MONOCID
Clinical safety rating: caution
Comprehensive clinical and safety monograph for MONOCID (MONOCID).
Cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), disrupting peptidoglycan cross-linking.
| Metabolism | Not significantly metabolized; primarily excreted unchanged in urine via glomerular filtration and tubular secretion. |
| Excretion | Renal: ~90% unchanged in urine via glomerular filtration and tubular secretion; biliary/fecal: ~5% (cefonicid undergoes minimal hepatic metabolism; ~4% excreted in feces as parent drug and metabolites). |
| Half-life | Terminal elimination half-life: 4-5 hours (prolonged to 12-24 hours in severe renal impairment; dosing adjustment recommended for CrCl <50 mL/min). |
| Protein binding | ~90% bound to serum albumin. |
| Volume of Distribution | 0.11-0.14 L/kg (low Vd indicates primarily confined to extracellular fluid; distributes into bile, sputum, pleural and synovial fluids; minimal CNS penetration unless inflamed meninges). |
| Bioavailability | Intramuscular: ~98% (nearly complete); Oral: not available (parenteral only). |
| Onset of Action | Intramuscular: 1-2 hours; Intravenous: immediate (peak levels achieved within 5-15 minutes post-IV infusion). |
| Duration of Action | Approximately 12-24 hours for susceptible organisms (due to long half-life, once-daily dosing is effective; duration may be shorter for more resistant pathogens or in neutropenic patients). |
1 g intramuscularly or intravenously every 24 hours; for severe infections, 2 g every 24 hours.
| Dosage form | INJECTABLE |
| Renal impairment | Creatinine clearance (CrCl) 20-79 mL/min: 500 mg every 24 hours; CrCl <20 mL/min: 500 mg every 48 hours. Hemodialysis: 500 mg after each dialysis session. |
| Liver impairment | No dose adjustment required for hepatic impairment. Use with caution in severe hepatic dysfunction. |
| Pediatric use | Children >6 months: 20-50 mg/kg intramuscularly or intravenously once daily; maximum 1 g/day. |
| Geriatric use | No specific dose adjustment based on age alone; adjust based on renal function per renal adjustment guidelines. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for MONOCID (MONOCID).
| Breastfeeding | Cefonicid (Monocid) is excreted into human milk in low concentrations. The milk-to-plasma ratio is approximately 0.22–0.27. It is considered compatible with breastfeeding due to poor oral bioavailability in infants, but may alter infant gut flora. Monitor for diarrhea or rash. |
| Teratogenic Risk | FDA Pregnancy Category B. Animal studies have not demonstrated fetal risk, but adequate human studies in pregnant women are lacking. No teratogenic effects reported in first trimester; use only if clearly needed during second and third trimesters. Potential for neonatal kernicterus if given near term due to bilirubin displacement. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to cefonicid or other cephalosporins"]
| Precautions | ["Hypersensitivity reactions including anaphylaxis","Pseudomembranous colitis due to Clostridium difficile","Superinfection with prolonged use","Dosage adjustment in renal impairment (creatinine clearance < 20 mL/min)","Use with caution in patients with history of penicillin allergy"] |
Loading safety data…
| Fetal Monitoring | Monitor maternal renal function (creatinine clearance) due to renal excretion; adjust dose if impaired. Observe for signs of superinfection or allergic reactions. Fetal monitoring not specifically required but standard prenatal surveillance recommended. |
| Fertility Effects | No known adverse effects on human fertility. Animal studies showed no impairment of fertility at therapeutic doses. |