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nafcillin (Rx)Brand and Other Names:Nafcil, Nallpen

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 20mg/mL
  • 2g/100mL

powder for injection

  • 1g
  • 2g
  • 10g
more...

Susceptible Infections

500 mg IV/IM q4-6hr

Severe Infections

1 g IV/IM q4hr

Staphylococcal Endocarditis

2 g IV q4hr for 4-6 weeks; may be longer and may add rifampin and gentamicin if prosthetics present

Bursitis septic

2 g IV q4hr

Administration

Initial therapy for suspected penicillin G-resistant streptococcal or staphylococcal infections.

Use parenteral therapy initially in severe infections.

Change to oral therapy as condition warrants. Due to thrombophlebitis, particularly in the elderly, administer parenterally only for short term (1-2 d); change to oral route as clinically indicated.

Renal Impairment

Dose adjustment not necessary unless concomitant hepatic failure present

Hepatic Impairment

Dose adjustment not necessary unless concomitant renal failure present

Dosage Forms & Strengths

injectable solution

  • 20mg/mL
  • 2g/100mL

powder for injection

  • 1g
  • 2g
  • 10g
more...

Susceptible Infections

50-100 mg/kg/day IV/IM divided q6hr 

Maximum 12g/day

Severe Infections

100-200 mg/kg/day IV/IM divided q6hr  

Staphylococcal Endocarditis

200mg/kg/day IV divided q4-6hr for 6 weeks; may be longer and may add rifampin and gentamicin if prosthetics present 

Neonates (<28 Days Old)

(<7 days old, <2 kg) OR (>7 days old, <1.2 kg): 50 mg/kg/day IV/IM divided q12hr  

(<7 days old, >2 kg) OR (>7 days old, 1.2-2 kg): 75 mg/kg/day IV/IM divided q8hr

(>7 days old, >2 kg): 100-140 mg/kg/day IV/IM divided q6hr

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Interactions

Interaction Checker

nafcillin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Hypersensitivity

            Neutropenia

            Interstitial nephritis

            Possible hypokalemia

            <1%

            Neurotoxicity (high doses)

            Pseudomembranous colitis

            Phlebitis (oxacillin preferred in peds)

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            Warnings

            Contraindications

            A history of a hypersensitivity (anaphylactic) reaction to any penicillin

            Solutions containing dextrose in patients with known allergy to corn or corn products

            Cautions

            Evaluate renal, hepatic, hematologic systems periodically during prolonged treatment

            Serious and occasionally fatal hypersensitivity (anaphylactic) reactions reported; reactions are more likely to occur in individuals with history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens; inquire about previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens before initiating therapy; if allergic reaction occurs, discontinue treatment and institute appropriate therapy

            If clostridium difficile associated diarrhea (CDAD) suspected or confirmed, may need to discontinue ongoing antibiotic use not directed against C. difficile; appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated

            The use of antibiotics may result in overgrowth of nonsusceptible organisms; if new infections due to bacteria or fungi occur, discontinue drug and take appropriate measures

            To optimize therapy, determine causative organisms and susceptibility; > 10 d treatment to eliminate infection and prevent sequelae (eg, endocarditis, rheumatic fever); take cultures after treatment to confirm that infection is eradicated

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: Excreted into breast milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Inhibit synthesis of bacterial cell wall synthesis, which results in bactericidal activity

            Pharmacokinetics

            Half-Life: 0.5-1.5 hr (adults); 0.75-1.9 hr (children)

            Peak Plasma Time: 0.5-1 hr

            Protein binding: 90%

            Absorption: Poorly absorbed orally

            Distribution: In fluid, bone, bile, crosses placenta

            Vd: 0.5-1.5 L/kg

            Metabolism: Liver

            Excretion: Liver (primarily), renal (10-30%)

            Enzymes induced: Hepatic CYP3A4

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            Administration

            IV Incompatibilities

            Additive: aminophylline(?), ascorbic acid, aztreonam, bleomycin, cytarabine, gentamicin, hydrocortisone sodium succinate, methylprednisolone sodium succinate, promazine, vit B/C(?)

            Y-site: diltiazem(?), droperidol, insulin (regular), labetalol, meperidine(?), midazolam, nalbuphine, pentazocine, vancomycin(?), verapamil

            IV Compatibilities

            Solution: compatible w/ most common solvents

            Additive (partial list): dexamethasone sodium phosphate, diphenhydramine, heparin, lidocaine, KCl, prochlorperazine, Na bicarb

            Syringe: cimetidine, heparin

            Y-site (partial list): acyclovir, atropine, diazepam, fentanyl, fluconazole, heparin, MgSO4, morphine, propofol, zidovudine

            IV/IM Preparation

            IM/IV: reconstitute 1-2 g of drug w/ 3.4- 6.8 mL SWI/BWI/NS to 250 mg/mL

            IV inj: further dilute w/ 15-30 mL SWI/NS

            IV infusion: further dilute w/ IV solution according to Mfr's directions

            Bulk Packages:

            • Reconstitute 10 g of drug w/ 93 mL SWI/NS to 100 mg/mL
            • THEN further dilute before administration
            • Not for direct IV injection

            IV/IM Administration

            IM: deep into large muscle

            IV inj: slowly over 5-10 min

            IV infusion: over at least 30-60 min

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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