Nafcillin Sodium

A to Z Drug Facts

 Action Inhibits bacterial cell wall mucopeptide synthesis.

 Indications Treatment of infections caused by penicillinase-producing staphylococci.

 Contraindications Standard considerations.

 Route/Dosage

Adults: IV Usual, 500 mg q 4 hr. Severe infections, 1 g q 4 hr. Infuse over at least 30 to 60 min.

 Interactions

Cyclosporine: May reduce blood levels of cyclosporine. Disulfuram: May increase nafcillin levels. Probenecid: May increase nafcillin levels. Tetracycline: May reduce effectiveness of nafcillin. Warfarin: May increase warfarin effects.

 Lab Test Interferences May cause false-positive urine reaction for protein when the sulfosalicylic acid test is used.

 Adverse Reactions

GI: Pseudomembranous colitis. GU: Renal tubular damage; interstitial nephritis. HYPERSENSITIVITY: Immediate hypersensitivity reactions including urticaria; pruritus; angioneurotic edema; laryngospasm; bronchospasm; hypotension; vascular collapse. Delayed reactions including fever, malaise, urticaria, myalgia, arthralgia, abdominal pain, and rashes. METABOLIC: Agranulocytosis; neutropenia; bone marrow depression. OTHER: Local reactions include pain, swelling, phlebitis, thrombophlebitis, inflammation at the injection site.

 Precautions

Pregnancy: Category B. Lactation: Secreted into breast milk. Children: Excretion may be impaired in newborns. Not approved for IV use in neonates or children. Hypersensitivity: Use with caution in patients with histories of significant allergies to pencillins or asthma. Superinfection: May result in overgrowth of nonsusceptible organisms. Liver dysfuntion: May reduce nafcillin elimination. Renal function impairment: May reduce nafcillin elimination.

 Administration/Storage

• For IV administration only. Do not administer intradermal, SC, or IM.
• Infuse prescribed dose q 4 hr.
• Infuse over 30 to 60 min to reduce risk of vein irritation and extravasation.
• Thaw frozen container at room temperature (77°F) or under refrigeration (41°F). Do not force thawing by immersion in water or by microwave irradiation.
• Check thawed IV container for minute leaks by squeezing bag firmly. If leaks are detected discard solution because sterility may be impaired.
• Agitate thawed IV container and inspect visually. Do not administer if thawed solution is cloudy, discolored, or contains particulate matter or if any seal or outlet port is not intact.
• Do not add other medications to IV container.
• Follow manufacturer's instructions for preparing the IV container for administration.
• Do not use plastic nafcillin containers in series to reduce risk of air embolism.
• Store IV bag in freezer at -4°F. Thawed solutions are stable for 21 days under refrigeration (41°F) or for 72 hr at room temperature (77°F). Do not refreeze thawed solutions.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies, especially to penicillin and beta-lactam antibiotics. Note history of asthma, multiple allergies, or concomitant liver and renal impairment.
• Ensure that culture and susceptibility test results indicate sensitivity to nafcillin.
• Ensure that nafcillin is discontinued and another antimicrobial agent is started if culture and sensitivity tests indicate that the infection is caused by an organism other than a pencillinase-producing staphylococci.
• Ensure that WBC and differential are determined prior to starting therapy and periodically during therapy.
• Ensure that periodic urinalysis, liver enzymes, and renal function are determined periodically during prolonged therapy.
• Ensure that nafcillin serum levels are determined periodically in patients with concomitant renal and hepatic dysfunction and that the nafcillin dose is changed appropriately.
• Monitor for signs of infection, especially fever, and for positive response to antibiotic therapy.
• Monitor patient for signs of anaphylaxis or severe allergic reaction. If noted discontinue therapy and immediately notify health care provider. Be prepared to treat appropriately.
• Monitor administration site for pain, inflammation, swelling, or phlebitis. Change administration site and treat injection site reaction appropriately if noted.
• Monitor patient for GI, CNS, and general body side effects. Report to health care provider if noted and significant.
• If seizure occurs, withhold drug, institute safety measures, and notify health care provider.
• Withhold drug and notify health care provider if any of the following occurs: severe diarrhea; loose, foul-smelling stools; vaginal itching or discharge.

 Patient/Family Education

• Explain name, dose, action, and potential side effects of drug.
• Explain to patient or caregiver that medication is usually prepared and administered by a health care provider in a health care setting but may be used at home in some situations if ordered by the patient's health care provider.
• If patient or caregiver is administering at home ensure that the patient or caregiver understands how to store, prepare and administer the dose, and dispose of used equipment and supplies. The first injection should be performed under the supervision of a qualified health professional.
• Review dosing schedule and prescribed length of therapy with patient. Advise patient that dose and duration of therapy are dependent on site and cause of infection and response to therapy.
• Instruct patient to report the following to health care provider: itching; rash; hives; difficulty breathing; diarrhea; loose, foul-smelling stools; injection site reaction.
• Advise patient that follow-up visits and lab tests may be needed to monitor therapy and to keep appointments.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts