What happens if I overdose Nexlin?
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local ( ), or emergency room immediately.
Proper storage of Nexlin:
Nexlin is usually handled and stored by a health care provider. If you are using Nexlin at home, store Nexlin as directed by your pharmacist or health care provider. Keep Nexlin out of the reach of children and away from pets.
Overdose of Nexlin in details
There have been postmarketing reports of overdose with Nexlin. The majority of those events experienced, including nausea, vomiting, and diarrhea, have also been reported with the usual recommended dosages. Patients may experience neuromuscular excitability or convulsions if higher than recommended doses are given intravenously (particularly in the presence of renal failure).
Treatment should be supportive and symptomatic according the patient's clinical presentation. Excessive serum concentrations of either Nexlin or Tazobactam (Nexlin) may be reduced by hemodialysis. Following a single 3.375 g dose of Nexlin, the percentage of the Nexlin and Tazobactam (Nexlin) dose removed by hemodialysis was approximately 31% and 39%, respectively.
What should I avoid while taking Nexlin?
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.
Nexlin warnings
Hypersensitivity Adverse Reactions
Serious and occasionally fatal hypersensitivity (anaphylactic/anaphylactoid) reactions (including shock) have been reported in patients receiving therapy with Nexlin. These reactions are more likely to occur in individuals with a history of penicillin, cephalosporin, or carbapenem hypersensitivity or a history of sensitivity to multiple allergens. Before initiating therapy with Nexlin, careful inquiry should be made concerning previous hypersensitivity reactions. If an allergic reaction occurs, Nexlin should be discontinued and appropriate therapy instituted.
Severe Cutaneous Adverse Reactions
Nexlin may cause severe cutaneous adverse reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, and acute generalized exanthematous pustulosis. If patients develop a skin rash they should be monitored closely and Nexlin discontinued if lesions progress.
Hematologic Adverse Reactions
Bleeding manifestations have occurred in some patients receiving β-lactam drugs, including Nexlin. These reactions have sometimes been associated with abnormalities of coagulation tests such as clotting time, platelet aggregation and prothrombin time, and are more likely to occur in patients with renal failure. If bleeding manifestations occur, Nexlin should be discontinued and appropriate therapy instituted.
The leukopenia/neutropenia associated with Nexlin administration appears to be reversible and most frequently associated with prolonged administration.
Periodic assessment of hematopoietic function should be performed, especially with prolonged therapy, ie, ≥ 21 days.
Central Nervous System Adverse Reactions
As with other penicillins, patients may experience neuromuscular excitability or convulsions if higher than recommended doses are given intravenously (particularly in the presence of renal failure).
Electrolyte Effects
Nexlin contains a total of 2.84 mEq (65 mg) of Na+ (sodium) per gram of Nexlin in the combination product. This should be considered when treating patients requiring restricted salt intake. Periodic electrolyte determinations should be performed in patients with low potassium reserves, and the possibility of hypokalemia should be kept in mind with patients who have potentially low potassium reserves and who are receiving cytotoxic therapy or diuretics.
Clostridium difficile Associated Diarrhea
Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Nexlin, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibacterial drug use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibacterial drug use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
Development of Drug-Resistant Bacteria
Prescribing Nexlin in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of development of drug-resistant bacteria.
What should I discuss with my healthcare provider before taking Nexlin?
Some medical conditions may interact with Nexlin. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
- if you are pregnant, planning to become pregnant, or are breast-feeding
- if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
- if you have allergies to medicines, foods, or other substances
- if you have cystic fibrosis, bowel inflammation, bleeding problems, congestive heart failure, or kidney problems
- if you are on dialysis, or if you have a history of severe diarrhea or bowel problems due to an antibiotic
- if you are on a salt-restricted diet or have low blood potassium levels
Some MEDICINES MAY INTERACT with Nexlin. Tell your health care provider if you are taking any other medicines, especially any of the following:
- Chemotherapy or diuretics (eg, furosemide, hydrochlorothiazide) because the risk of side effects, such as low blood potassium levels, may be increased
- Probenecid because it may increase the risk of Nexlin's side effects
- Anticoagulants (eg, warfarin), heparin, methotrexate, or nondepolarizing muscle relaxants (eg, vecuronium) because the risk of their side effects may be increased by Nexlin
- Aminoglycosides (eg, tobramycin) or oral contraceptives (birth control pills) because their effectiveness may be decreased by Nexlin
This may not be a complete list of all interactions that may occur. Ask your health care provider if Nexlin may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Nexlin precautions
Serious and occasionally fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy, including those receiving Nexlin, a thorough inquiry about patient's previous hypersensitivity reactions is important. Serious anaphylactoid reactions require emergency treatment with epinephrine. Oxygen, IV steroids and airway management including intubation should also be administered as indicated.
Pseudomembranous colitis has been reported with nearly all antibacterial agents and may range in severity from mild to life-threatening. It is important to consider this diagnosis in patients who present with diarrhea following administration of antibacterial agents.
Superinfection with fungal or bacterial pathogens may develop with prolonged use. Bleeding has been reported in some patients receiving β-lactam antibiotics, including Nexlin, it is advised that Nexlin be discontinued immediately when bleeding occurs and appropriate therapy be initiated.
A higher incidence of fever and rash in patients with cystic fibrosis has also occurred with Nexlin.
Carcinogenicity, Mutagenicity & Impairment of Fertility: Fertility/Reproduction: Reproduction studies have been performed in rats and have revealed no evidence of impaired fertility when Nexlin is given at a dose similar to the maximum recommended human daily dose based on body surface area.
Use in pregnancy: (Pregnancy Category B): Teratology studies have been performed in mice and rats and have revealed no harmful effects on the fetus when Nexlin was administered at a dose 1-2 times and 2-3 times the human dose of Nexlin and Tazobactam (Nexlin), respectively, based on body surface area.
However, there are no adequate and well-controlled studies that evaluated the combination of Nexlin or monotherapy with Nexlin in pregnant women. Nexlin should only be used during pregnancy when clearly needed.
Use in lactation: Nexlin is excreted at low concentrations in human milk while Tazobactam (Nexlin) concentrations in human milk have not been studied.
Exercise caution when Nexlin is administered to breastfeeding women.
Use in children: Nexlin is used to treat serious abdominal infections in children 2-12 years. However, it is not recommended in the treatment of abdominal infections in children <2 years.
Use in the
Elderly: Patients >65 years do not have an increased risk of developing adverse effects solely because of age. However, the dosage should be adjusted in the presence of renal insufficiency.
What happens if I miss a dose of Nexlin?
Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.
References
- DrugBank. "Tazobactam". http://www.drugbank.ca/drugs/DB01606 (accessed September 17, 2018).
- DrugBank. "piperacillin". http://www.drugbank.ca/drugs/DB00319 (accessed September 17, 2018).
- MeSH. "beta-Lactamase Inhibitors". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
