Nafcillin side effects: what 708 FDA adverse event reports show

Nafcillin · 16 reaction terms · 268 drug–reaction co-reports · data 2026-09-14

Drug class

Not stated in label

Who reports

708 reports · 87% serious · 97 with death outcome · 33% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Nafcillin is indicated in the treatment of infections caused by penicillinase-producing staphylococci which have demonstrated susceptibility to the drug. Culture and susceptibility tests should be performed initially to determine the causative organism and its susceptibility to the drug (see CLINICAL PHARMACOLOGY - Susceptibility Test Methods ).

FDA label, Indications and Usage

What it is

DESCRIPTION Nafcillin for Injection, USP is a semisynthetic antibiotic penicillin derived from the penicillin nucleus 6-aminopenicillanic acid. It is the sodium salt in a parenteral dosage form.

FDA label, Description section

Boxed warning

None in the current label

How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 16 strongest signals

Labeled adverse reaction 1Labeled (related wording) 1Reporting / coding artifact 1Not in label — unassessed 13

What the badges mean

Labeled adverse reaction The exact term appears in the label's warnings or adverse-reactions sections: a known, expected effect. The FAERS signal confirms the label rather than discovering anything.
Labeled (related wording) The label describes this effect under different wording (e.g. 'neutropenia' for 'neutrophil count decreased'). Treated as known.
Reporting / coding artifact An administrative, monitoring or exposure term (product issue, off-label use, 'test normal', overdose...). Not a biological reaction; a high PRR here reflects how reports are coded.
Not in label — unassessed Not found in the label text, not an artifact pattern. This is a genuine candidate for a formal causality assessment (Bradford Hill / WHO-UMC); it has NOT had one here.

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only and flags pairs whose reports are unusually skewed by sex or come mostly from consumers rather than clinicians. 0 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show: hide coding/lab/outcome terms hide indication terms unlabeled only hide PRR-only

Reaction	Reports	PRR 95% CI · ROR · χ²/p	EBGM EB05 · IC025	Label screen	Serious-only & strata	Trial cross-check
Nephropathy toxic	24	64.0 43.1–94.8ROR 66.2 · χ² 1,423 / p <1e-300	60.9 EB05 43.1 · IC025 +4.1 3/3 methods agree	Not in label — unassessed	serious PRR 43.2 · 100% clinician	no trial data cached
Tubulointerstitial nephritis	39	61.8 45.5–83.9ROR 65.3 · χ² 2,269 / p <1e-300	59.9 EB05 45.8 · IC025 +4.6 3/3 methods agree	Not in label — unassessed	serious PRR 36.7 · ♀ 13% (drug 33%) · 100% clinician	no trial data cached
Hypokalaemia (low potassium)	38	24.5 18.0–33.4ROR 25.9 · χ² 836 / p 4e-184	24.3 EB05 18.4 · IC025 +3.7 3/3 methods agree	Not in label — unassessed	serious PRR 15.6 · 100% clinician	no trial data cached
Renal failure acute	35	24.1 17.4–33.3ROR 25.3 · χ² 753 / p 4e-166	23.8 EB05 17.9 · IC025 +3.6 3/3 methods agree	Not in label — unassessed	serious PRR 14.7 · 94% clinician	no trial data cached
Cardiogenic shock	9	18.7 9.8–35.8ROR 18.9 · χ² 134 / p 3e-31	17.1 EB05 8.4 · IC025 +2.1 3/3 methods agree	Not in label — unassessed	serious PRR 12.3	no trial data cached
Eosinophilia	10	17.0 9.2–31.4ROR 17.2 · χ² 135 / p 2e-31	15.5 EB05 7.8 · IC025 +2.2 3/3 methods agree	Labeled adverse reaction exact term	serious PRR 11.7	no trial data cached
Anhedonia	15	16.8 10.2–27.7ROR 17.1 · χ² 207 / p 3e-47	16.0 EB05 9.7 · IC025 +2.6 3/3 methods agree	Not in label — unassessed	serious PRR 12.3	no trial data cached
Fear	15	16.4 9.9–27.1ROR 16.7 · χ² 202 / p 4e-46	15.6 EB05 9.4 · IC025 +2.6 3/3 methods agree	Not in label — unassessed	serious PRR 14.7	no trial data cached
Renal injury	16	15.8 9.7–25.6ROR 16.1 · χ² 207 / p 3e-47	15.1 EB05 9.2 · IC025 +2.6 3/3 methods agree	Not in label — unassessed	serious PRR 10.5	no trial data cached
Serotonin syndrome	10	15.5 8.4–28.7ROR 15.7 · χ² 121 / p 1e-28	13.9 EB05 6.9 · IC025 +2.1 3/3 methods agree	Not in label — unassessed	serious PRR 10.3	no trial data cached
Drug-induced liver injury	16	15.4 9.5–25.0ROR 15.7 · χ² 201 / p 6e-46	14.6 EB05 8.9 · IC025 +2.6 3/3 methods agree	Not in label — unassessed	serious PRR 10.3	no trial data cached
Device related infection	8	15.4 7.7–30.6ROR 15.5 · χ² 94 / p 2e-22	13.0 EB05 5.8 · IC025 +1.8 3/3 methods agree	Reporting / coding artifact	serious PRR 10.4	no trial data cached
Sinus bradycardia	5	15.3 6.4–36.6ROR 15.4 · χ² 53 / p 1e-13	10.8 EB05 3.7 · IC025 +1.2 3/3 methods agree	Not in label — unassessed	serious PRR 10.4	no trial data cached
Drug reaction with eosinophilia and systemic symptoms	13	15.1 8.8–25.8ROR 15.3 · χ² 157 / p 2e-36	14.0 EB05 7.8 · IC025 +2.4 3/3 methods agree	Labeled (related wording) related wording	serious PRR 9.2	no trial data cached
Fluid overload	7	14.0 6.7–29.4ROR 14.2 · χ² 72 / p 9e-18	11.1 EB05 4.6 · IC025 +1.6 3/3 methods agree	Not in label — unassessed	serious PRR 12.0	no trial data cached
Rash generalised	8	9.0 4.5–18.0ROR 9.1 · χ² 49 / p 1e-12	6.7 EB05 3.4 · IC025 +1.4 3/3 methods agree	Not in label — unassessed	serious PRR 8.9	no trial data cached

Trial evidence (ClinicalTrials.gov)

Trial cross-check not yet run for this drug (ClinicalTrials.gov pull covers the 800 most-reported drugs first).

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

Reaction	Reports	PRR 95% CI · ROR · χ²/p	EBGM EB05 · IC025	Label screen	Serious-only & strata	Trial cross-check
Tubulointerstitial nephritis	39	61.8 45.5–83.9ROR 65.3 · χ² 2,269 / p <1e-300	59.9 EB05 45.8 · IC025 +4.6 3/3 methods agree	Not in label — unassessed	serious PRR 36.7 · ♀ 13% (drug 33%) · 100% clinician	no trial data cached
Hypokalaemia (low potassium)	38	24.5 18.0–33.4ROR 25.9 · χ² 836 / p 4e-184	24.3 EB05 18.4 · IC025 +3.7 3/3 methods agree	Not in label — unassessed	serious PRR 15.6 · 100% clinician	no trial data cached
Renal failure acute	35	24.1 17.4–33.3ROR 25.3 · χ² 753 / p 4e-166	23.8 EB05 17.9 · IC025 +3.6 3/3 methods agree	Not in label — unassessed	serious PRR 14.7 · 94% clinician	no trial data cached
Nephropathy toxic	24	64.0 43.1–94.8ROR 66.2 · χ² 1,423 / p <1e-300	60.9 EB05 43.1 · IC025 +4.1 3/3 methods agree	Not in label — unassessed	serious PRR 43.2 · 100% clinician	no trial data cached
Drug-induced liver injury	16	15.4 9.5–25.0ROR 15.7 · χ² 201 / p 6e-46	14.6 EB05 8.9 · IC025 +2.6 3/3 methods agree	Not in label — unassessed	serious PRR 10.3	no trial data cached
Renal injury	16	15.8 9.7–25.6ROR 16.1 · χ² 207 / p 3e-47	15.1 EB05 9.2 · IC025 +2.6 3/3 methods agree	Not in label — unassessed	serious PRR 10.5	no trial data cached
Fear	15	16.4 9.9–27.1ROR 16.7 · χ² 202 / p 4e-46	15.6 EB05 9.4 · IC025 +2.6 3/3 methods agree	Not in label — unassessed	serious PRR 14.7	no trial data cached
Anhedonia	15	16.8 10.2–27.7ROR 17.1 · χ² 207 / p 3e-47	16.0 EB05 9.7 · IC025 +2.6 3/3 methods agree	Not in label — unassessed	serious PRR 12.3	no trial data cached
Drug reaction with eosinophilia and systemic symptoms	13	15.1 8.8–25.8ROR 15.3 · χ² 157 / p 2e-36	14.0 EB05 7.8 · IC025 +2.4 3/3 methods agree	Labeled (related wording) related wording	serious PRR 9.2	no trial data cached
Serotonin syndrome	10	15.5 8.4–28.7ROR 15.7 · χ² 121 / p 1e-28	13.9 EB05 6.9 · IC025 +2.1 3/3 methods agree	Not in label — unassessed	serious PRR 10.3	no trial data cached
Eosinophilia	10	17.0 9.2–31.4ROR 17.2 · χ² 135 / p 2e-31	15.5 EB05 7.8 · IC025 +2.2 3/3 methods agree	Labeled adverse reaction exact term	serious PRR 11.7	no trial data cached
Cardiogenic shock	9	18.7 9.8–35.8ROR 18.9 · χ² 134 / p 3e-31	17.1 EB05 8.4 · IC025 +2.1 3/3 methods agree	Not in label — unassessed	serious PRR 12.3	no trial data cached
Rash generalised	8	9.0 4.5–18.0ROR 9.1 · χ² 49 / p 1e-12	6.7 EB05 3.4 · IC025 +1.4 3/3 methods agree	Not in label — unassessed	serious PRR 8.9	no trial data cached
Device related infection	8	15.4 7.7–30.6ROR 15.5 · χ² 94 / p 2e-22	13.0 EB05 5.8 · IC025 +1.8 3/3 methods agree	Reporting / coding artifact	serious PRR 10.4	no trial data cached
Fluid overload	7	14.0 6.7–29.4ROR 14.2 · χ² 72 / p 9e-18	11.1 EB05 4.6 · IC025 +1.6 3/3 methods agree	Not in label — unassessed	serious PRR 12.0	no trial data cached

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

Nephropathy toxic — n=24, PRR 64.0
Tubulointerstitial nephritis — n=39, PRR 61.8
Hypokalaemia — n=38, PRR 24.5
Renal failure acute — n=35, PRR 24.1

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Nafcillin?

In FDA FAERS, the most frequently co-reported reaction terms for Nafcillin are tubulointerstitial nephritis, hypokalaemia, renal failure acute, nephropathy toxic, drug-induced liver injury, renal injury. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Nafcillin have an FDA boxed warning?

No. The FDA label retrieved for Nafcillin has no boxed warning; see the label's Warnings and Precautions for the recognised risks.

Do FAERS signals prove that Nafcillin causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

FDA label via openFDA (set ID 91ebf84a-310f-4271-8446-5a10a877883a, effective 20240227; matched on openfda.generic_name.exact:"NAFCILLIN")
Bayesian shrinkage measures computed offline over all 1,317,300 cached pairs: BCPNN information component (IC, with Norén closed-form IC025) and MGPS empirical-Bayes geometric mean (EBGM, EB05) with a two-component gamma prior fitted by maximum marginal likelihood (α₁=0.57, β₁=0.02, α₂=1.42, β₂=0.70, w=0.17); unstratified
FAERS pair statistics from the OpenPV build of 2026-09-14 (openFDA count= aggregation, field patient.drug.openfda.generic_name.exact, 16 reaction terms, min 3 co-reports); PRR/ROR with 95% CI, chi-square with Yates correction
Serious-only and stratified counts (serious:1, patient.patientsex, primarysource.qualification) from openFDA count queries; serious-only PRR uses the drug serious report total and the term global serious total (N_serious=11,882,979); strata shown only when n ≥ 20
Seriousness and sex counts from openFDA count=serious, patient.patientsex, seriousnessdeath

Page generated 2026-10-08. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.