i DIKS ik AS
Treatment of urinary tract infections
Hypersensitivity to nalidixic acid or any component; infants <3 months of
Use with caution in patients with impaired hepatic or renal function and
prepubertal children; has been shown to cause cartilage degeneration in immature
animals; may induce hemolysis in patients with G-6-PD deficiency; use caution in
patients with seizure disorder.
>10%: Central nervous system: Dizziness, drowsiness, headache
1% to 10%: Gastrointestinal: Nausea, vomiting
<1%: Increased intracranial pressure, malaise, vertigo, confusion, toxic
psychosis, convulsions, fever, chills, rash, urticaria, photosensitivity
reactions, metabolic acidosis, leukopenia, thrombocytopenia, hepatotoxicity,
Symptoms of overdose include nausea, vomiting, toxic psychosis, convulsions,
increased intracranial pressure, metabolic acidosis; severe overdose,
intracranial hypertension, increased pressure, and seizures have occurred
After GI decontamination, treatment is symptomatic
Decreased effect with antacids containing magnesium, aluminum, or calcium,
sucralfate, metal ions and didanosine. Avoid by 2 hours.
Increased effect of warfarin
Inhibits DNA polymerization in late stages of chromosomal
Distribution: Crosses the placenta; appears in breast milk; achieves
significant antibacterial concentrations only in the urinary tract
Protein binding: 90%
Metabolism: Partly in the liver
Half-life: 6-7 hours; increases significantly with renal impairment
Time to peak serum concentration: Oral: Within 1-2 hours
Elimination: In urine as unchanged drug and 80% as metabolites; small amounts
appear in feces
Adults: 1 g 4 times/day for 2 weeks; then suppressive therapy of 500 mg 4
Dosing comments in renal impairment: Clcr <50
mL/minute: Avoid use
Should be administered 1 hour before meals; can administer with food to
False-positive urine glucose with Clinitest®, false
increase in urinary VMA
|Mental Health: Effects
on Mental Status|
Dizziness and drowsiness are common; may rarely cause confusion or
Effects on Psychiatric
May rarely cause leukopenia; use caution with clozapine and
|Dental Health: Local
No information available to require special precautions
Effects on Dental Treatment|
No effects or complications reported
Avoid undue exposure to direct sunlight or use a sunscreen; take 1 hour
before meals, but can take with food to decrease GI upset, finish all
medication, do not skip doses; if persistent cough occurs, notify physician.
Antacids containing calcium, magnesium or aluminum; sucralfate; minerals;
multivitamin with zinc; or didanosine should not be taken within 2 hours of
Administer around-the-clock rather than 4 times/day, 3 times/day, etc, (ie,
12-6-12-6, not 9-1-5-9) to promote less variation in peak and trough serum
Monitor urinalysis, urine culture; CBC, renal and hepatic function tests
Suspension, oral (raspberry flavor): 250 mg/5 mL (473 mL)
Tablet: 250 mg, 500 mg, 1 g
Barbeau G, Belanger PM,
"Pharmacokinetics of Nalidixic Acid in Old and Young Volunteers," J Clin
Pharmacol, 1982, 22(10):490-6.
Belton EM and Jones RV, "Haemolytic Anaemia Due to Nalidixic Acid,"
Lancet, 1965, 2(7414):691.
Leslie PJ, Cregeen RJ, and Proudfoot AT, et al,
"Lactic Acidosis, Hyperglycaemia and Convulsions Following Nalidixic Acid Overdosage,"
Hum Toxicol, 1984, 3(3):249-53.
Nuutinen M, Turtinen J, and Uhari M,
"Growth and Joint Symptoms in Children Treated With Nalidixic Acid," Pediatr
Infect Dis J, 1994, 13(9):798-800.
Stutman HR and Marks MI, "Review of Pediatric Antimicrobial Therapies,"
Semin Pediatr Infect Dis, 1991, 2:3-17.
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