Brand and Other Names:Nafcil, Nallpen
- Classes: Penicillins, Penicillinase-Resistant
Dosing & Uses
Dosage Forms & Strengths
powder for injection
500 mg IV/IM q4-6hr
1 g IV/IM q4hr
2 g IV q4hr for 4-6 weeks; may be longer and may add rifampin and gentamicin if prosthetics present
2 g IV q4hr
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.
Dose adjustment not necessary unless concomitant hepatic failure present
Dose adjustment not necessary unless concomitant renal failure present
Dosage Forms & Strengths
powder for injection
Serious - Use Alternative
Significant - Monitor Closely
Neurotoxicity (high doses)
Phlebitis (oxacillin preferred in peds)
A history of a hypersensitivity (anaphylactic) reaction to any penicillin
Solutions containing dextrose in patients with known allergy to corn or corn products
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
Pregnancy & Lactation
Pregnancy Category: B
Lactation: Excreted into breast milk; use caution
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.
Mechanism of Action
Inhibit synthesis of bacterial cell wall synthesis, which results in bactericidal activity
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
Excretion: Liver (primarily), renal (10-30%)
Enzymes induced: Hepatic CYP3A4
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
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
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
- Reconstitute 10 g of drug w/ 93 mL SWI/NS to 100 mg/mL
- THEN further dilute before administration
- Not for direct IV injection
IM: deep into large muscle
IV inj: slowly over 5-10 min
IV infusion: over at least 30-60 min
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