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Nallpen (nafcillin) Disease Interactions

There are 4 disease interactions with Nallpen (nafcillin):

Major

Penicillinase-Resistant Pcns (Includes Nallpen) ↔ Marrow Toxicity

Severe Potential Hazard, Moderate plausibility

Applies to: Neutropenia, Thrombocytopenia

The use of penicillinase-resistant penicillins has been associated with adverse hematologic effects, including neutropenia, leukopenia, granulocytopenia and thrombocytopenia, particularly when given in high parenteral dosages. Agranulocytosis and prolonged bleeding time have been reported rarely. Therapy with penicillinase-resistant penicillins should be administered cautiously in patients with preexisting blood dyscrasias or bone marrow depression, and hematopoietic function should be monitored. Blood counts with differential should be performed prior to initiation of therapy and 1 to 3 times weekly during therapy. Hematologic abnormalities are generally reversible and resolve within several days to two weeks following discontinuation of therapy.

References

  1. "Product Information. Staphcillin (methicillin)." Apothecon Inc, Plainsboro, NJ.
  2. "Product Information. Dynapen (dicloxacillin)." Apothecon Inc, Plainsboro, NJ.
  3. Leventhal JM, Silken AB "Oxacillin-induced neutropenia in children." J Pediatr 89 (1976): 769-71
View all 29 references
Moderate

Antibiotics (Includes Nallpen) ↔ Colitis

Moderate Potential Hazard, Moderate plausibility

Applies to: Colitis/Enteritis (Noninfectious)

Pseudomembranous colitis has been reported with most antibacterial agents and may range in severity from mild to life-threatening, with an onset of up to two months following cessation of therapy. Antibiotic therapy can alter the normal flora of the colon and permit overgrowth of Clostridium difficile, whose toxin is believed to be a primary cause of antibiotic- associated colitis. The colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus. The most common culprits are clindamycin, lincomycin, the aminopenicillins (amoxicillin, ampicillin), and the cephalosporins. Therapy with broad-spectrum antibiotics and other agents with significant antibacterial activity should be administered cautiously in patients with a history of gastrointestinal diseases, particularly colitis. There is some evidence that pseudomembranous colitis, if it occurs, may run a more severe course in these patients and that it may be associated with flares in their underlying disease activity. The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically. A large bowel endoscopy may be considered to establish a definitive diagnosis in cases of severe diarrhea.

References

  1. Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
  2. Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
  3. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
View all 47 references
Moderate

Nafcillin (Includes Nallpen) ↔ Renal/Liver Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease, Renal Dysfunction

Nafcillin is primarily metabolized by the liver but also partially excreted unchanged by the kidney. The serum concentration of nafcillin may be increased and the half-life prolonged in patients with significantly impaired renal and/or hepatic function. In general, dosage adjustments are not necessary in either renal or hepatic impairment alone, but may be appropriate in patients with both renal and hepatic failure. Renal and liver function tests should be performed periodically during prolonged therapy.

References

  1. Diaz CR, Kane JG, Parker RH, Pelsor FR "Pharmacokinetics of nafcillin in patients with renal failure." Antimicrob Agents Chemother 12 (1977): 98-101
  2. Rudnick M, Morrison G, Walker B, Singer I "Renal failure, hemodialysis, and nafcillin kinetics." Clin Pharmacol Ther 20 (1976): 413-25
  3. "Product Information. Unipen (nafcillin)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 4 references
Moderate

Nafcillin (Includes Nallpen) ↔ Sodium/Potassium

Moderate Potential Hazard, High plausibility

Applies to: Congestive Heart Failure, Fluid Retention, Hypertension, Hypernatremia, Hypokalemia

Each gram of parenteral nafcillin sodium contains approximately 67 mg (2.9 mEq) of sodium and is buffered with 40 mg of sodium citrate. Each 250 mg capsule of nafcillin sodium contains approximately 17 mg (0.7 mEq) of sodium buffered with calcium carbonate. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention. In addition, hypokalemia has been reported rarely during therapy with the penicillinase-resistant penicillins, which may be particularly important to bear in mind when treating patients with low potassium reserves or fluid and electrolyte imbalance. Clinical monitoring of electrolytes is recommended if these agents are used for prolonged periods.

References

  1. Schlaeffer F "Oxacillin-associated hypokalemia." Drug Intell Clin Pharm 22 (1988): 695-6
  2. "Product Information. Unipen (nafcillin)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. Andreoli SP, Kleiman MB, Glick MR, Bergstein JM "Nafcillin, pseudoproteinuria, and hypokalemic alkalosis." J Pediatr 97 (1980): 841-2

Nallpen (nafcillin) drug Interactions

There are 282 drug interactions with Nallpen (nafcillin)

Nallpen (nafcillin) alcohol/food Interactions

There are 2 alcohol/food interactions with Nallpen (nafcillin)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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