Nafcillin

DEA Class; Rx

Common Brand Names; Nafcil, Nallpen

Indicated for the treatment of mastitis.

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

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

• Hypersensitivity
• Neutropenia
• Interstitial nephritis
• Possible hypokalemia
• Neurotoxicity (high doses)
• Pseudomembranous colitis
• Phlebitis (oxacillin preferred in peds)

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

Use with caution in patients with histories of significant allergies and/or asthma; whenever allergic reactions occur, withdraw penicillin unless, in the opinion of the physician, the condition being treated is life-threatening and amenable only to penicillin therapy

Liver/biliary tract is primary route of nafcillin clearance; exercise caution when patients with concomitant hepatic insufficiency and renal dysfunction are treated with this drug

Prescribing the antibiotic in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria

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

Elevation of liver transaminases and/or cholestasis may occur, specifically with administration of high doses

Urinalysis, serum blood urea nitrogen, and creatinine determinations should be performed at baseline and periodically during therapy; serum bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, and gamma-glutamyl transferase should be obtained at baseline and periodically during therapy, especially when using high nafcillin doses; in patients with worsening hepatic

Renal tubular damage and interstitial nephritis associated with administration of nafcillin; manifestations of nephrotoxicity are hematuria, proteinuria, and acute kidney injury, and may be associated with rash, fever, and eosinophilia; majority of cases resolve upon discontinuation of nafcillin; some patients, may require dialysis treatment and may develop permanent renal damage

Pregnancy Category: B

Lactation: Excreted into breast milk; use caution