CEFPIRAMIDE SODIUM
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CEFPIRAMIDE SODIUM (CEFPIRAMIDE SODIUM).
Cefpiramide sodium is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to cell lysis and death.
| Metabolism | Cefpiramide is primarily excreted unchanged in urine via renal tubular secretion and glomerular filtration; minimal hepatic metabolism. |
| Excretion | Renal: 80-90% unchanged via glomerular filtration and tubular secretion; biliary/fecal: 10-20% |
| Half-life | 4-5 hours in normal renal function; prolonged to 12-20 hours in severe renal impairment (CrCl < 20 mL/min) |
| Protein binding | High (85-95%), primarily to albumin |
| Volume of Distribution | 0.2-0.3 L/kg, indicating limited extravascular distribution |
| Bioavailability | IM: ~90%; IV: 100% |
| Onset of Action | IV: immediate; IM: 30-60 minutes |
| Duration of Action | 12 hours due to sustained bactericidal concentrations; dosing interval adjusted per renal function |
1-2 g IV every 12 hours; maximum 8 g/day
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 30-50 mL/min: 1 g every 12 hours; CrCl 15-29: 1 g every 24 hours; CrCl <15: 0.5 g every 24 hours; hemodialysis: 1 g after dialysis |
| Liver impairment | No adjustment required for Child-Pugh A or B; Child-Pugh C: consider monitoring and dose reduction if severe impairment |
| Pediatric use | Neonates: 50 mg/kg IV every 12 hours; Infants/children: 50-100 mg/kg/day divided every 8-12 hours; maximum 4 g/day |
| Geriatric use | Start at lower end of dosing range; adjust based on renal function as elderly often have reduced CrCl |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CEFPIRAMIDE SODIUM (CEFPIRAMIDE SODIUM).
| Breastfeeding | Cefpiramide is excreted into human breast milk in low concentrations. The milk-to-plasma ratio is not established. According to available data, it is likely compatible with breastfeeding due to low oral bioavailability in infants, but caution should be exercised in neonates with jaundice or glucose-6-phosphate dehydrogenase deficiency due to theoretical risk of hemolysis. |
| Teratogenic Risk | Cefpiramide is classified as FDA Pregnancy Category B. Animal studies have not demonstrated teratogenic effects. There are no adequate and well-controlled studies in pregnant women. First trimester: limited data, no known fetal risk. Second and third trimesters: considered safe when clinically indicated, as cephalosporins cross the placenta but have low teratogenic potential. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to cefpiramide or other cephalosporins","Severe immediate hypersensitivity to penicillins"]
| Precautions | ["Hypersensitivity reactions including anaphylaxis","Clostridioides difficile-associated diarrhea","Renal impairment requiring dose adjustment","Prolonged use may lead to superinfection"] |
| Food/Dietary | No significant food interactions. Avoid alcohol during therapy and for 72 hours after last dose due to risk of disulfiram-like reaction (nausea, vomiting, headache, flushing). |
| Clinical Pearls |
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| Fetal Monitoring | Monitor renal function (serum creatinine, BUN) and hepatic function periodically, as cefpiramide undergoes both hepatic and renal clearance. Observe for signs of bleeding due to possible hypoprothrombinemia (cephalosporins with NMTT side chain). Monitor fetal growth and well-being with standard obstetric assessments if used for prolonged periods. |
| Fertility Effects | Animal studies have not shown impairment of fertility. Clinical data on human fertility are lacking. No specific adverse reproductive effects are anticipated at therapeutic doses. |
| Cefpiramide sodium is a third-generation cephalosporin with a prolonged half-life (approximately 5 hours) allowing twice-daily dosing. It has enhanced activity against Pseudomonas aeruginosa and Enterobacteriaceae. Note cross-allergy in penicillin-allergic patients (approximately 10%). Monitor renal function; dose adjustment required for CrCl <30 mL/min. May cause false-positive Coombs test and urine glucose test (Clinitest). Use with caution in patients with history of gastrointestinal disease, particularly colitis. |
| Patient Advice | Take this medication exactly as prescribed; do not skip doses or stop early. · Notify your healthcare provider immediately if you develop a skin rash, hives, or difficulty breathing (signs of allergy). · Report any severe or persistent diarrhea, as this may indicate Clostridium difficile colitis. · This drug may cause dizziness; avoid driving until you know how it affects you. · Inform your provider if you have a history of kidney disease, as dose adjustments may be needed. · Avoid alcohol during treatment and for at least 72 hours after the last dose to prevent disulfiram-like reaction. · Store at room temperature away from moisture and heat. |