pivmecillinam hydrochloride

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

Acute uncomplicated cystitis: 400 mg initially, then 200 mg 3 times a dayChronic or recurrent bacteriuria: 400 mg every 6–8 hoursEnteric fever (typhoid): 1.2–2.4 g daily for 14 days

PHARMACOKINETICS

Molecular weight :476

%Protein binding :5–10

%Excreted unchanged in urine : 45–50 (as mecillinam)

Volume of distribution (L/kg) :0.2–0.4 (as mecillinam)

half-life – normal/ESRD (hrs) :1.2/Increased

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function. See ‘Other Information’

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Likely dialysability. Dose as in GFR <10 mL/min

HD :Likely dialysability. Dose as in GFR <10 mL/min

HDF/high flux :Likely dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Likely dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsMethotrexate: penicillins can reduce the excretion of methotrexate (increased risk of toxicity)Probenecid: reduces excretion of penicillins

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

–

Comments

Take with food

OTHER INFORMATION

Hydrolysed to mecillinam which is the active drug

Contraindicated in carnitine deficiency as it can cause carnitine deficiencyCan cause oesophageal injury, take with water and food while standing upCan cause porphyria Accumulation may occur in patients with severe renal impairment, so use the lower dose if using for extended periods of timeUnlikely to work in people with little residual kidney function as works by renal excretion into the bladder, where its site of action

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