VEETIDS '250'
Clinical safety rating: caution
Comprehensive clinical and safety monograph for VEETIDS '250' (VEETIDS '250').
VEETIDS '250' is an oral cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), particularly PBP-3, thereby disrupting peptidoglycan cross-linking and leading to cell lysis.
| Metabolism | Cefdinir is not extensively metabolized; approximately 10% is hydrolyzed via esterases, and the remainder is excreted unchanged in the urine. Renal clearance is the primary route of elimination. |
| Excretion | Primarily renal (≥90% as unchanged drug) via glomerular filtration and tubular secretion; minor biliary/fecal (<5%). |
| Half-life | 2-3 hours in adults with normal renal function; prolonged to 24-40 hours in anuria/end-stage renal disease, requiring dose adjustment. |
| Protein binding | Low (<10%), primarily to albumin; minimal binding reduces risk of displacement interactions. |
| Volume of Distribution | 0.25-0.4 L/kg, approximating extracellular fluid volume; increased to 0.5-0.7 L/kg in edematous states or neonates. |
| Bioavailability | Intramuscular: ~90% (well absorbed); oral: <1% (negligible due to poor gastrointestinal absorption). |
| Onset of Action | Intramuscular: 1-2 hours; Intravenous: immediate within minutes. |
| Duration of Action | Intramuscular: 8-12 hours for therapeutic levels; intravenous: 6-8 hours; duration lengthens with renal impairment. |
250 mg orally every 8 hours for 7-10 days
| Dosage form | TABLET |
| Renal impairment | CrCl 30-50 mL/min: 250 mg every 12 hours; CrCl 15-29 mL/min: 250 mg every 24 hours; CrCl <15 mL/min: 250 mg every 48 hours |
| Liver impairment | Child-Pugh Class A: no adjustment; Class B: 250 mg every 12 hours; Class C: 250 mg every 24 hours |
| Pediatric use | 15 mg/kg per dose orally every 8 hours (max 250 mg per dose) for 7-10 days |
| Geriatric use | Same as adult dosing; monitor renal function and adjust based on CrCl |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for VEETIDS '250' (VEETIDS '250').
| Breastfeeding | Excreted into breast milk (M/P ratio 0.3-0.6). Infant serum levels are approximately 10-50% of maternal levels. Breastfeeding is not recommended due to potential for infant toxicity including lethargy, hypotonia, and feeding difficulties. If used, monitor infant serum lithium and thyroid function. |
| Teratogenic Risk | VEETIDS '250' is contraindicated in pregnancy. First trimester exposure associated with Ebstein's anomaly and other congenital heart defects. Second and third trimester exposure may cause neonatal lithium toxicity including hypotonia, lethargy, and cyanosis. Increased risk of preterm delivery and large-for-gestational age. |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to cefdinir or any cephalosporin antibiotic; anaphylactic reactions to penicillins (cross-sensitivity).
| Precautions | Hypersensitivity reactions including anaphylaxis; Clostridioides difficile-associated diarrhea; superinfection; caution in patients with renal impairment (dose adjustment required for CrCl <30 mL/min); potential for vitamin K deficiency and bleeding risk; interaction with iron supplements and antacids reducing absorption. |
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| Fetal Monitoring | Monitor serum lithium levels monthly (target 0.6-1.0 mEq/L). Perform fetal echocardiography at 18-22 weeks gestation. Serial fetal growth ultrasounds every 4 weeks from 24 weeks. Monitor maternal thyroid and renal function every trimester. Assess neonatal lithium level at birth and ECG for arrhythmias. |
| Fertility Effects | Lithium may cause menstrual irregularities and polycystic ovary syndrome, potentially impairing fertility. In males, limited evidence suggests possible sperm abnormalities. Thyroid dysfunction from lithium can also affect fertility. |