Clavulanic Acid
J01C - Beta-lactam antibacterials, penicillins
ATC J01CR02
Small molecule
approved 1984
Oral
Parenteral
Natural product
JFDA label: Megamox Tab
Indications
Off-label
- Asthma
- Bronchitis
- Bronchitis, Chronic
- Buruli Ulcer
- Cholecystitis
- Clostridium Infections
- Cocaine-Related Disorders
- Cystitis, Hemorrhagic
- Depressive Disorder, Major
- Enterobacteriaceae Infections
- Erectile Dysfunction
- Head and Neck Neoplasms
- Helicobacter Infections
- Hernia
- Infections
- Influenza, Human
- Mastitis
- Otitis Media
- Otitis Media, Suppurative
- Periapical Periodontitis
- Pneumonia
- Pneumonia, Bacterial
- Severe Acute Respiratory Syndrome
- Sinusitis
- Tobacco Use Disorder
- Tuberculosis
- Tuberculosis, Pulmonary
- Urinary Bladder Neoplasms
- Urinary Tract Infections
Class profile
| gramStatus | Both |
|---|---|
| spectrumBreadth | Moderate |
| atypicalCoverage | No |
| isBactericidal | 1 |
| moaCategory | Beta-lactamase inhibitor (suicide substrate) |
| pdIndex | Time-dependent |
| postAntibioticEffect | None |
| mrsaCoverage | 0 |
| resistanceMechanisms | ESBL production (reduced susceptibility),Carbapenemase production |
Adverse Reactions
Very Common >10%Common 1–10%Uncommon 0.1–1%
Rare 0.01–0.1%Very Rare <0.01%Not Known
Gastrointestinal disorders (2)
Common Nausea · Vomiting
Skin and subcutaneous tissue disorders (1)
Common Skin Rashes And Urticaria
General disorders and administration site conditions (2)
Common And Vaginitis · Loose Stools
Monitoring
| Efficacy | Culture and susceptibility testing; clinical resolution (temperature, WBC, CRP, procalcitonin) |
|---|---|
| Toxicity | Renal function (dose adjustment in renal impairment); hepatic function for hepatically cleared agents; signs of C. difficile infection (diarrhoea) |
| Clinical pearl | Culture results guide de-escalation to narrower-spectrum therapy. Review antibiotic appropriateness at 48–72 h (antimicrobial stewardship). |
| Counseling | Complete the full course. Report persistent diarrhoea, rash, or lack of improvement after 48–72 h. |
Chemistry & Properties
| Formula | C8H9NO5 |
|---|---|
| Molecular weight | 199.16 g/mol |
| IUPAC name | (2R,3Z,5R)-3-(2-hydroxyethylidene)-7-oxo-4-oxa-1-azabicyclo[3.2.0]heptane-2-carboxylic acid |
| CAS | 58001-44-8 |
| PubChem CID | 5280980 |
| InChIKey | HZZVJAQRINQKSD-PBFISZAISA-N |
| logP | -1.1 (XLogP -1.2) |
| Polar surface area | 87.07 Ų |
| H-bond acceptors / donors | 4 / 2 |
| Drug-likeness (QED) | 0.55 |
| Lipinski violations | 0 |
SMILES
O=C(O)[C@H]1/C(=C/CO)O[C@@H]2CC(=O)N21Biology & Pharmacokinetics
Pharmacokinetics predicted
| Bioavailability | 10.0% |
|---|---|
| Half-life | 0.995 h |
| Volume of distribution | 0.228 L/kg |
| Protein binding | 16.0% |
| BBB penetrant | No |
Enzyme interactions
| Enzyme | Role | Detail |
|---|---|---|
| CYP2C19 | Substrate | — |
| CYP2C9 | Substrate | — |
Transporters
BCRP (Inhibitor)BSEP (Inhibitor)BSEP (Inhibitor)MRP1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)P-gp (Inhibitor)P-gp (Substrate)
Drug–drug interactions (16, DDInter)
| Interacting drug | Severity | Management |
|---|---|---|
| Leflunomide | major | |
| Teriflunomide | major | |
| Asparaginase Escherichia coli | moderate | |
| Balsalazide | moderate | |
| Brentuximab vedotin | moderate | |
| Clofarabine | moderate | |
| Epirubicin | moderate | |
| Idelalisib | moderate | |
| Interferon beta-1a | moderate | |
| Interferon beta-1b | moderate | |
| Methotrexate | moderate | |
| Naltrexone | moderate | |
| Pegaspargase | moderate | |
| Peginterferon beta-1a | moderate | |
| Tioguanine | moderate | |
| Trabectedin | moderate |
Registered Products (82)
| Brand | Form / strength | Pack | Agent | Citizen (JOD) |
|---|---|---|---|---|
| Amoclan 600 vials | Vial (as Sodium)500 mg, 100 mg | 1 pack varies | Hikma Pharmaceuticals Co.Ltd/Jordan | 0.960 |
| Ramoclav-156 suspension | Suspension 125 mg/5 ml, 31.25 mg/5 ml | 60 ml pack varies | AL-RAM PHARMA.INDUS.CO.LTD/JORDAN | 1.270 |
| Moxiclav | Vial 1000 mg, 200 mg | 1 vial pack varies | Khoury Drug Store | 1.510 |
| Amoclan 1200 vials | Vial (as Sodium)1000 mg, as potassium clavulanate 200 mg | 1 vial pack varies | Hikma Pharmaceuticals Co.Ltd/Jordan | 1.790 |
| Klavox Susp. | Suspension 125 mg/5 ml, 31.25 mg/5 ml | 100 ml | Regional Drug Store | 1.790 |
| Koact | Suspension 125 mg/5 ml, 31.25 mg/5 ml | 100 ml | AL Rahma Drug Store | 1.790 |
| Megamox Susp | Suspension 125 mg/5 ml, 31.25 mg/5 ml | 100 ml | IBN CINA DRUG STORE | 1.790 |
| Curam | Suspension 125 mg/5 ml, 31.25 mg/5 ml | 100 ml | Nabulsi Drug Store | 1.850 |
| Moxiclav Sus | Suspension 125 mg/5 ml, 31.25 mg/5 ml | 100 ml | Khoury Drug Store | 1.850 |
| Amoclan Suspension | Suspension (as trihydrate) 125 mg/5 ml, (as potassium)31.25 mg/5 ml | 100 ml | Hikma Pharmaceuticals Co.Ltd/Jordan | 2.120 |
| Clavar | Suspension 125 mg/5 ml, 31.25 mg/5 ml | 100 ml | The Arab Pharmaceutical Manufacturing PSC/Salt | 2.120 |
| Ramoclav-156 suspension | Suspension 125 mg/5 ml, 31.25 mg/5 ml | 100 ml pack varies | AL-RAM PHARMA.INDUS.CO.LTD/JORDAN | 2.120 |
| Amoclan BID | Suspension 400 mg/5 ml, 57 mg/5 ml | 35 ml pack varies | Hikma Pharmaceuticals Co.Ltd/Jordan | 2.150 |
| Curam | Vial 2000 mg, 200 mg | one vial | Nabulsi Drug Store | 2.240 |
| Augmentin 156 Susp. | Suspension 125 mg/5 ml, 31.25 mg/5 ml | 100 ml | Suleiman Tannous & Sons Co. Ltd | 2.550 |
| Klavox Tab | Tablet 250 mg, 125 mg | 20 tab | Shawi & Rushedat Drug Store | 2.680 |
| Koact | Tablet 250 mg, 125 mg | 20 tab | AL Rahma Drug Store | 2.680 |
| Amoclan Forte Suspension | Suspension (as Trihydrate)250 mg/5 ml, (as potassium) 62.5 mg/5 ml | 60 ml | Hikma Pharmaceuticals Co.Ltd/Jordan | 2.770 |
| Ramoclav-312 suspension | Suspension 250 mg/5 ml, 62.5 mg/5 ml | 60 ml pack varies | AL-RAM PHARMA.INDUS.CO.LTD/JORDAN | 2.770 |
| Megamox Tab | Tablet 875 mg, 125 mg | 10 tab | IBN CINA DRUG STORE | 2.810 |
| Amoclan Forte Tablets | Tablet (as trihydrate) 500 mg, (as potassium) 125 mg | 12 tab pack varies | Hikma Pharmaceuticals Co.Ltd/Jordan | 2.900 |
| Ramoclav-625 tablets | Tablet Anhydrous 500 mg, 125 mg | 12 tab pack varies | AL-RAM PHARMA.INDUS.CO.LTD/JORDAN | 2.900 |
| Moxiclav Tab | Tablet 250 mg, 125 mg | 20 tab | Khoury Drug Store | 2.920 |
| Klavox Susp | Suspension 200 mg, 28 mg/5 ml | 70 ml | Regional Drug Store | 2.970 |
| Klavox Susp | Suspension 400 mg/5 ml, 57 mg/5 ml | 70 ml | Shawi & Rushedat Drug Store | 2.990 |
| Koact | Tablet 500 mg, 125 mg | 15 tab | AL Rahma Drug Store | 2.990 |
| Klavox Susp. | Suspension 250 mg/5 ml, 62.5 mg/5 ml | 100 ml | Shawi & Rushedat Drug Store | 3.210 |
| Amoclan BID | Suspension 200 mg/5 ml, 28.5 mg/5 ml | 70 ml | Hikma Pharmaceuticals Co.Ltd/Jordan | 3.230 |
| CLAVODAR 200/28.5 SUSPENSION | Suspension 200 mg/5 ml, 28.5 mg | 70 ml | Dar Al Dawa Development and Investment Co Ltd/Jordan | 3.230 |
| Curam | Suspension 400 mg/5 ml, 57 mg/5 ml | 70 ml pack varies | Nabulsi Drug Store | 3.260 |
| Curam | Tablet 500 mg, 125 mg | 15 tab pack varies | Nabulsi Drug Store | 3.260 |
| CLAVODAR 625 TABLETS | Tablet 500 mg, 125 mg | 14 tab pack varies | Dar Al Dawa Development and Investment Co Ltd/Jordan | 3.390 |
| Moxiclav F.C Tab | Film-Coated Tablet 500 mg, 125 mg | 16 tab pack varies | Khoury Drug Store | 3.460 |
| Koact | Suspension 250 mg/5 ml, 62.5 mg/5 ml | 100 ml | AL Rahma Drug Store | 3.490 |
| Amoclan Forte Tablets | Tablet (as trihydrate) 500 mg, (as potassium) 125 mg | 15 tab pack varies | Hikma Pharmaceuticals Co.Ltd/Jordan | 3.630 |
| Ramoclav-625 tablets | Tablet Anhydrous 500 mg, 125 mg | 15 tab pack varies | AL-RAM PHARMA.INDUS.CO.LTD/JORDAN | 3.630 |
| Amoclan Tablets | Tablet (as trihydrate) 250 mg, (as potassium) 125 mg | 20 tab | Hikma Pharmaceuticals Co.Ltd/Jordan | 3.640 |
| Clavar 375mg Tab Tablets | Tablet 250 mg, 125 mg | 20 tab | The Arab Pharmaceutical Manufacturing PSC/Salt | 3.640 |
| Ramoclav-375 tablets | Tablet Anhydrous 250 mg, 125 mg | 20 tab | AL-RAM PHARMA.INDUS.CO.LTD/JORDAN | 3.640 |
| Klamoks Bid Fort | Solution 400 mg, 57 mg | 70 ml | Itqan Pharmaceutical Industries/Jordan | 3.700 |
| Augmentin Tab | Tablet 250 mg, 125 mg | 20 tab | Suleiman Tannous & Sons Co. Ltd | 3.830 |
| Curam | Suspension 250 mg/5 ml, 62.5 mg/5 ml | 100 ml | Nabulsi Drug Store | 3.910 |
| Megamox Tab | Tablet 125 mg, 875 mg | 14 tab | IBN CINA DRUG STORE | 3.930 |
| Klamoks BID Tab | Tablet 875 mg, 125 mg | 10 tab | Itqan Pharmaceutical Industries/Jordan | 3.940 |
| Augmentin 457 Susp. | Suspension 400 mg/5 ml, 57 mg/5 ml | 70 ml | Suleiman Tannous & Sons Co. Ltd | 4.010 |
| Moxiclav Forte Sus | Suspension 250 mg/5 ml, 62.5 mg/5 ml | 100 ml | Khoury Drug Store | 4.070 |
| Augmentin Infant Drops 62.5mg/ml Powder for oral suspension | Suspension 250 mg/5 ml, 62.5 mg/5 ml | 20 ml | Suleiman Tannous & Sons Co. Ltd | 4.080 |
| Amoclan BID | Suspension 400 mg/5 ml, 57 mg/5 ml | 70 ml pack varies | Hikma Pharmaceuticals Co.Ltd/Jordan | 4.100 |
| CLAVODAR 400/57 Forte | Suspension 400 mg/5 ml, 57 mg/5 ml | 70 ml | Dar Al Dawa Development and Investment Co Ltd/Jordan | 4.100 |
| Julmentin 2X | Solution 400 mg, 57 mg | 70 ml | Professional Drug Store | 4.110 |
| Moxiclav | Tablet 875 mg, 125 mg | 14 tab | Khoury Drug Store | 4.200 |
| KOACT | Tablet 875 mg, 125 mg | 15 tab | AL Rahma Drug Store | 4.210 |
| Curam Tab | Tablet 875 mg, 125 mg | 10 tab pack varies | Nabulsi Drug Store | 4.250 |
| Curam | Tablet 500 mg, 125 mg | 20 tab pack varies | Nabulsi Drug Store | 4.340 |
| Moxiclav F.C Tab | Film-Coated Tablet 500 mg, 125 mg | 20 tab pack varies | Khoury Drug Store | 4.340 |
| Augmentin 312 Susp. | Suspension 250 mg/5 ml, 62.5 mg/5 ml | 100 ml | Suleiman Tannous & Sons Co. Ltd | 4.590 |
| Amoclan Forte Suspension | Suspension (as Trihydrate) 250 mg/5 ml, (as potassium) 62.5 mg/5 ml | 100 ml | Hikma Pharmaceuticals Co.Ltd/Jordan | 4.620 |
| Clavar Forte | Suspension 250 mg/5 ml, 62.5 mg/5 ml | 100 ml | The Arab Pharmaceutical Manufacturing PSC/Salt | 4.620 |
| Megamox susp. | Suspension 250 mg/5 ml, 62.5 mg/5 ml | 100 ml | IBN CINA DRUG STORE | 4.620 |
| Ramoclav-312 suspension | Suspension 250 mg/5 ml, 62.5 mg/5 ml | 100 ml pack varies | AL-RAM PHARMA.INDUS.CO.LTD/JORDAN | 4.620 |
| Amoclan BID Tablets | Tablet 875 mg, 125 mg | 10 tab pack varies | Hikma Pharmaceuticals Co.Ltd/Jordan | 4.630 |
| Julmentin Forte 312mg/5ml Susp. | Suspension 250 mg/5 ml, 62.5 mg/5 ml | 100 ml | Professional Drug Store | 4.630 |
| Curam | Suspension 400 mg/5 ml, 57 mg/5 ml | 100 ml pack varies | Nabulsi Drug Store | 4.660 |
| Amoclan Bid | Suspension 600 mg/5 ml, 42.9 mg/5 ml | 75 ml | Hikma Pharmaceuticals Co.Ltd/Jordan | 4.700 |
| Amoclan Forte Tablets | Tablet (as trihydrate) 500 mg, (as potassium) 125 mg | 20 tab pack varies | Hikma Pharmaceuticals Co.Ltd/Jordan | 4.840 |
| CLAVODAR 625 TABLETS | Tablet 500 mg, 125 mg | 20 tab pack varies | Dar Al Dawa Development and Investment Co Ltd/Jordan | 4.840 |
| Clavar Forte | Tablet 500 mg, 125 mg | 20 tab | The Arab Pharmaceutical Manufacturing PSC/Salt | 4.840 |
| Ramoclav | Tablet Anhydrous 500 mg, 125 mg | 20 tab pack varies | AL-RAM PHARMA.INDUS.CO.LTD/JORDAN | 4.840 |
| Julmentin ES Susp | Suspension 600 mg/5 ml, 42.9 mg/5 ml | 100 ml | Professional Drug Store | 4.880 |
| CLAVODAR | Tablet 875 mg, 125 mg | 10 tab pack varies | Dar Al Dawa Development and Investment Co Ltd/Jordan | 4.960 |
| Curam Tab | Tablet 875 mg, 125 mg | 14 tab pack varies | Nabulsi Drug Store | 5.050 |
| Augmentin 1 gm FC Tablet | Film-Coated Tablet 875 mg, 125 mg | 14 tab | Suleiman Tannous & Sons Co. Ltd | 5.610 |
| Augmentin Tab | Tablet 500 mg, 125 mg | 20 tab | Suleiman Tannous & Sons Co. Ltd | 5.690 |
| Clavodar ES Powder For Oral Susp | Suspension 600 mg/5 ml, 42.9 mg/5 ml | 100 ml | Dar Al Dawa Development and Investment Co Ltd/Jordan | 6.270 |
| Amoclan BID Tablets | Tablet 875 mg, 125 mg | 14 tab pack varies | Hikma Pharmaceuticals Co.Ltd/Jordan | 6.490 |
| Klavox Tab | Tablet 875 mg, 125 mg | 14 tab | Shawi & Rushedat Drug Store | 6.490 |
| CLAVODAR | Tablet 875 mg, 125 mg | 14 tab pack varies | Dar Al Dawa Development and Investment Co Ltd/Jordan | 6.940 |
| Amoclan Bid 400/57 Chewable Tab | Chewable Tablet 400 mg, 57 mg | 18 Chew Tab | Hikma Pharmaceuticals Co.Ltd/Jordan | 7.480 |
| Julmentin 2X | Tablet 875 mg, 125 mg | 15 tab | Professional Drug Store | 7.540 |
| Amoclan 600mg vials | Vial (as Sodium)500 mg, 100 mg | 10 vial pack varies | Hikma Pharmaceuticals Co.Ltd/Jordan | 8.750 |
| Moxiclav | Vial 1000 mg, 200 mg | 10 vial pack varies | Khoury Drug Store | 13.630 |
| Amoclan 1200 vials | Vial (as Sodium)1000 mg, as potassium clavulanate 200 mg | 10 vial pack varies | Hikma Pharmaceuticals Co.Ltd/Jordan | 16.300 |