|
|
|
Pronunciation |
|
(lor
a KAR
bef) |
|
|
U.S. Brand
Names |
|
Lorabid™ |
|
|
Generic
Available |
|
No |
|
|
Pharmacological Index |
|
Antibiotic, Carbacephem |
|
|
Use |
|
Infections caused by susceptible organisms involving the respiratory tract,
acute otitis media, sinusitis, skin and skin structure, bone and joint, and
urinary tract and gynecologic |
|
|
Pregnancy Risk
Factor |
|
B |
|
|
Contraindications |
|
Patients with a history of hypersensitivity to loracarbef or
cephalosporins |
|
|
Warnings/Precautions |
|
Modify dosage in patients with severe renal impairment; prolonged use may
result in superinfection; use with caution in patients with a previous history
of hypersensitivity to other beta-lactam antibiotics (eg, penicillins,
cephalosporins) |
|
|
Adverse
Reactions |
|
>1%: Gastrointestinal: Diarrhea
<1%: Seizures (with high doses and renal dysfunction), headache,
nervousness, rash, urticaria, pruritus, Stevens-Johnson syndrome, nausea,
vomiting, pseudomembranous colitis, eosinophilia, hemolytic anemia, neutropenia,
positive Coombs' test, thrombocytopenia, cholestatic jaundice, slightly
increased AST/ALT, arthralgia, nephrotoxicity with transient elevations of
BUN/creatinine, interstitial nephritis, serum sickness, candidiasis
|
|
|
Overdosage/Toxicology |
|
Symptoms of overdose include abdominal discomfort, diarrhea
Supportive care only |
|
|
Drug
Interactions |
|
Increased effect: Probenecid may decrease cephalosporin elimination
Increased toxicity: Furosemide, aminoglycosides may be a possible additive to
nephrotoxicity |
|
|
Stability |
|
Suspension may be kept at room temperature for 14 days |
|
|
Mechanism of
Action |
|
Inhibits bacterial cell wall synthesis by binding to one or more of the
penicillin binding proteins (PBPs); inhibits the final transpeptidation step of
peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall
biosynthesis. It is thought that beta-lactam antibiotics inactivate
transpeptidase via acylation of the enzyme with cleavage of the CO-N bond of the
beta-lactam ring. Upon exposure to beta-lactam antibiotics, bacteria eventually
lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and
murein hydrolases) while cell wall assembly is arrested. |
|
|
Pharmacodynamics/Kinetics |
|
Absorption: Oral: Rapid
Half-life, elimination: ~1 hour
Time to peak serum concentration: Oral: Within 1 hour
Elimination: Plasma clearance: ~200-300 mL/minute |
|
|
Usual Dosage |
|
Oral:
Acute otitis media: 15 mg/kg twice daily for 10 days
Pharyngitis and impetigo: 7.5-15 mg/kg twice daily for 10 days
Adults:
Uncomplicated urinary tract infections: 200 mg once daily for 7 days
Skin and soft tissue: 200-400 mg every 12-24 hours
Uncomplicated pyelonephritis: 400 mg every 12 hours for 14 days
Upper/lower respiratory tract infection: 200-400 mg every 12-24 hours for
7-14 days
Dosing comments in renal impairment:
Clcr 10-49 mL/minute: 50% of usual dose at usual interval or usual
dose given half as often
Clcr <10 mL/minute: Administer usual dose every 3-5 days
Hemodialysis: Doses should be administered after dialysis sessions
|
|
|
Dietary
Considerations |
|
Should be administered on an empty stomach at least 1 hour before or 2 hours
after meals; administration with food decreases and delays the peak plasma
concentration |
|
|
Mental Health: Effects
on Mental Status |
|
May cause nervousness; cephalosporins reported to cause illusions, delusion,
depersonalization, and euphoria |
|
|
Mental Health:
Effects on Psychiatric
Treatment |
|
May cause neutropenia; use caution with clozapine and
carbamazepine |
|
|
Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
|
No information available to require special precautions |
|
|
Dental Health:
Effects on Dental Treatment |
|
No effects or complications reported |
|
|
Patient
Information |
|
Take as directed, preferably on an empty stomach (30 minutes before or 2
hours after meals). Take entire prescription even if feeling better. Maintain
adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid
intake). You may experience nausea, vomiting, or anorexia (small frequent meals,
frequent mouth care, sucking lozenges, or chewing gum may help). Report
immediately any signs of skin rash, joint or back pain, or difficulty breathing.
Report unusual fever, chills, vaginal itching or foul-smelling vaginal
discharge, or easy bruising or bleeding. Breast-feeding precautions:
Consult prescriber if breast-feeding. |
|
|
Nursing
Implications |
|
Finish all medication |
|
|
Dosage Forms |
|
Capsule: 200 mg, 400 mg
Suspension, oral: 100 mg/5 mL (50 mL, 100 mL); 200 mg/5 mL (50 mL, 100 mL)
|
|
|
References |
|
DeSante KA and Zeckel ML, "Pharmacokinetic Profile of Loracarbef," Am J
Med, 1992, 92(6A):16S-9S.
Force RW and Nahata MC,
"Loracarbef: A New Orally Administered Carbacephem Antibiotic," Ann
Pharmacother, 1993, 27(3):321-9.
Foshee WS,
"Loracarbef (LY163892) Versus Amoxicillin-Clavulanate in the Treatment of Acute Otitis Media With Effusion,"
J Pediatr, 1992, 120(6):980-6.
Nelson JD, Shelton S, and Kusmiesz H,
"Pharmacokinetics of LY163892 in Infants and Children," Antimicrob Agents
Chemother, 1988, 32(11):1738-9.
Schatz BS, Karavokiros KT, Taeubel MA, et al,
"Comparison of Cefprozil, Cefpodoxime Proxetil, Loracarbef, Cefixime, and Ceftibuten,"
Ann Pharmacother, 1996, 30(3):258-68. |
|
Copyright © 1978-2000 Lexi-Comp Inc. All Rights Reserved
| |