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Pronunciation |
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(kar
ben i SIL
in) |
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U.S. Brand
Names |
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Geocillin® |
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Generic
Available |
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No |
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Canadian Brand
Names |
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Geopen® |
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Synonyms |
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Carbenicillin Indanyl Sodium; Carindacillin |
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Pharmacological Index |
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Antibiotic, Penicillin |
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|
Use |
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Treatment of serious urinary tract infections and prostatitis caused by
susceptible gram-negative aerobic bacilli |
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Pregnancy Risk
Factor |
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B |
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Contraindications |
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Hypersensitivity to carbenicillin or any component or
penicillins |
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|
Warnings/Precautions |
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Do not use in patients with severe renal impairment (Clcr <10
mL/minute); dosage modification required in patients with impaired renal and/or
hepatic function; oral carbenicillin should be limited to treatment of urinary
tract infections. Use with caution in patients with history of hypersensitivity
to cephalosporins. |
|
|
Adverse
Reactions |
|
>10%: Gastrointestinal: Diarrhea
1% to 10%: Gastrointestinal: Nausea, bad taste, vomiting, flatulence,
glossitis
<1%: Headache, skin rash, urticaria, anemia, thrombocytopenia, leukopenia,
neutropenia, eosinophilia, hyperthermia, itchy eyes, vaginitis, hypokalemia,
hematuria, thrombophlebitis |
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|
Overdosage/Toxicology |
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Symptoms of overdose include neuromuscular hypersensitivity, convulsions;
many beta-lactam containing antibiotics have the potential to cause
neuromuscular hyperirritability or convulsive seizures
Hemodialysis may be helpful to aid in the removal of the drug from the blood,
otherwise most treatment is supportive or symptom directed |
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Drug
Interactions |
|
Decreased effect with administration of aminoglycosides within 1 hour; may
inactivate both drugs
Increased duration of half-life with probenecid |
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Mechanism of
Action |
|
Inhibits bacterial cell wall synthesis by binding to one or more of the
penicillin binding proteins (PBPs); which in turn inhibits the final
transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus
inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing
activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while
cell wall assembly is arrested. |
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Pharmacodynamics/Kinetics |
|
Absorption: Oral: 30% to 40%
Distribution: Crosses the placenta; small amounts appear in breast milk;
distributes into bile, low concentrations attained in CSF
Half-life: Children: 0.8-1.8 hours; Adults: 1-1.5 hours, prolonged to 10-20
hours with renal insufficiency
Time to peak serum concentration: Within 0.5-2 hours in patients with normal
renal function; serum concentrations following oral absorption are inadequate
for treatment of systemic infections
Elimination: ~80% to 99% excreted unchanged in urine |
|
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Usual Dosage |
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Oral:
Adults: 1-2 tablets every 6 hours for urinary tract infections or 2 tablets
every 6 hours for prostatitis
Dosing interval in renal impairment: Adults:
Clcr 10-50 mL/minute: Administer 382-764 mg every 12-24 hours
Clcr <10 mL/minute: Administer 382-764 mg every 24-48 hours
Moderately dialyzable (20% to 50%) |
|
|
Dietary
Considerations |
|
Should be administered with water on empty stomach |
|
|
Monitoring
Parameters |
|
Renal, hepatic, and hematologic function tests |
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|
Reference Range |
|
Therapeutic: Not established; Toxic: >250 mg/mL
(SI:
>660 mmol/L) |
|
|
Test
Interactions |
|
May interfere with urinary glucose tests using cupric sulfate (Benedict's
solution, Clinitest®); may inactivate aminoglycosides
in vitro; false-positive urine or serum proteins |
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|
Mental Health: Effects
on Mental Status |
|
Penicillins have been reported to cause apprehension, illusions, agitation,
insomnia, depersonalization, and encephalopathy |
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|
Mental Health:
Effects on Psychiatric
Treatment |
|
Rare reports of leukopenia and neutropenia; use caution with clozapine and
carbamazepine |
|
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
|
Prolonged use of penicillins may lead to development of oral
candidiasis |
|
|
Patient
Information |
|
Take as prescribed, at equal intervals around-the-clock, with a full glass of
water, and preferably on an empty stomach (1 hour before or 2 hours after
meals). Do not skip doses and take full course of treatment even if feeling
better. Frequent mouth care will help relieve dry mouth and bitter aftertaste.
Report swelling, respiratory difficulty, easy bruising or bleeding, or signs of
opportunistic infection (eg, sore throat, fever, chills, fatigue, thrush,
vaginal discharge, diarrhea). If diabetic, drug may cause false tests with
Clinitest® urine glucose monitoring; use of glucose
oxidase methods (Clinistix®) or serum glucose monitoring
is preferable. Pregnancy/breast-feeding precautions: This drug may
interfere with oral contraceptives; an alternate form of birth control should be
used. Consult prescriber if breast-feeding. |
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Nursing
Implications |
|
Administer around-the-clock to promote less variation in peak and trough
serum levels
Watch for increased edema, rales, or signs of congestion, bruising, or
bleeding; monitor renal, hepatic, and hematologic function tests
|
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Dosage Forms |
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Tablet, film coated: 382 mg |
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References |
|
Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med,
1988, 318(7):419-26 and 318(8):490-500.
Wright AJ, "The Penicillins," Mayo Clin Proc, 1999, 74(3):290-307.
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