Nalidixin
Generic Name
Nalidixic acid 500 mg tablet
Manufacturer
Various Pharmaceutical Companies
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| nalidixin 500 mg tablet | ৳ 4.67 | N/A |
Description
Overview of the medicine
Nalidixic acid is a first-generation quinolone antibiotic used to treat urinary tract infections (UTIs) caused by susceptible Gram-negative bacteria. It is effective against a range of common urinary pathogens.
Uses & Indications
Dosage
Adults
Adults: 1 gram four times daily for 7-14 days. For long-term suppressive therapy, 500 mg four times daily.
Elderly
Elderly: Dosage adjustment may be necessary based on renal function. Close monitoring is recommended.
Renal_impairment
Renal impairment: Dosage reduction is required in patients with severe renal insufficiency (creatinine clearance < 20 mL/min).
How to Take
Nalidixic acid tablets should be taken orally, preferably on an empty stomach to ensure maximum absorption, but may be taken with food to minimize gastrointestinal upset. Complete the full course of therapy.
Mechanism of Action
Nalidixic acid selectively inhibits bacterial DNA gyrase (topoisomerase II), an enzyme essential for bacterial DNA replication, transcription, repair, and recombination. This inhibition leads to disruption of bacterial DNA synthesis and ultimately bacterial cell death.
Pharmacokinetics
Onset
Rapid, with antibacterial effects seen shortly after absorption.
Excretion
Primarily excreted in the urine, with approximately 80% of an oral dose eliminated within 24 hours. Both parent drug and active metabolite are excreted.
Half life
Plasma half-life of the parent drug is 1-2.5 hours; the active metabolite (hydroxynalidixic acid) has a half-life of 6-7 hours.
Absorption
Rapidly and well absorbed from the gastrointestinal tract after oral administration. Peak plasma concentrations are achieved in 1-2 hours.
Metabolism
Extensively metabolized in the liver, primarily to an active hydroxynalidixic acid metabolite and inactive glucuronide conjugates.
Side Effects
Contraindications
- Hypersensitivity to nalidixic acid or any other quinolone
- History of seizure disorders or epilepsy
- Children under 3 months of age
- Severe renal or hepatic impairment
- Pregnancy (especially first trimester and near term)
Drug Interactions
Warfarin
May enhance the anticoagulant effect of warfarin, requiring dose adjustments and INR monitoring.
Theophylline
May increase plasma concentrations of theophylline, leading to increased toxicity.
Nitrofurantoin
Antagonistic effect; concomitant use should be avoided as it may reduce the antibacterial effect of nalidixic acid.
Oral hypoglycemics
Potentiates the effect of certain oral hypoglycemics, leading to hypoglycemia.
Antacids, iron, zinc salts
Can chelate with nalidixic acid, reducing its absorption. Administer at least 2 hours apart.
Storage
Store below 30°C in a cool, dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose may include nausea, vomiting, abdominal pain, diarrhea, metabolic acidosis, and CNS effects such as headache, dizziness, drowsiness, confusion, visual disturbances, and seizures. Management involves gastric lavage, supportive care, and anticonvulsants for seizures.
Pregnancy & Lactation
Nalidixic acid is generally contraindicated in pregnancy, especially during the first trimester and near term, due to potential adverse effects on fetal cartilage development and hemolytic anemia risk in G6PD deficient neonates. It is also excreted in breast milk, so it should be avoided during lactation.
Side Effects
Contraindications
- Hypersensitivity to nalidixic acid or any other quinolone
- History of seizure disorders or epilepsy
- Children under 3 months of age
- Severe renal or hepatic impairment
- Pregnancy (especially first trimester and near term)
Drug Interactions
Warfarin
May enhance the anticoagulant effect of warfarin, requiring dose adjustments and INR monitoring.
Theophylline
May increase plasma concentrations of theophylline, leading to increased toxicity.
Nitrofurantoin
Antagonistic effect; concomitant use should be avoided as it may reduce the antibacterial effect of nalidixic acid.
Oral hypoglycemics
Potentiates the effect of certain oral hypoglycemics, leading to hypoglycemia.
Antacids, iron, zinc salts
Can chelate with nalidixic acid, reducing its absorption. Administer at least 2 hours apart.
Storage
Store below 30°C in a cool, dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose may include nausea, vomiting, abdominal pain, diarrhea, metabolic acidosis, and CNS effects such as headache, dizziness, drowsiness, confusion, visual disturbances, and seizures. Management involves gastric lavage, supportive care, and anticonvulsants for seizures.
Pregnancy & Lactation
Nalidixic acid is generally contraindicated in pregnancy, especially during the first trimester and near term, due to potential adverse effects on fetal cartilage development and hemolytic anemia risk in G6PD deficient neonates. It is also excreted in breast milk, so it should be avoided during lactation.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture, consult product packaging for exact details.
Availability
Pharmacies, Hospitals
Approval Status
Approved (since 1960s)
Patent Status
Expired
Clinical Trials
As an older drug, the primary clinical trials for nalidixic acid were conducted decades ago, establishing its efficacy and safety profile. Newer trials are typically focused on resistance patterns or specific subpopulations.
Lab Monitoring
- Renal function (creatinine, BUN) for patients with pre-existing kidney disease or on long-term therapy
- Liver function tests (ALT, AST) if there are signs of hepatic dysfunction
- Complete Blood Count (CBC) during prolonged therapy, especially for G6PD deficient patients
- Urine culture and sensitivity to monitor treatment effectiveness
Doctor Notes
- Nalidixic acid is primarily active against Gram-negative urinary pathogens; consider susceptibility testing before initiating therapy.
- Counsel patients on avoiding sun exposure due to the risk of photosensitivity.
- Monitor for CNS side effects, especially in patients with a history of seizure disorders.
- Not recommended as a first-line agent for complicated UTIs or pyelonephritis due to evolving resistance patterns and availability of newer, broader-spectrum agents.
Patient Guidelines
- Complete the entire course of medication as prescribed, even if symptoms improve, to prevent recurrence and resistance.
- Avoid excessive exposure to direct sunlight or artificial UV light, and use sunscreen or protective clothing, as this medication can cause photosensitivity.
- Drink plenty of fluids to help flush out bacteria from the urinary tract.
- Report any unusual side effects, especially severe headache, visual changes, or joint pain, to your doctor.
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 resume your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Nalidixic acid may cause dizziness, drowsiness, or visual disturbances. Patients should be cautioned about operating machinery or driving until they know how the medication affects them.
Lifestyle Advice
- Maintain good personal hygiene to prevent UTIs.
- Avoid holding urine for long periods.
- Stay well-hydrated by drinking adequate water throughout the day.
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