CEFPROZIL — cefprozil powder, for suspension
NorthStar Rx LLC
To reduce the development of drug-resistant bacteria and maintain the effectiveness of cefprozil and other antibacterial drugs, cefprozil should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
Cefprozil is a semi-synthetic broad-spectrum cephalosporin antibiotic. Cefprozil is a cis and trans isomeric mixture (≥90% cis). The chemical name for the monohydrate is (6R, 7R)-7-[(R)-2-Amino-2-(p -hydroxyphenyl)acetamido]-8-oxo-3-propenyl-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid monohydrate, and the structural formula is:
Cefprozil, USP is a white to yellowish powder with a molecular formula for the monohydrate of C18 H19 N3 O5 S•H2 O and a molecular weight of 407.45.
Cefprozil for oral suspension, USP is intended for oral administration. Cefprozil for oral suspension, USP contains cefprozil USP equivalent to 125 mg or 250 mg anhydrous cefprozil per 5 mL constituted suspension. In addition, the oral suspension contains the following inactive ingredients: aspartame, microcrystalline cellulose, carboxymethylcellulose sodium, citric acid monohydrate, colloidal silicon dioxide, FD&C Red No.3, glycine, polysorbate 80, simethicone emulsion, sodium benzoate, sodium chloride, bubble gum flavor and sucrose.
The pharmacokinetic data were derived from the capsule formulation; however, bioequivalence has been demonstrated for the oral solution, capsule, tablet, and suspension formulations under fasting conditions.
Following oral administration of cefprozil to fasting subjects, approximately 95% of the dose was absorbed. The average plasma half-life in normal subjects was 1.3 hours, while the steady-state volume of distribution was estimated to be 0.23 L/kg. The total body clearance and renal clearance rates were approximately 3 mL/min/kg and 2.3 mL/min/kg, respectively. Average peak plasma concentrations after administration of 250 mg, 500 mg, or 1 g doses of cefprozil to fasting subjects were approximately 6.1, 10.5, and 18.3 mcg/mL, respectively, and were obtained within 1.5 hours after dosing. Urinary recovery accounted for approximately 60% of the administered dose. (See Table.)
|*Data represent mean values of 12 healthy volunteers.|
|Dosage (mg)||Mean Plasma Cefprozil Concentrations (mcg/mL)*||8-hourUrinary Excretion (%)|
|Peak appx. 1.5 h||4 h||8 h|
During the first 4-hour period after drug administration, the average urine concentrations following 250 mg, 500 mg, and 1 g doses were approximately 700 mcg/mL, 1000 mcg/mL, and 2900 mcg/mL, respectively.
Administration of cefprozil tablet or suspension formulations with food did not affect the extent of absorption (AUC) or the peak plasma concentration (Cmax ) of cefprozil. However, there was an increase of 0.25 to 0.75 hours in the time to maximum plasma concentration of cefprozil (Tmax ).
Plasma protein binding is approximately 36% and is independent of concentration in the range of 2 mcg/mL to 20 mcg/mL.
There was no evidence of accumulation of cefprozil in the plasma in individuals with normal renal function following multiple oral doses of up to 1000 mg every 8 hours for 10 days.
In patients with reduced renal function, the plasma half-life may be prolonged up to 5.2 hours depending on the degree of the renal dysfunction. In patients with complete absence of renal function, the plasma half-life of cefprozil has been shown to be as long as 5.9 hours. The half-life is shortened during hemodialysis. Excretion pathways in patients with markedly impaired renal function have not been determined. (See PRECAUTIONS and DOSAGE AND ADMINISTRATION.)
In patients with impaired hepatic function, the half-life increases to approximately 2 hours. The magnitude of the changes does not warrant a dosage adjustment for patients with impaired hepatic function.
Healthy geriatric volunteers (≥65 years old) who received a single 1-g dose of cefprozil had 35% to 60% higher AUC and 40% lower renal clearance values compared with healthy adult volunteers 20 to 40 years of age. The average AUC in young and elderly female subjects was approximately 15 to 20% higher than in young and elderly male subjects. The magnitude of these age- and gender-related changes in the pharmacokinetics of cefprozil is not sufficient to necessitate dosage adjustments.
Adequate data on CSF levels of cefprozil are not available.Comparable pharmacokinetic parameters of cefprozil are observed between pediatric patients (6 months to 12 years) and adults following oral administration of selected matched doses. The maximum concentrations are achieved at 1 to 2 hours after dosing. The plasma elimination half-life is approximately 1.5 hours. In general, the observed plasma concentrations of cefprozil in pediatric patients at the 7.5, 15, and 30 mg/kg doses are similar to those observed within the same time frame in normal adult subjects at the 250, 500, and 1000 mg doses, respectively. The comparative plasma concentrations of cefprozil in pediatric patients and adult subjects at the equivalent dose level are presented in the table below.
|a n=11; b n=5; c n=9; d n=11.|
|Mean (SD) Plasma Cefprozil Concentrations (mcg/mL)|
|Population||Dose||1 h||2 h||4 h||6 h||TT1/2 (h)|
|children (n=18)||7.5 mg/kg||4.7 (1.57)||3.99 (1.24)||0.91 (0.3)||0.23a (0.13)||0.94 (0.32)|
|adults (n=12)||250 mg||4.82 (2.13)||4.92 (1.13)||1.7b (0.53)||0.53 (0.17)||1.28 (0.34)|
|children (n=19)||15 mg/kg||10.86 (2.55)||8.47 (2.03)||2.75 (1.07)||0.61c (0.27)||1.24 (0.43)|
|adults (n=12)||500 mg||8.39 (1.95)||9.42 (0.98)||3.18d (0.76)||1d (0.24)||1.29 (0.14)|
|children (n=10)||30 mg/kg||16.69 (4.26)||17.61 (6.39)||8.66 (2.7)||–||2.06 (0.21)|
|adults (n=12)||1000 mg||11.99 (4.67)||16.95 (4.07)||8.36 (4.13)||2.79 (1.77)||1.27 (0.12)|
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