General

Pronunciation
a-seat-oh-hye-drox-AM-ikAS -id

Trade Name(s)

• AHA

• Lithostat

Pregnancy Category
Category X

Ther. class.
anti-infectives
(adjunct)

Pharm. class.
urease inhibitors

Indications

Adjunct therapy in chronic urea-splitting urinary tract infection

Action

Reversibly inhibits the bacterial enzyme urease, which results in decreased hydrolysis of urea and subsequent production of ammonia in urine infected with urea-splitting bacteria

Therapeutic Effect(s):

• Decreased urinary ammonia levels and decreased urine pH, which increases the efficacy of anti-infective therapy and cure rates

• Does not directly alter pH or have any direct antibacterial activity

Pharmacokinetics

Absorption: Well absorbed following oral administration

Distribution: Distributed throughout body water

Metabolism and Excretion: 36–65% excreted unchanged in urine

Half-life: 5–10 hr (increased in renal impairment)

TIME/ACTION PROFILE (effect on urine)

ROUTE	ONSET	PEAK	DURATION
PO	4–8 hrs	0.25–1 hr†	6–8 hr

†Blood levels

Contraindication/Precautions

Contraindicated in:

• Urinary tract infection with non-urea-splitting organisms

• Urinary tract infections that can be controlled by culture-specific oral antibiotics

• Serum creatinine >2.5 mg/dl or CCr<20 ml/min

• OB: Causes birth defects; women of childbearing potential must use adequate contraception

• Lactation: Safety not established

Use Cautiously in:

• Renal impairment (increased risk of adverse reactions; dosage reduction recommended)

• Hepatic impairment

• Pre-existing thrombophlebitis or phlebothrombosis (increased risk of adverse reactions)

Adverse Reactions/Side Effects

CNS: headache, anxiety, depression, malaise, nervousness, tremulousness.

CV: palpitations, superficial phlebitis of the lower extremities.

Derm: alopecia, rash (in association with alcohol).

GI: anorexia,, nausea,, vomiting.

Hemat: anemia, hemolytic anemia.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug

• Decreases absorption of iron

• Iron decreases the absorption of acetohydroxamic acid

• Concurrent ingestion of alcohol increases the incidence of rash

Route/Dosage

• PO (Adults): 250 mg 3–4 times daily (total dose 10–15 mg/kg/day)(maximum daily dose = 1500 mg).

• PO (Children): 10 mg/kg/day in divided doses; further titration may be necessary.

Renal Impairment

• PO (Adults):
Serum creatinine 1.8–2.5 mg/dl—do not exceed 1000 mg/day (given at 12 hr intervals; further adjustments may be necessary).

Availability

• Tablets: 250 mg

Assessment

• Assess patient for signs and symptoms of urinary tract infection (frequency, urgency, fever, pus in urine) throughout therapy

Lab Test Considerations

• Monitor CBC including reticulocyte count after 2 wk of treatment and every 3 mo during therapy. Reticulocytosis and hemolytic anemia may occur. If reticulocyte count is >6%, reduce dose

» Monitor renal and hepatic function closely during therapy

Potential Nursing Diagnoses

• Risk for infection (Indications)

• Impaired urinary elimination (Indications)

Implementation

• If a patient requires iron for a microcytic anemia, intramuscular iron can be used during the course of treatment with acetohydroxamic acid

• PO: Administer on an empty stomach, 1 hr before or 2 hr after meals

Patient/Family Teaching

• Instruct patient to take medication exactly as directed

• Inform patient that mild headache may occur during first 48 hr of treatment. Headaches usually respond to oral salicylates (aspirin) and usually disappear spontaneously

• Advise patient that taking acetohydroxamic acid concurrently with alcohol may cause a nonpruritic macular skin rash to occur on upper extremities and face. Rash usually appears 30–45 min after ingestion of alcohol and may be associated with a sensation of warmth. It usually spontaneously disappears in 30–60 min

• Emphasize the importance of periodic lab tests to monitor for side effects

• Caution patients of childbearing potential to use a reliable form of contraception while taking acetohydroxamic acid

Evaluation/Desired Outcomes

Decreased urinary ammonia levels and decreased urine pH which increases the efficacy of anti-infective therapy and cure rates in urinary tract infections

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