Nalidixin
Generic Name
Nalidixic Acid
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| nalidixin 300 mg suspension | ৳ 30.75 | N/A |
Description
Overview of the medicine
Nalidixic acid is a synthetic chemotherapeutic agent, a first-generation quinolone antibiotic, used to treat urinary tract infections (UTIs) caused by susceptible Gram-negative bacteria.
Uses & Indications
Dosage
Adults
Oral: 1 g four times daily for 7 days. For prolonged therapy, dosage may be reduced to 500 mg four times daily.
Elderly
Lower doses may be considered, especially with reduced renal function. Close monitoring is advised.
Renal_impairment
Use with caution. Dosage reduction may be necessary. Not recommended for severe renal impairment.
How to Take
Nalidixic acid suspension should be taken orally, preferably on an empty stomach 1 hour before meals. However, if gastrointestinal upset occurs, it may be taken with food or milk.
Mechanism of Action
Nalidixic acid inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication, transcription, repair, and recombination, leading to bacterial cell death.
Pharmacokinetics
Onset
Clinical effects usually within 1-2 hours.
Excretion
Mainly by the kidneys, with about 80% appearing in the urine, largely as inactive glucuronide conjugates.
Half life
Approximately 1-2.5 hours in adults, longer in renal impairment.
Absorption
Rapidly and well absorbed from the gastrointestinal tract, reaching peak plasma concentrations within 1-2 hours.
Metabolism
Primarily in the liver by conjugation (glucuronidation) and hydroxylation to an active metabolite (hydroxynalidixic acid).
Side Effects
Contraindications
- Hypersensitivity to nalidixic acid or other quinolones.
- Patients with a history of convulsive disorders or epilepsy.
- Children under 3 months of age.
- Severe renal or hepatic impairment.
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency due to risk of hemolytic anemia.
Drug Interactions
Warfarin
Nalidixic acid may enhance the effects of oral anticoagulants like warfarin, leading to increased bleeding risk. Monitor INR closely.
Theophylline
Quinolones may increase theophylline levels, though this is less significant with nalidixic acid than with fluoroquinolones.
Nitrofurantoin
May antagonize the antibacterial effect of nalidixic acid.
Antacids (containing magnesium, aluminum, calcium)
May decrease the absorption of nalidixic acid. Administer at least 2 hours apart.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children. Do not freeze.
Overdose
Symptoms of overdose include headache, visual disturbances, nausea, vomiting, lethargy, and occasionally convulsions. Management involves gastric lavage, supportive care, and maintaining adequate hydration. Seizures can be controlled with intravenous diazepam or barbiturates.
Pregnancy & Lactation
Pregnancy Category C. Not recommended during pregnancy, especially in the first trimester, unless clearly necessary. Excreted into breast milk, therefore not recommended during lactation due to potential risks to the infant (e.g., arthropathy, hemolytic anemia in G6PD deficient infants).
Side Effects
Contraindications
- Hypersensitivity to nalidixic acid or other quinolones.
- Patients with a history of convulsive disorders or epilepsy.
- Children under 3 months of age.
- Severe renal or hepatic impairment.
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency due to risk of hemolytic anemia.
Drug Interactions
Warfarin
Nalidixic acid may enhance the effects of oral anticoagulants like warfarin, leading to increased bleeding risk. Monitor INR closely.
Theophylline
Quinolones may increase theophylline levels, though this is less significant with nalidixic acid than with fluoroquinolones.
Nitrofurantoin
May antagonize the antibacterial effect of nalidixic acid.
Antacids (containing magnesium, aluminum, calcium)
May decrease the absorption of nalidixic acid. Administer at least 2 hours apart.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children. Do not freeze.
Overdose
Symptoms of overdose include headache, visual disturbances, nausea, vomiting, lethargy, and occasionally convulsions. Management involves gastric lavage, supportive care, and maintaining adequate hydration. Seizures can be controlled with intravenous diazepam or barbiturates.
Pregnancy & Lactation
Pregnancy Category C. Not recommended during pregnancy, especially in the first trimester, unless clearly necessary. Excreted into breast milk, therefore not recommended during lactation due to potential risks to the infant (e.g., arthropathy, hemolytic anemia in G6PD deficient infants).
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years when unopened. Refer to the specific product packaging for exact expiry date.
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Generic available
Clinical Trials
Nalidixic acid is an older drug. Its efficacy and safety have been established through early clinical studies. Newer trials are rare, typically focusing on resistance patterns or specific patient populations.
Lab Monitoring
- Monitor renal function (creatinine, BUN) in patients with impaired kidney function.
- Complete blood count (CBC) if prolonged therapy is planned or in patients with G6PD deficiency.
Doctor Notes
- Ensure bacterial sensitivity testing is performed if possible, especially in recurrent or chronic UTIs.
- Counsel patients on the importance of completing the full course and photoprotection.
- Monitor for signs of CNS toxicity, especially in elderly or predisposed patients.
Patient Guidelines
- Complete the full course of treatment as prescribed, even if symptoms improve, to prevent recurrence and resistance.
- Avoid prolonged exposure to sunlight or artificial UV light while taking this medicine, as it can cause photosensitivity. Use protective clothing and sunscreen.
- Report any unusual or severe side effects, especially convulsions or severe skin reactions, to your doctor immediately.
- Do not take antacids containing magnesium, aluminum, or calcium within 2 hours of taking nalidixic acid.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
May cause dizziness, visual disturbances, or drowsiness. Patients should be cautioned against driving or operating machinery until they know how nalidixic acid affects them.
Lifestyle Advice
- Maintain good hydration by drinking plenty of fluids.
- Practice good personal hygiene to help prevent urinary tract infections.
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