Nafcillin interactions

Taylor AT, Pritchard DC, Goldstein AO, Fletcher JL Jr. Continuation of warfarin-nafcillin interaction during dicloxaciUin therapy. J Fam Pract 1994 39(2) 182-5. 

Shovick VA, Rihn TL. Decreased hypoprothrombinemic response to warfarin secondary to the warfarin-nafcillin interaction. DICP Ann Pharmacother ( 99V) 25, 598-9. 

A patient experienced the effects of interactions of warfarin with nafcillin and dicloxacillin (333). During co-administration of nafcillin, warfarin doses were increased to as much as 4.5 times the previous amounts needed to provide adequate anticoagulation. During co-administration of dicloxacillin, warfarin doses gradually fell, but still stabilized at a higher maintenance dose than before. 

HeUker GM, Fowler JW Jr, Self TH. Possible nafcillin-warfarin interaction. Arch Intern Med 1994 154(7) 822-4. 

Clinically important, potentially hazardous interactions with amiloride, aminoglycosides, amphotericin B, ampicillin, anisindione, anticoagulants, armodafinil, atorvastatin, azathioprine, azithromycin, bacampicillin, basiliximab, bezafibrate, bosentan, bupropion, carbenicillin, caspofungin, cholestyramine, clarithromycin, cloxacillin, co-trimoxazole, corticosteroids, cyclophosphamide, daclizumab, danazol, dicloxacillin, dicumarol, digoxin, diltiazem, disulfiram, echinacea, erythromycin, ethotoin, etoposide, ezetimibe, flunisolide, fluoxymesterone, fluvastatin, foscarnet, fosphenytoin, gemfibrozil, hemophilus B vaccine, HMG-CoA reductase inhibitors, imatinib, imipenem/cilastatin, influenza vaccines, ketoconazole, lanreotide, lopinavir, lovastatin, mephenytoin, methicillin, methoxsalen, methylphenidate, methylprednisolone, methyltestosterone, mezlocillin, mizolastine, mycophenolate, nafcillin, nisoldipine, NSAIDs, orlistat, oxacillin, penicillins, phellodendron, phenytoin, pravastatin, prednisolone, prednisone, pristinamycin, ranolazine, red rice yeast, rifabutin, rifampin, rifapentine, ritonavir, rosuvastatin, simvastatin, sirolimus, spironolactone, St John s wort, sulfacetamide, sulfadiazine, sulfamethoxazole, sulfisoxazole, sulfonamides, tacrolimus, telithromycin, tenoxicam, testosterone, ticarcillin, tolvaptan, trabectedin, triamterene, troleandomycin, ursodeoxycholic acid, vaccines, vecuronium, warfarin, zofenopril... 

Clinically important, potentially hazardous interactions with amoxicillin, ampicillin, antacids, bacampicillin, calcium carbonate, carbenicillin, cloxacillin, digoxin, methotrexate, methoxyflurane, mezlocillin, nafcillin, oxacillin, penicillins, piperacillin, ticarcillin, zinc... 

Clinically important, potentially hazardous interactions with acitretin, aldesleukin, aminoglycosides, amiodarone, amoxicillin, ampicillin, aspirin, bacampicillin, bismuth, carbenicillin, chloroquine, cisplatin, cloxacillin, co-trimoxazole, dapsone, demeclocycline, dexamethasone, diclofenac, dicloxacillin, etodolac, etoricoxib, etretinate, fenoprofen, flurbiprofen, folic acid antagonists, haloperidol, hydrocortisone, ibuprofen, indomethacin, influenza vaccines, ketoprofen, ketorolac, lithium, magnesium trisalicylate, meclofenamate, mefenamic acid, methicillin, mezlocillin, minocycline, nabumetone, nafcillin, naproxen, NSAIDs, omeprazole, oxacillin, oxaprozin, oxytetracycline, paromomycin, penicillin G, penicillin V, penicillins, phenylbutazone, piperacillin, piroxicam, polypeptide antibiotics, prednisolone, prednisone, probenecid, procarbazine, rofecoxib, salicylates, salsalate, sapropterin, sulfadiazine, sulfamethoxazole, sulfapyridine, sulfasalazine, sulfisoxazole, sulindac, tazobactum, tenoxicam, tetracycline, ticarcillin, tolmetin, trimethoprim, vaccines... 

Clinically important, potentially hazardous interactions with acitretin, aluminum hydroxide, amoxicillin, ampicillin, antacids, bacampicillin, betamethasone, bismuth, bromelain, calcium, carbenicillin, cholestyramine, doxacillin, corticosteroids, dairy products, dicloxacillin, didanosine, digoxin, food, glidazide, iron, isotretinoin, methicillin, methotrexate, methoxyflurane, mezlocillin, nafcillin, oxacillin, penicillins, piperacillin, retinoids, rocuronium, strontium ranelate, sucralfate, ticarcillin, vitamin A, zinc... 

Nafcillin and aminoglycosides are chemically inactivated and should not be mixed together. Probenecid blocks renal tubular secretion of penicillins however, this interaction has only a small effect on the excretion of nafcillin. 

There appear to be no clinically significant pharmacokinetic interactions between aztreonam and amikacin, cefradine, clindamycin, gentamicin, metronidazole or nafcillin. 

Lang CC, Jamal SK, Mohamed Z, Mustafa MR, Mustafa AM, Lee TC Evidence of an interaction between nifedipine and nafcillin in humans. BrJ Clin Pharmacol (2003) 55, 588-90. 

Not understood. The interaction between nafcillin and warfarin is possibly due to increases in the metabolism of warfarin by the liver. Dicloxacillin also possibly reduces serum warfarin levels. Other penicillins (ampicillin, benzylpenicillin, carbenicillin, methicillin, ticarcillin ) have caused increased bleeding times when given alone, principally due to platelet inhibition, which might be additive with the effects of oral anticoagulants. Broad-spectrum antibacterials may decrease the gut flora and thereby possibly decrease production of vitamin K. Other factors relating to the disease may be important, see Coumarins -i- Antibacterials p.365. 

Ampicillin does not interact adversely with ciclosporin. Increased nephrotoxicity has been seen in lung transplant patients given nafcillin prophylactically, whereas an isolated report describes a fall in ciclosporin levels in a patient treated with nafcillin. A case of raised ciclosporin levels in a patient taking ticarcillin has been described. 

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