Use In Combination With Antibacterial Agents
Patients who are allergic to antibacterial agents (clarithromycin and amoxicillin) should take precaution when using with Zulbex.
Stomach Cancer (Gastric Malignancy)
Treatment with Zulbex does not prevent the presence of stomach
ulcers in these patients.
Magnesium Deficiency
Patients on prolonged treatment (at least three months or years) or who are taking Zulbex with digoxin or may cause the deficiency of magnesium are at an increased risk. This may cause harmful effects like
seizures, muscle spasm, increase or decrease in heartbeat,
dizziness, disturbance in mental abilities and
fatigue. Treatment of low magnesium level in the blood can be improved by magnesium replacement or discontinuation of Zulbex.
Use With Methotrexate
When Zulbex is used with methotrexate, it may increase the level of methotrexate in the blood. In case of high dose intake of methotrexate, a temporary withdrawal of Zulbex should be considered.
Stomach And Intestinal Infection
Patients who are taking Zulbex are at an increased risk. Zulbex increases the count of bacteria in the stomach and intestine. It may increase the risk of infection caused by
Salmonella,
Campylobacter and Clostridium difficile.
Interference With Laboratory Tests
Increased Chromogranin A (protein) level may interfere with the test for both neural and endocrine
cancer (neuroendocrine
tumors). To avoid this interference, Zulbex should be discontinued for at least 5 days before chromogranin A measurements.
Subacute Cutaneous Lupus Erythematosus
Zulbex may cause subacute cutaneous
lupus erythematosus, lesion and
pain in a joints (arthralgia). Immediate medical help and discontinuation of proton pump inhibitors should be considered on the occurrence of lesions and pain in joints (arthralgia).
Use With Warfarin
Use of Zulbex with warfarin increases the levels of blood parameters such as blood clotting time which may lead to abnormal
bleeding and may cause a fatality. Blood parameters should be monitored in patients taking Zulbex with warfarin.
Inflammation Within The Kidneys
Patients who are taking Zulbex are at an increased risk. Zulbex may cause inflammation in the kidneys which lead to unknown harmful allergic reactions in the body. If a patient develops inflammation in the kidneys, discontinue the use of Zulbex.
Vitamin B-12 Deficiency
Patients who are taking Zulbex are at an increased risk. Long-term (more than 3 years) use of acid-suppressing agents may lead to
vitamin B-12 deficiency due to the absence of hydrochloric acid in the stomach. Diagnosis should be considered if these clinical symptoms persist.
Bacteria (Clostridium difficile) Associated Diarrhea
Patients who are taking Zulbex are at an increased risk. The use of Zulbex with clarithromycin or amoxicillin may cause bacteria associated
diarrhea. Patients with bacteria associated diarrhea should take the lowest dose of Zulbex for short period of time.
Bone Fracture
Patients with bone weakness related
fractures are at an increased risk when using Zulbex for the longer period of time or taking its high doses. Long-term use or high doses of Zulbex may increase the risk of fractures of the wrist, hip, or spine. Patients with bone weakness related fractures should take the lowest dose of Zulbex for the shorter duration of time. Also, patients should have an adequate intake of
calcium and
vitamin D.
