.

"Do not crush or chew the Augmentin XR (extended-release) tablet. Swallow the pill whole, or break the pill in half and take both halves one at a time. If you have trouble swallowing a whole or half pill, talk with your doctor about using another form of Augmentin. "

 

I would guess that breaking the pill in half would have some negative effect on the time release aspect just because you are exposing more surface area of the exteneded release portion more quickly but I imagine still get the majority of the controlled release aspect.

 

Dr. B prescibed the Augmentin XR for Eli and he just took his first dose and was immediately cured of PANDAS. I wish. Eli is also a go for monthly IVIG starting Friday. Part of me wants to see how he would do on the Augmentin XR alone but more than anything we want to put PANDAS as far behind us as quickly as possible so will almost certainly proceed with the IVIG. We will keep you posted.

 

Alex

[MomWithOCDSon]

Thanks for the links, Alex. That's exactly what I'm looking for!

 

Good luck with Eli and the IVIG.

 

We've done a month of regular Augmentin at 875 mg./2 x day and 3 weeks of Augmentin XR at 1,000 mg./2 x day and we feel the XR was much more effective. I was just tonight successful in obtaining another 2 months' prescription for the XR from our ped, so I'll let you know how that goes. We are somewhat more fortunate in that our son's primary symptoms are OCD behaviors that, while annoying and sometimes intrusive, are in sufficient "remission" that most parts of his day are "doable," if not EASILY doable, so we are going to try sticking with the abx for a while rather than moving on to IVIG. I'll let you know how it goes!

[Alex]

Just one quick thoughut. On this forum I think the 'Saving Sammy' dose has been perceived as some really high dose. Turns out it is not. For anyone with a child/teen over say 100lbs then you would probably be a go for the full 4000mg daily (recommended in fact) dose of XR. Maybe better would be three pills spaced 8 hours apart to enhance the extended coverage aspect. The dosing guidlines that I read did allow for 8 hour spacing. The hard part about that would be that the XR is supposed to be taken immediately before a regular meal which would be tough to do on an 8 hour schedule.

 

Alex