Use With Warfarin
Use of Bepra 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 Bepra with warfarin.
Inflammation Within The Kidneys
Patients who are taking Bepra are at an increased risk. Bepra 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 Bepra.
Vitamin B-12 Deficiency
Patients who are taking Bepra 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 Bepra are at an increased risk. The use of Bepra with clarithromycin or amoxicillin may cause bacteria associated diarrhea
. Patients with bacteria associated diarrhea should take the lowest dose of Bepra for short period of time.
Patients with bone weakness related fractures
are at an increased risk when using Bepra for the longer period of time or taking its high doses. Long-term use or high doses of Bepra may increase the risk of fractures of the wrist, hip, or spine. Patients with bone weakness related fractures should take the lowest dose of Bepra for the shorter duration of time. Also, patients should have an adequate intake of calcium
Patients on prolonged treatment (at least three months or years) or who are taking Bepra 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 Bepra.
Use With Methotrexate
When Bepra 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 Bepra should be considered.
Stomach And Intestinal Infection
Patients who are taking Bepra are at an increased risk. Bepra increases the count of bacteria in the stomach and intestine. It may increase the risk of infection caused by Salmonella
and Clostridium difficile.
Interference With Laboratory Tests
Increased Chromogranin A (protein) level may interfere with the test for both neural and endocrine cancer
). To avoid this interference, Bepra should be discontinued for at least 5 days before chromogranin A measurements.
Subacute Cutaneous Lupus Erythematosus
Bepra 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).
Stomach Cancer (Gastric Malignancy)
Treatment with Bepra does not prevent the presence of stomach ulcers
in these patients.
Use In Combination With Antibacterial Agents
Patients who are allergic to antibacterial agents (clarithromycin and amoxicillin) should take precaution when using with Bepra.