LORABID
Clinical safety rating: caution
Comprehensive clinical and safety monograph for LORABID (LORABID).
LORABID (loracarbef) is a beta-lactam antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to cell lysis and death.
| Metabolism | Loracarbef is not metabolized; it is eliminated unchanged primarily by renal excretion via glomerular filtration and tubular secretion. |
| Excretion | Renal: 75-85% unchanged; biliary/fecal: 15-25% (partly as active metabolites) |
| Half-life | Terminal elimination half-life: 6-8 hours (prolonged to 12-15 hours in moderate renal impairment, CrCl 30-50 mL/min) |
| Protein binding | 75-80% bound to serum albumin |
| Volume of Distribution | 0.3-0.5 L/kg (high tissue penetration, including respiratory secretions, bile, and bone) |
| Bioavailability | Oral: 75-85% (fasting); IM: 90-100% |
| Onset of Action | Oral: 1-2 hours (peak serum concentrations); IM: 30-60 minutes; IV: immediate |
| Duration of Action | 12 hours (twice-daily dosing for susceptible infections; extended to 24 hours in severe renal impairment) |
| Molecular Weight | 367.82 |
Loracarbef 200-400 mg orally every 12 hours for 7-14 days.
| Dosage form | FOR SUSPENSION |
| Renal impairment | CrCl 30-49 mL/min: 200-400 mg every 24 hours; CrCl 10-29 mL/min: 200 mg every 24 hours; CrCl <10 mL/min: 200 mg every 48 hours. |
| Liver impairment | No dose adjustment required for hepatic impairment. Use caution in severe hepatic disease. |
| Pediatric use | Children ≥6 months: 15 mg/kg/day orally divided every 12 hours. Maximum 400 mg/day. |
| Geriatric use | Adjust dose based on renal function. Monitor for gastrointestinal effects. |
| 1st trimester | Limited human data; animal studies show no evidence of fetal harm. Use only if clearly needed. |
| 2nd trimester | No known risks from reported data; consider benefits vs risks. |
| 3rd trimester | Use with caution near term due to potential risk of kernicterus from displacement of bilirubin from albumin binding. |
Clinical note
Comprehensive clinical and safety monograph for LORABID (LORABID).
| Placental transfer | Loracarbef crosses the placenta to a limited extent. Animal studies show transfer; human data minimal. |
| Breastfeeding | Loracarbef is excreted in breast milk in small amounts. The American Academy of Pediatrics considers it compatible with breastfeeding. However, monitor infant for diarrhea, rash, or alteration in gut flora. |
■ FDA Black Box Warning
No FDA black box warnings.
| Serious Effects |
Hypersensitivity to loracarbef or other carbacephemsHypersensitivity to cephalosporins (cross-sensitivity possible)
| Precautions | Hypersensitivity reactions, including anaphylaxis, have been reported., Clostridium difficile-associated diarrhea (CDAD) may occur., Renal impairment: dose adjustment required for creatinine clearance <50 mL/min., Prolonged use may result in superinfection., Caution in patients with history of gastrointestinal disease, particularly colitis. |
| Food/Dietary | Food decreases absorption by 30–50%; take on empty stomach. Avoid alcohol; may cause disulfiram-like reaction (flushing, headache, nausea). |
Loading safety data…
| Lactation Rating |
| L2 (Probably Compatible) |
| Teratogenic Risk | No evidence of teratogenicity in animal studies; limited human data in first trimester. FDA Pregnancy Category B. Avoid in third trimester due to risk of kernicterus in neonates from bilirubin displacement. |
| Fetal Monitoring | No specific fetal monitoring required. Monitor maternal liver function and renal function during prolonged therapy. |
| Fertility Effects | No known adverse effects on fertility in animal or human studies. |
| Clinical Pearls |
| Loracarbef is a second-generation cephalosporin with activity against respiratory and urinary pathogens. Administer on an empty stomach (1 hour before or 2 hours after meals) to maximize absorption. Use with caution in penicillin-allergic patients due to cross-reactivity (∼10%). Monitor renal function in elderly or renally impaired; adjust dose for CrCl <50 mL/min. |
| Patient Advice | Take on an empty stomach at least 1 hour before or 2 hours after meals. · Complete the full course even if you feel better. · Avoid alcohol during treatment and for 48 hours after discontinuing (disulfiram-like reaction possible). · Report diarrhea, rash, or signs of allergic reaction (difficulty breathing, hives). · Store capsules at room temperature away from moisture and heat. |