Names and pronunciation
(naf-sill′in)
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Drug reference
(naf-sill′in)
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Func. class.: Antibiotic, broad-spectrum
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Chem. class.: Penicillinase-resistant penicillin
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ACTION: Bacteriocidal, interferes with cell-wall replication of susceptible organisms
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USES: Effective for gram-positive cocci (Staphylococcus aureus, Streptococcus viridans, Streptococcus pneumoniae), infections caused by penicillinase- producing Staphylococcus
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CONTRAINDICATIONS: Hyper- sensitivity to penicillins Precautions: Pregnancy, breastfeed- ing, neonates; hypersensitivity to cepha- losporins or carbapenems; GI disease, asthma, electrolyte imbalances, hepatic/ renal disease, CDAD
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SIDE EFFECTS CNS: Neurotoxicity, seizures GI: Nausea, vomiting, diarrhea, CDAD GU: Proteinuria, glomerulonephritis, interstitial nephritis HEMA: Neutropenia, thrombocytopenia, leukopenia, agranulocytosis, anemia INTEG: Tissue necrosis, extravasation at site, inj rash, pruritus, exfoliative dermatitis SYST: Anaphylaxis, serum sickness, Stevens-Johnson syndrome
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INTERACTIONS Increase: nafcillin concentrations— probenecid, used to increase nafcillin action Decrease: effect of cycloSPORINE— warfarin, monitor closely Decrease: nafcillin effect—tetracyclines, aminoglycosides Decrease: effect of live virus vaccines, do not use together Decrease: effects of CYP3A4 substrates, bedaquiline, clarithromycin, cloZAPine, fentaNYL, lurasidone, zolpidem, monitor closely Decrease: effect of hormonal contracep- tives, use additional contraceptives Drug/Lab Test Increase: LFTs Decrease: HB/HcT, neutrophils False positive: urine glucose, urine pro- tein, Coombs test
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DOSAGE AND ROUTES • Adult: IV 1-2 g q4hr for severe infec- tions • Child and infant >1 mo: IV 100-200 mg/kg/day in divided doses, max 12 g/day • Neonate 25 mg/kg/dose q6h × 14 days
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Available forms: inj 1 g/vial, 2 g/vial, 10 g/vial premixed or Add Vantage Vials
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Administer: • Product after C&S has been drawn, begin therapy while waiting for results • Check for allergy to penicillins, cepha- losporins IM route • Reconstitute vials: add 1.7, 3.4, or 6.4 mL sterile water for inj, 0.9% NaCl, bac- teriostatic water for inj to vials with 500 mg, 1 g, 2 g of nafcillin, respectively (250 mg/mL) • After reconstitution, inject in deep muscle mass • Use sterile water for injection or 0.9% NaCl to prevent using benzyl alcohol (neonate) IV route • Reconstitute vials: add 1.7, 3.4, or 6.4 mL sterile water for inj, 0.9% NaCl, bacterio- static water for inj to vials with 500 mg, 1 g, 2 g of nafcillin, respectively (250 mg/mL) Intermittent IV route • Vials, further dilute reconstituted sol to 10-40 mg/mL infuse ≥ 30-60 mins • Change IV site q48hr to prevent irrita- tion, check for extravasation often Y-site compatibilities: Acyclovir, alfentanil, amikacin, aminophylline, amphotericin B lipid complex (Abelcet), anidulafungin, argatroban, ascorbic acid injection, ateno- lol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bretylium, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, cefamandole, ceFAZolin, cefoperazone, cefotaxime, cefo- TEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMA- ZINE, cimetidine, CISplatin, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, DACTINomycin, DAPTOmy- cin, DAUNOrubicin liposome, dexametha- sone, digoxin, DOBUTamine, DOCEtaxel, DOPamine, DOXOrubicin liposomal, enal- aprilat, EPHEDrine, EPINEPHrine, epoetin alfa, erythromycin, etoposide, etoposide phosphate, famotidine, fenoldopam, fen- taNYL, fluconazole, fludarabine, foscarnet, furosemide, gallium, ganciclovir, gatifloxa- cin, gemtuzumab, gentamicin, glycopyrro- late, granisetron, heparin, hydrocortisone, HYDROmorphone, imipenem-cilastatin, indomethacin, isoproterenol, ketorolac, lactated Ringer’s, lepirudin, leucovorin, lidocaine, linezolid injection, LORazepam, magnesium sulfate, mannitol, methyldo- pate, methylPREDNISolone, metoclo- pramide, metoprolol, metroNIDAZOLE, milrinone, morphine, multiple vitamins injection, naloxone, niCARdipine, nitro- glycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxali- platin, oxytocin, PACLitaxel (solvent/sur- factant), pamidronate, pancuronium, pan- toprazole, PEMEtrexed, penicillin G potassium/sodium, PENTobarbital, per- phenazine, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacillin, polymyxin B, potassium acetate/chloride, procainamide, prochlorperazine, propo- fol, propranolol, ranitidine, Ringer’s injec- tion, sodium bicarbonate, SUFentanil, tacrolimus, teniposide, theophylline, thia- mine, thiotepa, ticarcillin, ticarcillin-clavu- lanate, tigecycline, tirofiban, TNA (3-in-1), tobramycin, tolazoline, TPN (2-in-1), uro- kinase, vasopressin, vinBLAStine, voricon- azole, zidovudine, zoledronic acid
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Assess: Infection: signs, symptoms of infection, N including characteristics of wounds, spu- tum, urine, stool, WBC >10,000/mm3, earache, fever, obtain information base- line, during treatment • I&O ratio; report hematuria, oliguria; high doses are nephrotoxic • CDAD: diarrhea, abdominal pain, fever, fatigue, anorexia; possible anemia, ele- vated WBC, low serum albumin; stop prod- uct; usually either vancomycin or IV met- roNIDAZOLE given • Renal studies: urinalysis, BUN, creati- nine; abnormal urinalysis may indicate nephrotoxicity • C&S before product therapy; product may be given as soon as culture is taken • Allergies before initiation of treat- ment; monitor for anaphylaxis, dyspnea, rash, laryngeal edema; stop product; keep emergency equipment nearby; skin erup- tions after administration of penicillin to 1 wk after discontinuing product • IV site: for redness, swelling, pain at site • Pregnancy/breastfeeding: use only if clearly needed; use caution in breast- feeding, excreted in breast milk
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Evaluate: • Therapeutic response: absence of signs/symptoms of infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report vaginal itching; loose, foul- smelling stools; furry tongue; sore throat; fever; fatigue (may indicate superinfec- tion); CNS reactions; CDAD (diarrhea, fe- ver, abdominal pain, fatigue) • To wear or carry emergency ID if al- lergic to penicillins TREATMENT OF ANAPHY- LAXIS: Withdraw product; maintain airway; administer EPINEPHrine, am- inophylline, O2, IV corticosteroids HIGH ALERT
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PHARMACOKINETICS Half-life 30-60 min; metabolized by liver; excreted in bile, urine; 70%-90% protein bound; peak rapid (IV) peak 30-60 min (IM)
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• Adult: IV 1-2 g q4hr for severe infec- tions
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