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Omnicef Side Effects, and Drug Interactions - Cefdinir

Omnicef Side Effects, and Drug Interactions - Cefdinir

SIDE EFFECTS

Clinical Trials - OMNICEF Capsules (Adult and Adolescent Patients)

In clinical trials, 5093 adult and adolescent patients (3841 US and 1252 non-US) were treated with the recommended dose of cefdinir capsules (600 mg/day). Most adverse events were mild and self-limiting. No deaths or permanent disabilities were attributed to cefdinir. One hundred forty-seven of 5093 (3%) patients discontinued medication due to adverse events thought by the investigators to be possibly, probably, or definitely associated with cefdinir therapy. The discontinuations were primarily for gastrointestinal disturbances, usually diarrhea or nausea. Nineteen of 5093 (0.4%) patients were discontinued due to rash thought related to cefdinir administration.

In the US, the following adverse events were thought by investigators to be possibly, probably, or definitely related to cefdinir capsules in multiple-dose clinical trials (N = 3841 cefdinir-treated patients):

ADVERSE EVENTS ASSOCIATED WITH CEFDINIR CAPSULES US TRIALS IN ADULT AND ADOLESCENT PATIENTS (N = 3275)a
Incidence ³1%	Diarrhea	16%
	Vaginal moniliasis	5% of women
	Nausea	3%
	Headache	2%
	Abdominal pain	1%
	Vaginitis	1% of women
Incidence <1% but >0.1%	Rash	0.9%
	Dyspepsia	0.8%
	Flatulence	0.6%
	Vomiting	0.6%
	Anorexia	0.3%
	Constipation	0.3%
	Abnormal stools	0.2%
	Asthenia	0.2%
	Dizziness	0.2%
	Insomnia	0.2%
	Leukorrhea	0.2% of women
	Pruritus	0.2%
	Somnolence	0.2%

The following laboratory value changes of possible clinical significance, irrespective of relationship to therapy with cefdinir, were seen during clinical trials conducted in the US:

LABORATORY VALUE CHANGES OBSERVED WITH CEFDINIR CAPSULES US TRIALS IN ADULT AND ADOLESCENT PATIENTS (N = 3275)
Incidence ³1%	­	Gamma- glutamyltransferase	1%
	­	Urine protein	1%
	­	Urine red blood cells	1%
Incidence <1% but >0.1%	­	Alanine aminotransferase (ALT)	0.9%
	­	Glucose, ¯ Glucose	0.9%, 0.2%
	­	Urine glucose	0.9%
	­	White blood cells, ¯ White blood cells	0.8%, 0.7%
	¯	Lymphocytes, ­ Lymphocytes	0.8%, 0.2%
	­	Urine specific gravity	0.8%
	¯	Bicarbonate	0.6%
	­	Eosinophils	0.6%
	­	Phosphorus, ¯ Phosphorus	0.6%, 0.3%
	­	Aspartate aminotransferase (AST)	0.4%
	­	Urine white blood cells	0.4%
	¯	Hemoglobin	0.3%
	­	Alkaline phosphatase	0.2%
	­	Blood urea nitrogen (BUN)	0.2%
	­	Bilirubin	0.2%
	­	Lactate dehydrogenase	0.2%
	­	Platelets	0.2%
	¯	Polymorphonuclear neutrophils (PMNs)	0.2%
	­	Potassium	0.2%
	­	Urine pH	0.2%

Clinical Trials - OMNICEF for Oral Suspension (Pediatric Patients)

In clinical trials, 2289 pediatric patients (1783 US and 506 non-US) were treated with the recommended dose of cefdinir suspension (14 mg/kg/day). Most adverse events were mild and self-limiting. No deaths or permanent disabilities were attributed to cefdinir. Forty of 2289 (2%) patients discontinued medication due to adverse events considered by the investigators to be possibly, probably, or definitely associated with cefdinir therapy. Discontinuations were primarily for gastrointestinal disturbances, usually diarrhea. Five of 2289 (0.2%) patients were discontinued due to rash thought related to cefdinir administration.

In the US, the following adverse events were thought by investigators to be possibly, probably, or definitely related to cefdinir suspension in multiple-dose clinical trials (N = 1783 cefdinir-treated patients):

ADVERSE EVENTS ASSOCIATED WITH CEFDINIR SUSPENSION US TRIALS IN PEDIATRIC PATIENTS (N = 1783)a
Incidence ³1%	Diarrhea	8%
	Rash	3%
	Vomiting	1%
Incidence <1% but >0.1%	Cutaneous moniliasis	0.9%
	Abdominal pain	0.8%
	Leukopenia b	0.3%
	Vaginal moniliasis	0.3% of girls
	Vaginitis	0.3% of girls
	Abnormal stools	0.2%
	Dyspepsia	0.2%
	Hyperkinesia	0.2%
	Increased AST b	0.2%
	Maculopapular rash	0.2%
	Nausea	0.2%

^a 977 males, 806 females
^b Laboratory changes were occasionally reported as adverse events.

NOTE: In both cefdinir- and control-treated patients, rates of diarrhea and rash were higher in the youngest pediatric patients. The incidence of diarrhea in cefdinir-treated patients £2 years of age was 17% (95/557) compared with 4% (51/1226) in those >2 years old. The incidence of rash (primarily diaper rash in the younger patients) was 8% (43/557) in patients £2 years of age compared with 1% (8/1226) in those >2 years old.

The following laboratory value changes of possible clinical significance, irrespective of relationship to therapy with cefdinir, were seen during clinical trials conducted in the US:

LABORATORY VALUE CHANGES OF POSSIBLE CLINICAL SIGNIFICANCE OBSERVED WITH CEFDINIR SUSPENSION US TRIALS IN PEDIATRIC PATIENTS (N = 1783)a
Incidence ³1%	­	Lymphocytes, ¯Lymphocytes	2%, 0.8%
	­	Alkaline phosphatase	1%
	¯	Bicarbonatea	1%
	­	Eosinophils	1%
	­	Lactate dehydrogenase	1%
	­	Platelets	1%
	­	PMNs, ¯ PMNs	1%, 1%
	­	Urine protein	1%
Incidence <1% but >0.1%	­	Phosphorus, ¯ Phosphorus	0.9%, 0.4%
	­	Urine pH	0.8%
	¯	White blood cells, ­ White blood cells	0.7%, 0.3%
	¯	Calciuma	0.5%
	¯	Hemoglobin	0.5%
	­	Urine leukocytes	0.5%
	­	Monocytes	0.4%
	­	AST	0.3%
	­	Potassium a	0.3%
	­	Urine specific gravity, ¯ Urine specific gravity	0.3%, 0.1%
	¯	Hematocrit a	0.2%

^a N = 1387 for these parameters.

Postmarketing Experience

The following adverse experiences and altered laboratory tests, regardless of their relationship to cefdinir, have been reported during extensive postmarketing experience, beginning with approval in Japan in 1991: Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, erythema nodosum, conjunctivitis, stomatitis, acute hepatitis, cholestasis, fulminant hepatitis, hepatic failure, jaundice, increased amylase, shock, anaphylaxis, facial and laryngeal edema, feeling of suffocation, acute enterocolitis, bloody diarrhea, hemorrhagic colitis, melena, pseudomembranous colitis, pancytopenia, granulocytopenia, leukopenia, thrombocytopenia, idiopathic thrombocytopenic purpura, hemolytic anemia, acute respiratory failure, asthmatic attack, drug-induced pneumonia, eosinophilic pneumonia, idiopathic interstitial pneumonia, fever, acute renal failure, nephropathy, bleeding tendency, coagulation disorder, disseminated intravascular coagulation, upper GI bleed, peptic ulcer, ileus, loss of consciousness, allergic vasculitis, possible cefdinir-diclofenac interaction, cardiac failure, chest pain, myocardial infarction, hypertension, involuntary movements, and rhabdomyolysis.

Cephalosporin Class Adverse Events

The following adverse events and altered laboratory tests have been reported for cephalosporin-class antibiotics in general:

Allergic reactions, anaphylaxis, Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, renal dysfunction, toxic nephropathy, hepatic dysfunction including cholestasis, aplastic anemia, hemolytic anemia, hemorrhage, false-positive test for urinary glucose, neutropenia, pancytopenia, and agranulocytosis. Pseudomembranous colitis symptoms may begin during or after antibiotic treatment (see WARNINGS).

Several cephalosporins have been implicated in triggering seizures, particularly in patients with renal impairment when the dosage was not reduced (see DOSAGE AND ADMINISTRATION and OVERDOSAGE). If seizures associated with drug therapy occur, the drug should be discontinued. Anticonvulsant therapy can be given if clinically indicated.

DRUG INTERACTIONS

Antacids (aluminum- or magnesium-containing)

Concomitant administration of 300-mg cefdinir capsules with 30 mL Maalox^® TC suspension reduces the rate (C_max) and extent (AUC) of absorption by approximately 40%. Time to reach C_max is also prolonged by 1 hour. There are no significant effects on cefdinir pharmacokinetics if the antacid is administered 2 hours before or 2 hours after cefdinir. If antacids are required during OMNICEF therapy, OMNICEF should be taken at least 2 hours before or after the antacid.

Probenecid

As with other b-lactam antibiotics, probenecid inhibits the renal excretion of cefdinir, resulting in an approximate doubling in A.C. a 54% increase in peak cefdinir plasma levels, and a 50% prolongation in the apparent elimination half-life.

Iron Supplements and Foods Fortified With Iron

Concomitant administration of cefdinir with a therapeutic iron supplement containing 60 mg of elemental iron (as FeSO₄) or vitamins supplemented with 10 mg of elemental iron reduced extent of absorption by 80% and 31%, respectively. If iron supplements are required during OMNICEF therapy, OMNICEF should be taken at least 2 hours before or after the supplement.

The effect of foods highly fortified with elemental iron (primarily iron-fortified breakfast cereals) on cefdinir absorption has not been studied.

Concomitantly administered iron-fortified infant formula (2.2 mg elemental iron/6 oz) has no significant effect on cefdinir pharmacokinetics. Therefore, OMNICEF for Oral Suspension can be administered with iron-fortified infant formula.

There have been rare reports of reddish stools in patients who have received cefdinir in Japan. The reddish color is due to the formation of a nonabsorbable complex between cefdinir or its breakdown products and iron in the gastrointestinal tract.

Drug/Laboratory Test Interactions

A false-positive reaction for ketones in the urine may occur with tests using nitroprusside, but not with those using nitroferricyanide. The administration of cefdinir may result in a false-positive reaction for glucose in urine using Clinitest^®, Benedict’s solution, or Fehling's solution. It is recommended that glucose tests based on enzymatic glucose oxidase reactions (such as Clinistix^® or Tes-Tape^®) be used. Cephalosporins are known to occasionally induce a positive direct Coombs’ test.

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