Nalidixic Acid (Systemic)

Brand name(s): NegGram

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For nalidixic acid, the following should be considered:

Allergies-Tell your doctor if you have ever had any unusual or allergic reaction to nalidixic acid, or to any related medicines such as alatrofloxacin or trovafloxacin (e.g., Trovan), cinoxacin (e.g., Cinobac), ciprofloxacin (e.g., Cipro), enoxacin (e.g., Penetrex), grepafloxacin (e.g., Raxar), levofloxacin (e.g., Levaquin), lomefloxacin (e.g., Maxaquin), norfloxacin (e.g., Noroxin), ofloxacin (e.g., Floxin), or sparfloxacin (e.g., Zagam). Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy-Studies have not been done in humans. In animal studies, nalidixic acid causes birth defects and other problems at doses several times the human dose. However, use is not recommended during pregnancy, since nalidixic acid has been shown to cause bone development problems in young animals.

Breast-feeding-Nalidixic acid passes into breast milk. This medicine may cause blood problems in nursing babies with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Your doctor my have you stop breast-feeding while taking this medicine. Talk to your doctor about haw long you need to formula feed your baby.

Children-This medicine should not be used in infants up to 3 months of age since nalidixic acid has been shown to cause bone development problems in young animals.

Caution is recommended in using nalidixic acid in children up to 18 years of age because nalidixic acid has been shown to cause bone development problems in young animals. However, your doctor my choose to use this medicine if other medicines cannot be used.

Older adults-This medicine has been studied in a limited number of elderly patients and has not been shown to cause different side effects or problems in older people than it does in younger adults.

Other medicines-Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking nalidixic acid, it is especially important that your health care professional know if you are taking any of the following:

• Antacids, aluminum-, calcium-, or magnesium-containing, or
• Didanosine (e.g., Videx) chewable tablets or pediatric powder for oral solution or
• Iron supplements or
• Multivitamin preparations, zinc-containing, or
• Sucralfate-These medicines interfere with the absorption of nalidixic acid into the body and may decrease the effect of nalidixic acid

• Antiarrhythmic agents (medicine for abnormal heart rhythm)
• Antipsychotics (medicine for mental illness) or
• Cisapride (e.g., Propulsid) or
• Erythromycin (e.g., Ery-tab) or
• Tricyclic antidepressants (medicine for depression) -Nalidixic acid may cause changes in heart rhythm when taken with these drugs

• Anticoagulants (blood thinners)-Patients taking nalidixic acid with anticoagulants may have an increased chance of bleeding

• Caffeine or
• Cyclosporine (e.g., Neoral, Sandimmune) or
• Theophylline (e.g., Theo-Dur)-Nalidixic acid may increase the amounts of these medicines in the blood and increase the chance of side effects from them

• Melphalan or
• Other cancer drugs (carmustine [e.g., BICNU], dacarbazine [e.g., DTIC-Dome], procarbazine [e.g., Matulane], or temozolomide [e.g., Temodal])-Should not be used together with nalidixic acid; may cause serious digestive system problems

Other medical problems-The presence of other medical problems may affect the use of nalidixic acid. Make sure you tell your doctor if you have any other medical problems, especially:

• Convulsive disorders, history of (seizures, epilepsy) or
• Hardening of the arteries in the brain (severe)-Patients with these medical problems may have an increased chance of serious side effects affecting the nervous system

• Diarrhea-May be a sign of colon problems and taking nalidixic acid could make this problem worse. Your doctor will want to check you before you begin taking this medicine.

• Glucose-6-phosphate dehydrogenase (G6PD) deficiency-Patients with G6PD deficiency may have an increased chance of side effects affecting the blood

• Heart rhythm problems-Nalidixic acid should be used with caution in patients with these conditions.

• Kidney disease (severe) or
• Liver disease-Patients with liver disease or severe kidney disease may have an increase in side effects

• QTc prolongation (rare heart rhythm problem)-Nalidixic acid may cause this condition to become worse, especially with higher doses of this medicine.

• Sensitivity of the skin to sunlight-Patients taking nalidixic acid may have an increased risk of severe reactions to sunlight. Patients with this condition should not take nalidixic acid.

Last Revised: 10/13/2004