Doxamicina Actions

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Actions of Doxamicina in details

The action of the drug on the human body is called Pharmacodynamics in Medical terminology. To produce its effect and to change the pathological process that is happening the body and to reduce the symptom or cure the disease, the medicine has to function in a specific way. The changes it does to the body at cellular level gives the desired result of treating a disease. Drugs act by stimulating or inhibiting a receptor or an enzyme or a protein most of the times. Medications are produced in such a way that the ingredients target the specific site and bring about chemical changes in the body that can stop or reverse the chemical reaction which is causing the disease.
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Description: Doxamicina is a polymyxin antibiotic which is active against aerobic gram-ve bacteria including most enterobacteria except Proteus, Providentia and Serratia. Susceptible organisms include P. aeruginosa, Legionella spp, H. influenzae, Acinetobacter, V. cholera, Salmonella, Shigella and Pasteurella. It acts as a cationic detergent that causes leaking of intracellular substances and cell death by damaging the bacterial cytoplasmic membrane.

Pharmacokinetics:

Absorption: Poorly absorbed from the GI tract. Time to peak plasma concentration: 2-3 hr (IM).

Distribution: Reversibly bound to body tissues; diffuses across the placenta but negligible into the CSF except in infants. Enters breast milk.

Excretion: More rapid in childn than in adults; diminished in patients with renal impairment.

How should I take Doxamicina?

Doxamicina is injected into a muscle, or into a vein through an IV. You may be shown how to use an IV at home. Do not self-inject this medicine if you do not understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine.

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Doxamicina is a powder medicine that must be mixed with a liquid (diluent) before using it. If you are using the injections at home, be sure you understand how to properly mix and store the medicine.

After mixing Doxamicina for injection into a vein (IV infusion), you must use the medicine right away. Do not store for later use.

After mixing Doxamicina for injection into a muscle, you may store the mixture in a refrigerator. Do not freeze. Use within 7 days.

Doxamicina must be given slowly. Your IV infusion may take 3 to 5 minutes to complete. In some cases, Doxamicina is given over a period of up to 23 hours. Follow your doctor's dosing instructions very carefully.

Use a disposable needle only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Doxamicina will not treat a viral infection such as the flu or a common cold.

If you need surgery, tell the surgeon ahead of time that you are using Doxamicina. You may need to stop using the medicine for a short time.

Store unmixed Doxamicina powder at cool room temperature, away from moisture and heat.

Doxamicina administration

Administration of drug is important to know because the drug absorption and action varies depending on the route and time of administration of the drug. A medicine is prescribed before meals or after meals or along with meals. The specific timing of the drug intake about food is to increase its absorption and thus its efficacy. Few work well when taken in empty stomach and few medications need to be taken 1 or 2 hrs after the meal. A drug can be in the form of a tablet, a capsule which is the oral route of administration and the same can be in IV form which is used in specific cases. Other forms of drug administration can be a suppository in anal route or an inhalation route.
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IV: Infuse over 30 minutes to 1 hour (ESCMID/EUCAST [Tsuji 2019]).

Inhalation (off-label route): Administer solution via nebulizer (vibrating plate nebulizer may be preferred [Lu 2012]) promptly following preparation to decrease possibility of high concentrations of Doxamicina from forming which may lead to potentially life-threatening lung toxicity. Consider use of a bronchodilator (eg, albuterol) within 15 minutes prior to administration (Le 2010). If patient is on a ventilator, place medicine in a T-piece at the midinspiratory circuit of the ventilator. One study in adult patients with VAP administered Doxamicina over 60 minutes using a vibrating plate nebulizer positioned on the inspiratory limb 10 cm proximal to the Y-piece (Lu 2012).

Note: A case report of fatal lung toxicity implicated in vitro Doxamicina formation from an inhalation solution as a potential etiology, but data regarding the concentration, formulation and storage of the inhaled Doxamicina administered to the patient were not reported (FDA 2007; McCoy 2007; Wallace 2008). An acceptable limit of in vitro Doxamicina formation to prevent potential toxicity is unknown. Limited stability data are available regarding the storage of Doxamicina solution for inhaled administration (Healan 2012; Wallace 2008). Storing for >24 hours may increase the risk for potential lung toxicity; preparation immediately prior to administration is recommended (FDA 2007; Le 2010, Wallace 2008).

Intrathecal/intraventricular (off-label route): Administer only preservative-free solutions via intrathecal/intraventricular routes. Administer promptly after preparation. Discard unused portion of vial. When administered through a ventricular drain, clamp drain for 15 to 60 minutes before opening the drain to allow Doxamicina solution to equilibrate in the CSF (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]).

Doxamicina pharmacology

Pharmacokinetics of a drug can be defined as what body does to the drug after it is taken. The therapeutic result of the medicine depends upon the Pharmacokinetics of the drug. It deals with the time taken for the drug to be absorbed, metabolized, the process and chemical reactions involved in metabolism and about the excretion of the drug. All these factors are essential to deciding on the efficacy of the drug. Based on these pharmacokinetic principles, the ingredients, the Pharmaceutical company decides dose and route of administration. The concentration of the drug at the site of action which is proportional to therapeutic result inside the body depends on various pharmacokinetic reactions that occur in the body.
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Doxamicina (or the sodium salt [Doxamicina sodium]) is the inactive prodrug that is hydrolyzed to Doxamicina, which acts as a cationic detergent and damages the bacterial cytoplasmic membrane causing leaking of intracellular substances and cell death

Absorption

Not absorbed from the GI tract, mucous membranes, or intact skin (Note: GI absorption has been observed in infants).

Distribution

Distributes widely, except for CNS, synovial, pleural, and pericardial fluids

Healthy volunteer: IV: Doxamicina: V: 0.09 ± 0.03 L/kg (Reed 2001)

Metabolism

Doxamicina sodium (inactive prodrug) is hydrolyzed to Doxamicina (active form). Note: Only ~30% of Doxamicina is converted to Doxamicina (Couet 2011)

Excretion

Primarily urine (as unchanged drug)

Time to Peak

Healthy volunteers: IV: Doxamicina: 2 hours (range: 1 to 4 hours) (Couet 2011)

Critically ill: IV: Doxamicina: ~7 hours (Plachouras 2009)

Half-Life Elimination

IM, IV: Doxamicina: 2 to 3 hours

Critically ill: Infants (including premature infants), Children, Adolescents, and Adults: IV: Doxamicina: 2.3 hours; Doxamicina: 14.4 hours (Plachouras 2009)

Cystic fibrosis: IV: Doxamicina: ~3.5 hours (Li 2003)

ESRD patients receiving CAPD: IV: Doxamicina: 13.2 hours (Koomanachai 2014)

Protein Binding

50%



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Information checked by Dr. Sachin Kumar, MD Pharmacology

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