Nafcillin

SERUM BINDING OF...NAFCILLIN...IS REDUCED WHEN ADMIN CONCURRENTLY WITH ASPIRIN.

CHLORAMPHENICOL MAY ANTAGONIZE ACTION OF PENICILLINS. /PENICILLINS/

...ALL...PENICILLINS & ERYTHROMYCINS MAY THEORETICALLY BE EXPECTED TO.../EXHIBIT SYNERGISTIC ANTIBACTERIAL ACTIVITY/. /PENICILLINS/

TETRACYCLINE MAY ANTAGONIZE BACTERICIDAL EFFECT OF PENICILLIN /G/...ANTAGONISM OF ACTION OF ALL...PENICILLINS MIGHT BE EXPECTED. /PENICILLINS/

For more Interactions (Complete) data for NAFCILLIN (14 total), please visit the HSDB record page.

Only rare instances of clinically apparent hepatotoxicity have been linked touse of nafcillin. Typically, the injury is a cholestatic hepatitis thatarises 1 to 6 weeks after starting nafcillin and can be prolonged butultimately resolves. Rash, fever, and eosinophilia are uncommon but canoccur (Case 1). The injury is much like that described with flucloxacillinand cloxacillin but is less frequent with nafcillin. Autoantibodies areuncommon. These favorable outcomes are typical but not invariable. At leastone instance of acute liver failure and one with persistent cholestasis andvanishing bile duct syndrome have been reported. Interestingly, thepersistent serum aminotransferase elevations that are common during highdose intravenous therapy with oxacillin appear to be rare with high doses ofintravenous nafcillin. In several reports of patients who developed elevatedserum aminotransferase levels while on high dose oxacillin, switching tointravenous nafcillin or other penicillin antibiotics was done withoutrecurrence of the liver injury. This may relate to the peak doses chosen forintravenous oxacillin versus nafcillin.

Renal, hepatic, and hematologic systems should be evaluated periodically during prolonged therapy with nafcillin. Because adverse hematologic effects have occurred during therapy with penicillinase-resistant penicillins, total and differential leukocyte counts should be performed prior to initiation of therapy and 1-3 times weekly during therapy. In addition, urinalysis should be performed and BUN and serum creatinine, AST (SCOT), and ALT (SGPT) concn should be determined prior to and periodically during therapy.

SEE PENICILLINS. MASSIVE IV DOSES...(20-60 MILLION UNITS/DAY...) MAY RESULT IN ENCEPHALOPATHY WITH MUSCULAR HYPERIRRITABILITY, MYOCLONUS, VISUAL & AUDITORY HALLUCINATIONS & GENERALIZED CONVULSIONS. /PENICILLINS/

OF 29 STAPH AUREUS PATIENTS TREATED WITH 12 G/DAY IV NAFCILLIN, 4 HAD FEVER, RASH, & LEUKOPENIA; 1 HAD ABSOLUTE NEUTROPENIA.

EFFECT IS MOST LIKELY DUE TO DIRECT TOXIC EFFECT ON BONE MARROW. USUALLY OCCURS DURING 3RD WK THERAPY & REMITS WITH DRUG CESSATION.

HYPOKALEMIA WAS ASSOCIATED WITH NAFCILLIN ADMINISTRATION.

For more Human Toxicity Excerpts (Complete) data for NAFCILLIN (46 total), please visit the HSDB record page.

Drug-Induced Liver Injury Severity and Toxicity (DILIst)

nafcillin

DILI Positive

Intravenous

DOI:10.1016/j.drudis.2019.09.022

IN MICE, RATS, RABBITS...DEATH FROM RESP FAILURE WITH OR WITHOUT CONVULSIONS OCCURRED 6-18 HR AFTER SINGLE ORAL DOSES. ACUTE GASTROENTERITIS & CARDIOVASCULAR SHOCK WERE ASSOC PHENOMENA. /PENICILLINS/

/IN GUINEA PIGS,/ DEATH FROM RESP FAILURE WITH OR WITHOUT CONVULSIONS OCCURRED 6-18 HR AFTER SINGLE ORAL DOSES. ACUTE GASTROENTERITIS & CARDIOVASCULAR SHOCK... ALSO...A LATE (1-2 WK) & GRADUALLY DEVELOPING TOXEMIA KILLED ALL SURVIVORS OF ACUTE RESPONSE. /PENICILLINS/

IN HAMSTERS THE DRUG IS SOMEWHAT MORE TOXIC BY THE ORAL THAN BY THE SC ROUTE WHEN OBSERVED FOR 14 DAYS AFTER SINGLE DOSES. TOLERANCE DEVELOPED TO MULTIPLE DOSING. PERHAPS THE SENSITIVITY OF GUINEA PIGS IS RELATED TO EFFECTS ON INTESTINAL MICROFLORA. /PENICILLINS/

...CATS & DOGS...DEATH FROM RESP FAILURE WITH OR WITHOUT CONVULSIONS OCCURRED 6-18 HR AFTER SINGLE ORAL DOSES. ACUTE GASTROENTERITIS & CARDIOVASCULAR SHOCK WERE ASSOC PHENOMENA. /PENICILLINS/

For more Non-Human Toxicity Excerpts (Complete) data for NAFCILLIN (6 total), please visit the HSDB record page.

Manufacturers, packers, and distributors of drug and drug products for human use are responsible for complying with the labeling, certification, and usage requirements as prescribed by the Federal Food, Drug, and Cosmetic Act, as amended (secs 201-902, 52 Stat. 1040 et seq., as amended; 21 U.S.C. 321-392).

MEDICATION

MEDICATION (VET)

6-AMINOPENICILLANIC ACID IS ACYLATED BY TREATMENT WITH 2-ETHOXY-1-NAPHTHOYL CHLORIDE IN ANHYDROUS ORG SOLVENT CONTAINING TRIETHYLAMINE. AQ EXTRACT OF THIS...IS ADMIXED WITH WATER-IMMISCIBLE SOLVENT & NAFCILLIN PPTD BY ADDN OF SULFURIC ACID. NAFCILLIN SODIUM IS PPTD BY MIXING ETHANOLIC SOLN OF ACID & SODIUM ETHYLHEXANOATE

POWDER FOR INJECTION IS BUFFERED WITH 40 MG SODIUM CITRATE/G OF DRUG; CAPSULES & TABLETS ARE BUFFERED WITH CALCIUM CARBONATE.

NAFCILLIN SODIUM, USP (UNIPEN)...AVAILABLE FOR ORAL & PARENTERAL USE. CAPSULES USUALLY CONTAIN 250 MG...DRUG. SOLN IS ALSO MARKETED FOR ORAL USE. STERILE PREPN FOR INJECTION...AMPULS CONTAINING 500 MG, 1 G, OR 2 G OF SALT. /NAFCILLIN SODIUM/

...A SEMISYNTHETIC PENICILLIN, DERIVED FROM 6-AMINOPENICILLANIC ACID, IS HIGHLY RESISTANT TO PENICILLINASE...

PATENTS: US PATENT 3,157,639. /NAFCILLIN SODIUM/

POTENCY: NOT LESS THAN 820 UG OF NAFCILLIN/MG. /NAFCILLIN SODIUM/

Doyle et al. Brit pat 880,400 (1961 to Beecham) /Nafcillin sodium/