Mosby's Drug Consult


Cephalexin (0698)

CATEGORIES, DRUG CLASSES, BRAND NAMES & COST OF THERAPY

CATEGORIES: Infection, bone; Infection, skin and skin structure; Infection, urinary tract; Infection, ear, middle; Infection, upper respiratory tract; Prostatitis; Pregnancy Category B; FDA Approved December 1981

Drug Classes: Antibiotics, cephalosporins

BRAND NAMES: Biocef; Keflex; Keftab

FOREIGN BRAND AVAILABILITY:
Alexin (India);
Anxer (Hong Kong);
Bloflex (Philippines);
Cefablan (Colombia);
Cefacin-M (Hong Kong);
Cefadin (Ecuador);
Cefadina (Spain);
Cefalin (Indonesia, Israel, Philippines);
Cefax (Colombia);
Ceforal (Israel);
Cefovit (Israel);
Cefrin (Peru);
Celexil (Philippines);
Celexin (Thailand);
Cepastar (Philippines);
Cepexin (Austria);
Cephalexyl (Thailand);
Cephanmycin (Singapore);
Cephia (Thailand);
Cepol (Japan);
Ceporex (Belgium, Bulgaria, Czech Republic, Ecuador, England, Hong Kong, Ireland, Italy, Malaysia, Mexico, Netherlands, Philippines, Portugal, South Africa, Spain, Switzerland, Thailand);
Ceporex Forte (Portugal);
Ceporexin (Argentina, Germany);
Ceporexine (France);
Cerexin (South Africa);
Cromlex (Philippines);
Difagen (Philippines);
Durantel DS (Japan);
Erocetin (Argentina);
Falexin (Korea);
Farmalex (Thailand);
Felexin (Hong Kong, Malaysia);
Fexin (South Africa);
Ibilex (Taiwan, Thailand);
Inphalex (Indonesia);
Kefacin (Korea);
Kefalex (Finland);
Kefalospes (Greece);
Kefaxin (Greece, Ireland);
Kefexin (Czech Republic, Finland, Germany, Ireland);
Kefloridina (Spain);
Keforal (Argentina, Belgium, France, Italy, Netherlands);
Kemolexin (Indonesia);
Lenocef (South Africa);
Lexin (Peru);
Lonflex (Taiwan);
Madlexin (Indonesia);
Mamalexin (Japan);
Montralex (Philippines);
Neokef (Malaysia);
Novolexin (Canada);
Nufex (India);
Oracef (Bulgaria, Czech Republic, Germany);
Oriphex (South Africa);
Ospexin (Austria, Bulgaria, Costa Rica, Czech Republic, Dominican Republic, El Salvador, Guatemala, Honduras, Hong Kong, Indonesia, Malaysia, Nicaragua, Panama);
Paferxin (Mexico);
Palitrex (Ecuador, Indonesia, Peru);
Pectril (Philippines);
Pharmexin (Israel);
Pondnacef (Thailand);
Pyassan (Hungary);
Refosporen (Argentina);
Relaxin (Philippines);
Rofex (India);
Sanaxin (Austria);
Sefasin (Thailand);
Sepexin (India);
Septilisin (Argentina);
Servicef (Mexico);
Servispor (Malaysia);
Sialexin (Thailand);
Sinlex (Taiwan);
Sinthecillin (Greece);
Sofilex (Hong Kong, Singapore);
Sporicef (Thailand);
Sporidex (India, Philippines);
Syncle (Japan);
Tepaxin (Indonesia);
Tokiolexin (Japan);
Uphalexin (Malaysia);
Velexin (Thailand);
Voxxim (Philippines);
Zeplex (Thailand)

COST OF THERAPY:

CostIndicationFormBrand nameNumber of dosesDays of therapy
$5.87 Infection 250 mg Generic Capsules 4 capsules/day 7 day supply
$46.12 Infection 250 mg Keflex 4 capsules/day 7 day supply

DESCRIPTION

Cephalexin is a semisynthetic cephalosporin antibiotic intended for oral administration. It is 7-(D-α-Amino-α-phenylacetamido)-3-methyl-3-cephem-4-carboxylic acid monohydrate. Cephalexin has the molecular formula C16H17N3O4S·H2O and the molecular weight is 365.41.

The nucleus of cephalexin is related to that of other cephalosporin antibiotics. The compound is a zwitterion; i.e., the molecule contains both a basic and an acidic group. The isoelectric point of cephalexin in water is approximately 4.5 to 5.

The crystalline form of cephalexin which is available is a monohydrate. It is a white crystalline solid having a bitter taste. Solubility in water is low at room temperature; 1 or 2 mg/ml may be dissolved readily, but higher concentrations are obtained with increasing difficulty.

The cephalosporins differ from penicillins in the structure of the bicyclic ring system. Cephalexin has a D-phenylglycyl group as substituent at the 7-amino position and an unsubstituted methyl group at the 3-position.

Each Pulvule contains cephalexin monohydrate equivalent to 250 mg (720 μmol) or 500 mg (1439 μmol) of cephalexin. The Pulvules also contain cellulose, D&C yellow no. 10, FD&C blue no. 1, F D&C yellow no. 6, gelatin, magnesium stearate, silicone, titanium dioxide, and other inactive ingredients.

Each capsule manufactured by Mylan contains cephalexin monohydrate equivalent to 250 mg (720 μmol) or 500 mg (1439 μmol) of cephalexin. The capsules also contain cellulose, FD&C blue no. 1, gelatin, magnesium stearate, silicone, titanium dioxide, and other inactive ingredients.

After mixing, each 5 ml of Keflex, for oral suspension, will contain cephalexin monohydrate equivalent to 125 mg (360 μmol) or 250 mg (720 μmol) of cephalexin. The suspensions also contain flavors, methylcellulose, silicone, sodium lauryl sulfate, and sucrose. The 125 mg suspension contains FD&C red no. 40, and the 250 mg suspension contains FD&C yellow no. 6.

Each capsule manufactured by Biocraft contains cephalexin monohydrate equivalent to 250 mg (720 μmol) or 500 mg (1439 μmol) of cephalexin. Inactive Ingredients: Magnesium stearate, silicone dioxide and may contain talc. Capsule shell and print constituents: black iron oxide, D&C yellow no. 10 aluminium lake, FD&C blue no. 1 aluminium lake, FD&C blue no. 2 aluminium lake, FD&C red no. 40 aluminium lake, gelatin, pharmaceutical glaze modified in SD-45, silcon dioxide or carbomethylcellulose sodium, sodium lauryl sulfate, titanium dioxide and may contian propylene glyceryl. In addition, the 250 mg capsule shell contains yellow iron oxide.

Each tablet manufactured by Biocraft contains cephalexin monohydrate equivalent to 250 mg (720 μmol) or 500 mg (1439 μmol) of cephalexin. Inactive ingredients: hydroxypropyl methylcellulose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 90, sodium starch glycolate and titanium dioxide.

CLINICAL PHARMACOLOGY

Human Pharmacology

Cephalexin is acid stable and may be given without regard to meals. It is rapidly absorbed after oral administration. Following doses of 250 mg, 500 mg, and 1 g, average peak serum levels of approximately 9, 18, and 32 μg/ml respectively were obtained at 1 hour. Measurable levels were present 6 hours after administration. Cephalexin is excreted in the urine by glomerular filtration and tubular secretion. Studies showed that over 90% of the drug was excreted unchanged in the urine within 8 hours. During this period, peak urine concentrations following the 250 mg, 500 mg, and 1 g doses were approximately 1000, 2200, and 5000 μg/ml respectively.

Microbiology

In vitro tests demonstrate that the cephalosporins are bactericidal because of their inhibition of cell-wall synthesis. Cephalexin has been shown to be active against most strains of the following microorganisms both in vitro and in clinical infections as described in INDICATIONS AND USAGE.

Aerobes, Gram-positive:

Staphylococcus aureus (including penicillinase-producing strains).
Staphylococcus epidermidis (penicillin-susceptible strains).
Streptococcus pneumoniae.
Streptococcus pyogenes.

Aerobes, Gram-negative:

Escherichia coli.
Haemophilus influenzae.
Klebsiella pneumoniae.
Moraxella (Branhamella) catarrhalis.
Proteus mirabilis.

Note:  Methicillin-resistant staphylococci and most strains of enterococci (Enterococcus faecalis [formerly Streptococcus faecalis]) are resistant to cephalosporins, including cephalexin. It is not active against most strains of Enterobacter spp,Morganella morganii, and Proteus vulgaris. It has no activity against Pseudomonas spp or Acinetobacter calcoaceticus.

Susceptibility Testing

Diffusion Techniques:  Quantitative methods that require measurement of zone diameters provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. One such standard procedure 1 that has been recommended for use with disks to test the susceptibility of microorganisms to cephalexin, uses the 30 μg cephalothin disk. Interpretation involves correlation of the diameter obtained in the disk test with the minimal inhibitory concentration (MIC) for cephalexin.

Reports from the laboratory providing results of the standard single-disk susceptibility test with a 30 μg cephalothin disk should be interpreted according to the criteria found in TABLE 1.

TABLE 1
Zone Diameter (mm)Interpretation
≥18 (S) Susceptible
15-17 (I) Intermediate
≤14 (R) Resistant

A report of "Susceptible" indicates that the pathogen is likely to be inhibited by usually achievable concentrations of the antimicrobial compound in blood. A report of “Intermediate” indicates that the result should be considered equivocal, and, if the microorganism is not fully susceptible to alternative, clinically feasible drugs, the test should be repeated. This category implies possible clinical applicability in body sites where the drug is physiologically concentrated or in situations where high dosage of drug can be used. This category also provides a buffer zone that prevents small uncontrolled technical factors from causing major discrepancies in interpretation. A report of “Resistant” indicates that usually achievable concentrations of the antimicrobial compound in the blood are unlikely to be inhibitory and that other therapy should be selected.

Measurement of MIC or MBC and achieved antimicrobial compound concentrations may be appropriate to guide therapy in some infections. (See CLINICAL PHARMACOLOGY for information on drug concentrations achieved in infected body sites and other pharmacokinetic properties of this antimicrobial drug product.)

Standardized susceptibility test procedures require the use of laboratory control microorganisms. The 30 μg cephalothin disk should provide the zone diameters in these laboratory test quality control strains (see TABLE 2).

TABLE 2
MicroorganismZone Diameter (mm)
E. coli ATCC 25922 15-21
S. aureus ATCC 25923 29-37

Dilution Techniques:  Quantitative methods that are used to determine MICs provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. One such standardized procedure uses a standardized dilution method2 (broth, agar, microdilution) or equivalent with cephalothin powder. The MIC values obtained should be interpreted according to the criteria found in TABLE 3.

TABLE 3
MIC (μg/ml)Interpretation
≤8 (S) Susceptible
16 (I) Intermediate
≥32 (R) Resistant

Interpretation should be as stated above for results using diffusion techniques.

As with standard diffusion techniques, dilution methods require the use of laboratory control microorganisms. Standard cephalothin powder should provide the MIC values seen in TABLE 4.

TABLE 4
MicroorganismMIC (μg/ml)
E. coli ATCC 25922 4-16
S. aureus ATCC 29213 0.12-0.5

INDICATIONS AND USAGE

Cephalexin is indicated for the treatment of the following infections when caused by susceptible strains of the designated microorganisms:

Respiratory tract infections caused by S. pneumoniae and S. pyogenes (Penicillin is the usual drug of choice in the treatment and prevention of streptococcal infections, including the prophylaxis of rheumatic fever. Cephalexin is generally effective in the eradication of streptococci from the nasopharynx; however, substantial data establishing the efficacy of cephalexin in the subsequent prevention of rheumatic fever are not available at present.)

Otitis media due to S. pneumoniae, H. influenzae, staphylococci, streptococci, and M. catarrhalis.

Skin and skin structure infections caused by staphylococci and/or streptococci.

Bone infections caused by staphylococci and/or P. mirabilis.

Genitourinary tract infections, including acute prostatitis, caused by E. coli, P. mirabilis, and K. pneumoniae.

Note:  Culture and susceptibility tests should be initiated prior to and during therapy. Renal function studies should be performed when indicated.

CONTRAINDICATIONS

Cephalexin is contraindicated in patients with known allergy to the cephalosporin group of antibiotics.

WARNINGS

BEFORE CEPHALEXIN THERAPY IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE CONCERNING PREVIOUS HYPERSENSITIVITY REACTIONS TO CEPHALOSPORINS AND PENICILLIN. CEPHALOSPORIN C DERIVATIVES SHOULD BE GIVEN CAUTIOUSLY TO PENICILLIN-SENSITIVE PATIENTS.

SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE EPINEPHRINE AND OTHER EMERGENCY MEASURES.

There is some clinical and laboratory evidence of partial cross-allergenicity of the penicillins and the cephalosporins. Patients have been reported to have had severe reactions (including anaphylaxis) to both drugs.

Any patient who has demonstrated some form of allergy, particularly to drugs, should receive antibiotics cautiously. No exception should be made with regard to cephalexin.

Pseudomembranous colitis has been reported with nearly all antibacterial agents, including cephalexin, and may range from mild to life threatening. Therefore, it is important to consider this diagnosis in patients with diarrhea subsequent to the administration of antibacterial agents.

Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of clostridia. Studies indicate that a toxin produced by Clostridium difficile is a primary cause of antibiotic-associated colitis.

After the diagnosis of pseudomembranous colitis has been established, appropriate therapeutic measures should be initiated. Mild cases of pseudomembranous colitis usually respond to drug discontinuation alone. In moderate to severe cases, consideration should be given to management with fluids and electrolytes, protein supplementation, and treatment with an antibacterial drug clinically effective against Clostridium difficile colitis.

PRECAUTIONS

General

Patients should be followed carefully so that any side effects or unusual manifestations of drug idiosyncrasy may be detected. If an allergic reaction to cephalexin occurs, the drug should be discontinued and the patient treated with the usual agents (e.g., epinephrine or other pressor amines, antihistamines, or corticosteroids).

Prolonged use of cephalexin may result in the overgrowth of nonsusceptible organisms. Careful observation of the patient is essential. If superinfection occurs during therapy, appropriate measures should be taken.

Positive direct Coombs' tests have been reported during treatment with the cephalosporin antibiotics. In hematologic studies or in transfusion cross-matching procedures when antiglobulin tests are performed on the minor side or in Coombs' testing of newborns whose mothers have received cephalosporin antibiotics before parturition, it should be recognized that a positive Coombs' test may be due to the drug.

Cephalexin should be administered with caution in the presence of markedly impaired renal function. Under such conditions, careful clinical observation and laboratory studies should be made because safe dosage may be lower than that usually recommended.

Indicated surgical procedures should be performed in conjunction with antibiotic therapy.

As a result of administration of cephalexin, a false-positive reaction for glucose in the urine may occur. This has been observed with Benedict's and Fehling's solutions and also with Clinitest tablets.

As with other β-lactams, the renal excretion of cephalexin is inhibited by probenecid.

Broad-spectrum antibiotics should be prescribed with caution in individuals with a history of gastrointestinal disease, particularly colitis.

Pregnancy Category B

The daily oral administration of cephalexin to rats in doses of 250 or 500 mg/kg prior to and during pregnancy, or to rats and mice during the period of organogenesis only, had no adverse effect on fertility, fetal viability, fetal weight, or litter size. Note that the safety of cephalexin during pregnancy in humans has not been established.

Cephalexin showed no enhanced toxicity in weanling and newborn rats as compared with adult animals. Nevertheless, because the studies in humans cannot rule out the possibility of harm, cephalexin should be used during pregnancy only if clearly needed.

Nursing Mothers

The excretion of cephalexin in the milk increased up to 4 hours after a 500 mg dose; the drug reached a maximum level of 4 μg/ml, then decreased gradually, and had disappeared 8 hours after administration. Caution should be exercised when cephalexin is administered to a nursing woman.

ADVERSE REACTIONS

Gastrointestinal:  Symptoms of pseudomembranous colitis may appear either during or after antibiotic treatment. Nausea and vomiting have been reported rarely. The most frequent side effect has been diarrhea. It was very rarely severe enough to warrant cessation of therapy. Dyspepsia, gastritis, and abdominal pain have also occurred. As with some penicillins and some other cephalosporins, transient hepatitis and cholestatic jaundice have been reported rarely.

Hypersensitivity:  Allergic reactions in the form of rash, urticaria, angioedema, and, rarely, erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis have been observed. These reactions usually subsided upon discontinuation of the drug. In some of these reactions, supportive therapy may be necessary. Anaphylaxis has also been reported.

Other reactions have included genital and anal pruritus, genital moniliasis, vaginitis and vaginal discharge, dizziness, fatigue, headache, agitation, confusion, hallucinations, arthralgia, arthritis, and joint disorder. Reversible interstitial nephritis has been reported rarely. Eosinophilia, neutropenia, thrombocytopenia, and slight elevations in AST and ALT have been reported.

OVERDOSAGE

Signs and Symptoms:  Symptoms of oral overdose may include nausea, vomiting, epigastric distress, diarrhea, and hematuria. If other symptoms are present, it is probably secondary to an underlying disease state, an allergic reaction, or toxicity due to ingestion of a second medication.

Treatment:  To obtain up-to-date information about the treatment of overdose, a good resource is your certified Regional Poison Control Center. In managing overdosage, consider the possibility of multiple drug overdoses, interaction among drugs, and unusual drug kinetics in your patient.

Unless 5-10 times the normal dose of cephalexin has been ingested, gastrointestinal decontamination should not be necessary.

Protect the patient's airway and support ventilation and perfusion. Meticulously monitor and maintain, within acceptable limits, the patient's vital signs, blood gases, serum electrolytes, etc. Absorption of drugs from the gastrointestinal tract may be decreased by giving activated charcoal, which, in many cases, is more effective than emesis or lavage; consider charcoal instead of or in addition to gastric emptying. Repeated doses of charcoal over time may hasten elimination of some drugs that have been absorbed. Safeguard the patient's airway when employing gastric emptying or charcoal.

Forced diuresis, peritoneal dialysis, hemodialysis, or charcoal hemoperfusion have not been established as beneficial for an overdose of cephalexin; however, it would be extremely unlikely that one of these procedures would be indicated.

The oral median lethal dose of cephalexin in rats is >5000 mg/kg.

DOSAGE AND ADMINISTRATION

Cephalexin is administered orally.

Adults:  The adult dosage ranges from 1-4 g daily in divided doses. The usual adult dose is 250 mg every 6 hours. For the following infections, a dosage of 500 mg may be administered every 12 hours: streptococcal pharyngitis, skin and skin structure infections, and uncomplicated cystitis in patients over 15 years of age. Cystitis therapy should be continued for 7-14 days. For more severe infections or those caused by less susceptible organisms, larger doses may be needed. If daily doses of cephalexin greater than 4 g are required, parenteral cephalosporins, in appropriate doses, should be considered.

Pediatric Patients:  The usual recommended daily dosage for pediatric patients is 25-50 mg/kg in divided doses. For streptococcal pharyngitis in patients over 1 year of age and for skin and skin structure infections, the total daily dose may be divided and administered every 12 hours (see TABLE 5).

TABLE 5 Cephalexin Suspension
Weight125 mg/5 ml250 mg/5 ml
10 kg (22 lb) ½-1 tsp qid ¼-½ tsp qid
20 kg (44 lb) 1-2 tsp qid ½-1 tsp qid
40 kg (88 lb) 2-4 tsp qid 1-2 tsp qid
OR
10 kg (22 lb) 1-2 tsp bid ½-1 tsp bid
20 kg (44 lb) 2-4 tsp bid 1-2 tsp bid
40 kg (88 lb) 4-8 tsp bid 2-4 tsp bid

In severe infections, the dosage may be doubled.

In the therapy of otitis media, clinical studies have shown that a dosage of 75-100 mg/kg/day in 4 divided doses is required.

In the treatment of β-hemolytic streptococcal infections, a therapeutic dosage of cephalexin should be administered for at least 10 days.

REFERENCES

References

1.
National Committee for Clinical Laboratory Standards: Performance standards for antimicrobial disk susceptibility tests—5th ed. Approved Standard NCCLS Document M2-A5, Vol 13, No 24, NCCLS, Villanova, PA, 1993.

2.
National Committee for Clinical Laboratory Standards: Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically—3rd ed. Approved Standard NCCLS Document M7-A3, Vol 13, No 25, NCCLS, Villanova, PA, 1993.

HOW SUPPLIED

Oral Suspension:  After mixing, store in refreigerator. May be kept for 14 days without significant loss of potency. Shake well before using. Keep tightly closed.

Pulvules:  The 250 mg Pulvules are a white powder filled into size 2 Para0-Posilok Caps (opaque white and opaque light green) that are imprinted with "Dista" and identity code "H69" on the green cap, and Keflex 250 on the white body in edible black ink.

The 500 mg Pulvules are a white powder filled into an elongated, size 0 Para-Posilok Caps (opaque light green and opaque dark green) that are imprinted with "Dista" and identity code "H71" on the light green cap, and Keflex 500 on the dark green body in edible black ink.

Storage:  Store at controlled room temperature, 15-30°C (59- 86°F).

PRODUCT LISTING

capsule - oral - monohydrate 250 mg
8.0 $16.86 Keflex, PD-RX Pharmaceuticals 55289088508
8.0 $23.06 Keflex, Quality Care Pharmaceuticals Inc 60346064908
10.0 $7.60 GENERIC, PD-RX Pharmaceuticals 55289005710
15.0 $8.30 GENERIC, PD-RX Pharmaceuticals 55289005715
20.0 $10.60 GENERIC, PD-RX Pharmaceuticals 55289005720
20.0 $34.58 Keflex, Dista Products Company 00777086920
20.0 $57.56 Keflex, Pharma Pac 52959066020
21.0 $8.26 GENERIC, DHS Inc 55887099121
24.0 $12.00 GENERIC, PD-RX Pharmaceuticals 55289005724
24.0 $50.64 Keflex, PD-RX Pharmaceuticals 55289088524
25.0 $15.00 GENERIC, PD-RX Pharmaceuticals 55289005797
28.0 $11.02 GENERIC, DHS Inc 55887099128
28.0 $13.98 GENERIC, PD-RX Pharmaceuticals 55289005728
30.0 $14.96 GENERIC, PD-RX Pharmaceuticals 55289005730
30.0 $66.42 Keflex, PD-RX Pharmaceuticals 55289088530
40.0 $6.62 GENERIC, PD-RX Pharmaceuticals 55289007240
40.0 $17.50 GENERIC, PD-RX Pharmaceuticals 55289005740
40.0 $18.83 GENERIC, DHS Inc 55887099140
100.0 $15.22 GENERIC, UDL Laboratories Inc 51079060420
100.0 $15.80 GENERIC, PD-RX Pharmaceuticals 55289007201
100.0 $20.95 GENERIC, CMC-Consolidated Midland Corporation 00223058101
100.0 $27.00 GENERIC, PD-RX Pharmaceuticals 55289005717
100.0 $27.00 GENERIC, PD-RX Pharmaceuticals 55289005701
100.0 $34.95 GENERIC, Major Pharmaceuticals Inc 00904380061
100.0 $49.40 GENERIC, Major Pharmaceuticals Inc 00904380060
100.0 $62.10 GENERIC, United Research Laboratories/Mutual Pharmaceutical Company 00677115801
100.0 $62.97 GENERIC, Teva Pharmaceuticals USA 00686314509
100.0 $64.00 GENERIC, Sandoz Inc 00781253101
100.0 $67.96 GENERIC, Stada Pharmaceuticals Inc 67253030010
100.0 $69.35 GENERIC, Ranbaxy Pharmaceuticals 63304065601
100.0 $69.35 GENERIC, Teva Pharmaceuticals USA 00093314501
100.0 $69.35 GENERIC, Mylan Pharmaceuticals Inc 00378602501
100.0 $73.13 GENERIC, IVAX Corporation 00172407360
100.0 $85.00 GENERIC, Sandoz Inc 00781253113
100.0 $164.70 Keflex, Dista Products Company 00777086902
500.0 $99.50 GENERIC, CMC-Consolidated Midland Corporation 00223058105
500.0 $159.70 GENERIC, Major Pharmaceuticals Inc 00904380040
500.0 $198.90 GENERIC, United Research Laboratories/Mutual Pharmaceutical Company 00677115805
500.0 $283.05 GENERIC, Sandoz Inc 00781253105
500.0 $305.71 GENERIC, Stada Pharmaceuticals Inc 67253030050
500.0 $311.95 GENERIC, Ranbaxy Pharmaceuticals 63304065605
500.0 $311.95 GENERIC, Teva Pharmaceuticals USA 00093314505
500.0 $311.95 GENERIC, Mylan Pharmaceuticals Inc 00378602505
500.0 $327.14 GENERIC, IVAX Corporation 00172407370
capsule - oral - monohydrate 500 mg
8.0 $8.20 GENERIC, PD-RX Pharmaceuticals 55289005808
9.0 $6.33 GENERIC, DHS Inc 55887095809
10.0 $9.40 GENERIC, PD-RX Pharmaceuticals 55289005810
14.0 $9.85 GENERIC, DHS Inc 55887095814
14.0 $12.30 GENERIC, PD-RX Pharmaceuticals 55289005814
15.0 $10.55 GENERIC, DHS Inc 55887095815
20.0 $12.92 GENERIC, DHS Inc 55887095820
20.0 $16.96 GENERIC, PD-RX Pharmaceuticals 55289005820
20.0 $68.04 Keflex, Dista Products Company 00777087120
20.0 $68.77 Keflex, Pharma Pac 52959008720
20.0 $76.21 Keflex, Physicians Total Care 54868042501
21.0 $13.56 GENERIC, DHS Inc 55887095821
21.0 $17.80 GENERIC, PD-RX Pharmaceuticals 55289005821
24.0 $18.00 GENERIC, PD-RX Pharmaceuticals 55289005824
28.0 $14.82 GENERIC, DHS Inc 55887095828
28.0 $19.00 GENERIC, PD-RX Pharmaceuticals 55289005828
30.0 $15.87 GENERIC, DHS Inc 55887095830
30.0 $20.34 GENERIC, PD-RX Pharmaceuticals 55289005830
40.0 $27.20 GENERIC, PD-RX Pharmaceuticals 55289005840
40.0 $47.17 GENERIC, Golden State Medical Supply 60429003740
40.0 $115.85 Keflex, Pharma Pac 52959008740
40.0 $118.44 GENERIC, Major Pharmaceuticals Inc 00904380139
40.0 $195.60 Keflex, PD-RX Pharmaceuticals 55289058240
100.0 $27.84 GENERIC, UDL Laboratories Inc 51079060520
100.0 $39.84 GENERIC, PD-RX Pharmaceuticals 55289005801
100.0 $46.50 GENERIC, CMC-Consolidated Midland Corporation 00223058201
100.0 $57.60 GENERIC, PD-RX Pharmaceuticals 55289005817
100.0 $98.60 GENERIC, Major Pharmaceuticals Inc 00904380160
100.0 $120.65 GENERIC, United Research Laboratories/Mutual Pharmaceutical Company 00677115901
100.0 $125.12 GENERIC, Major Pharmaceuticals Inc 00904380161
100.0 $125.99 GENERIC, Sandoz Inc 00781253201
100.0 $130.00 Biocef, International Ethical Laboratories Inc 11584103405
100.0 $134.85 GENERIC, Stada Pharmaceuticals Inc 67253030110
100.0 $137.50 GENERIC, Mylan Pharmaceuticals Inc 00378605001
100.0 $137.60 GENERIC, Ranbaxy Pharmaceuticals 63304065701
100.0 $137.60 GENERIC, Teva Pharmaceuticals USA 00093314701
100.0 $149.55 GENERIC, IVAX Corporation 00172407460
100.0 $173.25 GENERIC, Sandoz Inc 00781253213
100.0 $323.71 Keflex, Dista Products Company 00777087102
500.0 $225.00 GENERIC, CMC-Consolidated Midland Corporation 00223058205
500.0 $279.90 GENERIC, Major Pharmaceuticals Inc 00904380140
500.0 $551.35 GENERIC, Sandoz Inc 00781253205
500.0 $600.69 GENERIC, Stada Pharmaceuticals Inc 67253030150
500.0 $612.95 GENERIC, Ranbaxy Pharmaceuticals 63304065705
500.0 $612.95 GENERIC, Teva Pharmaceuticals USA 00093314705
500.0 $612.95 GENERIC, Mylan Pharmaceuticals Inc 00378605005
500.0 $674.15 GENERIC, IVAX Corporation 00172407470
powder for reconstitution - oral - 125 mg/5 ml
100.0 ml $6.40 GENERIC, Sandoz Inc 00781702846
100.0 ml $7.95 GENERIC, IVAX Corporation 00182702070
100.0 ml $7.95 GENERIC, Mylan Pharmaceuticals Inc 00378603002
100.0 ml $8.93 GENERIC, Ranbaxy Pharmaceuticals 63304095801
100.0 ml $8.93 GENERIC, Teva Pharmaceuticals USA 00093417573
100.0 ml $9.50 Biocef, International Ethical Laboratories Inc 11584103501
100.0 ml $13.36 GENERIC, Pharma Pac 52959020001
200.0 ml $10.50 GENERIC, Qualitest Pharmaceuticals Inc 00603654168
200.0 ml $12.00 GENERIC, Sandoz Inc 00781702848
200.0 ml $12.80 GENERIC, United Research Laboratories/Mutual Pharmaceutical Company 00677118729
200.0 ml $13.20 GENERIC, Teva Pharmaceuticals USA 00093417574
200.0 ml $13.95 GENERIC, Mylan Pharmaceuticals Inc 00378603004
200.0 ml $13.96 GENERIC, IVAX Corporation 00182702073
200.0 ml $15.75 GENERIC, Ranbaxy Pharmaceuticals 63304095802
200.0 ml $15.75 GENERIC, Allscripts Healthcare Solutions 54569102300
200.0 ml $24.12 GENERIC, Pharma Pac 52959145302
powder for reconstitution - oral - 250 mg/5 ml
100.0 ml $11.39 GENERIC, Sandoz Inc 00781702946
100.0 ml $12.62 GENERIC, Teva Pharmaceuticals USA 00332417732
100.0 ml $14.26 GENERIC, Teva Pharmaceuticals USA 00093417773
100.0 ml $15.20 Biocef, International Ethical Laboratories Inc 11584103602
100.0 ml $18.90 GENERIC, Ranbaxy Pharmaceuticals 63304095901
100.0 ml $32.99 GENERIC, Pharma Pac 52959102900
200.0 ml $21.12 GENERIC, Teva Pharmaceuticals USA 00093417774
200.0 ml $22.58 GENERIC, Sandoz Inc 00781702948
200.0 ml $22.60 GENERIC, United Research Laboratories/Mutual Pharmaceutical Company 00677118829
200.0 ml $25.25 GENERIC, Mylan Pharmaceuticals Inc 00378603504
200.0 ml $31.50 GENERIC, Ranbaxy Pharmaceuticals 63304095902
200.0 ml $47.05 GENERIC, Pharma Pac 52959102901
tablet - oral - monohydrate 250 mg
40.0's $27.00 GENERIC, Golden State Medical Supply 60429003640
100.0's $37.50 GENERIC, CMC-Consolidated Midland Corporation 00223058301
100.0's $40.02 GENERIC, Teva Pharmaceuticals USA 00093223801
100.0's $49.40 GENERIC, Major Pharmaceuticals Inc 00904379560
100.0's $57.00 GENERIC, IVAX Corporation 00182188601
500.0's $175.00 GENERIC, CMC-Consolidated Midland Corporation 00223058305
tablet - oral - monohydrate 500 mg
56.0's $38.00 GENERIC, PD-RX Pharmaceuticals 55289005856
100.0's $62.85 GENERIC, Major Pharmaceuticals Inc 00904379660
100.0's $72.50 GENERIC, CMC-Consolidated Midland Corporation 00223058401
100.0's $89.80 GENERIC, IVAX Corporation 00182188701
100.0's $225.02 GENERIC, Teva Pharmaceuticals USA 00093224001
500.0's $352.50 GENERIC, CMC-Consolidated Midland Corporation 00223058405
capsule - oral - monohydrate 250 mg
2.0 $3.54 GENERIC, Prescript Pharmaceuticals 00247000302
3.0 $3.64 GENERIC, Prescript Pharmaceuticals 00247000303
4.0 $2.56 GENERIC, Allscripts Healthcare Solutions 54569030408
4.0 $3.73 GENERIC, Prescript Pharmaceuticals 00247000304
5.0 $3.81 GENERIC, Prescript Pharmaceuticals 00247000305
6.0 $3.83 GENERIC, Allscripts Healthcare Solutions 54569497200
6.0 $3.91 GENERIC, Prescript Pharmaceuticals 00247000306
8.0 $4.09 GENERIC, Prescript Pharmaceuticals 00247000308
8.0 $5.12 GENERIC, Allscripts Healthcare Solutions 54569030406
10.0 $4.28 GENERIC, Prescript Pharmaceuticals 00247000310
12.0 $4.47 GENERIC, Prescript Pharmaceuticals 00247000312
12.0 $14.82 GENERIC, Southwood Pharmaceuticals Inc 58016013812
14.0 $4.65 GENERIC, Prescript Pharmaceuticals 00247000314
14.0 $17.49 GENERIC, Southwood Pharmaceuticals Inc 58016013814
15.0 $4.74 GENERIC, Prescript Pharmaceuticals 00247000315
15.0 $18.53 GENERIC, Southwood Pharmaceuticals Inc 58016013815
16.0 $4.84 GENERIC, Prescript Pharmaceuticals 00247000316
18.0 $5.02 GENERIC, Prescript Pharmaceuticals 00247000318
20.0 $4.68 GENERIC, Physicians Total Care 54868015301
20.0 $5.21 GENERIC, Prescript Pharmaceuticals 00247000320
20.0 $14.11 GENERIC, Allscripts Healthcare Solutions 54569030402
20.0 $14.24 GENERIC, Alpharma USPD 63874011120
20.0 $24.71 GENERIC, Southwood Pharmaceuticals Inc 58016013820
20.0 $31.26 GENERIC, Pharma Pac 52959003020
20.0 $35.68 GENERIC, Direct Dispensing Inc 57866721602
21.0 $5.29 GENERIC, Prescript Pharmaceuticals 00247000321
21.0 $25.94 GENERIC, Southwood Pharmaceuticals Inc 58016013821
24.0 $29.65 GENERIC, Southwood Pharmaceuticals Inc 58016013824
24.0 $33.71 GENERIC, Alpharma USPD 63874011124
24.0 $36.43 GENERIC, Pharma Pac 52959003024
28.0 $5.95 GENERIC, Prescript Pharmaceuticals 00247000328
28.0 $18.42 GENERIC, Pharmaceutical Corporation of America 51655002429
28.0 $19.77 GENERIC, Allscripts Healthcare Solutions 54569030403
28.0 $34.59 GENERIC, Southwood Pharmaceuticals Inc 58016013828
28.0 $36.51 GENERIC, Alpharma USPD 63874011128
28.0 $42.41 GENERIC, Pharma Pac 52959003028
30.0 $6.13 GENERIC, Prescript Pharmaceuticals 00247000330
30.0 $6.18 GENERIC, Physicians Total Care 54868015305
30.0 $21.18 GENERIC, Allscripts Healthcare Solutions 54569030405
30.0 $37.06 GENERIC, Southwood Pharmaceuticals Inc 58016013830
30.0 $38.95 GENERIC, Alpharma USPD 63874011130
30.0 $45.99 GENERIC, Pharma Pac 52959003030
32.0 $6.32 GENERIC, Prescript Pharmaceuticals 00247000332
40.0 $7.06 GENERIC, Prescript Pharmaceuticals 00247000340
40.0 $7.69 GENERIC, Physicians Total Care 54868015303
40.0 $25.88 GENERIC, Pharmaceutical Corporation of America 51655002451
40.0 $28.23 GENERIC, Allscripts Healthcare Solutions 54569030404
40.0 $48.89 GENERIC, Direct Dispensing Inc 57866721603
40.0 $49.41 GENERIC, Southwood Pharmaceuticals Inc 58016013840
40.0 $51.80 GENERIC, Alpharma USPD 63874011140
40.0 $59.79 GENERIC, Pharma Pac 52959003040
56.0 $69.18 GENERIC, Southwood Pharmaceuticals Inc 58016013856
56.0 $72.24 GENERIC, Pharma Pac 52959003056
60.0 $8.92 GENERIC, Prescript Pharmaceuticals 00247000360
60.0 $74.12 GENERIC, Southwood Pharmaceuticals Inc 58016013860
100.0 $12.62 GENERIC, Prescript Pharmaceuticals 00247000300
100.0 $15.92 GENERIC, Physicians Total Care 54868015308
100.0 $123.53 GENERIC, Southwood Pharmaceuticals Inc 58016013800
100.0 $180.86 GENERIC, American Health Packaging 62584023501
120.0 $148.24 GENERIC, Southwood Pharmaceuticals Inc 58016013802
150.0 $185.30 GENERIC, Southwood Pharmaceuticals Inc 58016013803
200.0 $247.06 GENERIC, Southwood Pharmaceuticals Inc 58016013889
300.0 $370.59 GENERIC, Southwood Pharmaceuticals Inc 58016013873
500.0 $49.68 GENERIC, Prescript Pharmaceuticals 00247000398
500.0 $63.65 GENERIC, Physicians Total Care 54868015300
500.0 $283.25 GENERIC, Alpharma USPD 63874011150
capsule - oral - monohydrate 500 mg
1.0 $3.59 GENERIC, Prescript Pharmaceuticals 00247000501
2.0 $3.84 GENERIC, Prescript Pharmaceuticals 00247000502
3.0 $4.07 GENERIC, Prescript Pharmaceuticals 00247000503
4.0 $2.62 GENERIC, Physicians Total Care 54868015408
4.0 $4.31 GENERIC, Prescript Pharmaceuticals 00247000504
4.0 $9.71 GENERIC, Southwood Pharmaceuticals Inc 58016013904
4.0 $12.54 GENERIC, Pharma Pac 52959003104
5.0 $12.14 GENERIC, Southwood Pharmaceuticals Inc 58016013905
6.0 $4.79 GENERIC, Prescript Pharmaceuticals 00247000506
6.0 $8.48 GENERIC, Allscripts Healthcare Solutions 54569332403
6.0 $14.57 GENERIC, Southwood Pharmaceuticals Inc 58016013906
8.0 $5.26 GENERIC, Prescript Pharmaceuticals 00247000508
8.0 $5.65 GENERIC, Allscripts Healthcare Solutions 54569030508
8.0 $13.06 GENERIC, Pharma Pac 52959003108
8.0 $19.42 GENERIC, Southwood Pharmaceuticals Inc 58016013908
9.0 $5.49 GENERIC, Prescript Pharmaceuticals 00247000509
10.0 $4.06 GENERIC, Physicians Total Care 54868015407
10.0 $5.74 GENERIC, Prescript Pharmaceuticals 00247000510
10.0 $14.15 GENERIC, Allscripts Healthcare Solutions 54569030505
10.0 $16.19 GENERIC, Pharma Pac 52959003110
10.0 $24.28 GENERIC, Southwood Pharmaceuticals Inc 58016013910
12.0 $6.21 GENERIC, Prescript Pharmaceuticals 00247000512
12.0 $19.18 GENERIC, Pharma Pac 52959003112
12.0 $29.13 GENERIC, Southwood Pharmaceuticals Inc 58016013912
14.0 $6.69 GENERIC, Prescript Pharmaceuticals 00247000514
14.0 $19.81 GENERIC, Allscripts Healthcare Solutions 54569030503
14.0 $22.12 GENERIC, Pharma Pac 52959003114
14.0 $23.00 GENERIC, Alpharma USPD 63874011214
14.0 $23.16 GENERIC, Direct Dispensing Inc 57866011704
14.0 $33.99 GENERIC, Southwood Pharmaceuticals Inc 58016013914
14.0 $43.72 GENERIC, Nucare Pharmaceuticals Inc 66267005014
15.0 $6.93 GENERIC, Prescript Pharmaceuticals 00247000515
15.0 $23.69 GENERIC, Pharma Pac 52959003115
15.0 $36.42 GENERIC, Southwood Pharmaceuticals Inc 58016013915
15.0 $46.31 GENERIC, Nucare Pharmaceuticals Inc 66267005015
16.0 $7.16 GENERIC, Prescript Pharmaceuticals 00247000516
18.0 $43.70 GENERIC, Southwood Pharmaceuticals Inc 58016013918
20.0 $6.45 GENERIC, Physicians Total Care 54868015401
20.0 $8.12 GENERIC, Prescript Pharmaceuticals 00247000520
20.0 $28.31 GENERIC, Allscripts Healthcare Solutions 54569030500
20.0 $29.09 GENERIC, Alpharma USPD 63874011220
20.0 $31.05 GENERIC, Pharma Pac 52959003120
20.0 $34.16 GENERIC, Direct Dispensing Inc 57866011705
20.0 $48.56 GENERIC, Southwood Pharmaceuticals Inc 58016013920
20.0 $59.23 GENERIC, Nucare Pharmaceuticals Inc 66267005020
21.0 $8.35 GENERIC, Prescript Pharmaceuticals 00247000521
21.0 $32.57 GENERIC, Pharma Pac 52959003121
21.0 $50.98 GENERIC, Southwood Pharmaceuticals Inc 58016013921
24.0 $9.07 GENERIC, Prescript Pharmaceuticals 00247000524
24.0 $37.18 GENERIC, Pharma Pac 52959003124
24.0 $58.27 GENERIC, Southwood Pharmaceuticals Inc 58016013924
25.0 $9.31 GENERIC, Prescript Pharmaceuticals 00247000525
28.0 $8.37 GENERIC, Physicians Total Care 54868015403
28.0 $10.02 GENERIC, Prescript Pharmaceuticals 00247000528
28.0 $39.63 GENERIC, Allscripts Healthcare Solutions 54569030501
28.0 $43.09 GENERIC, Pharma Pac 52959003128
28.0 $44.81 GENERIC, Alpharma USPD 63874011228
28.0 $67.98 GENERIC, Southwood Pharmaceuticals Inc 58016013928
28.0 $79.91 GENERIC, Nucare Pharmaceuticals Inc 66267005028
30.0 $8.84 GENERIC, Physicians Total Care 54868015402
30.0 $10.49 GENERIC, Prescript Pharmaceuticals 00247000530
30.0 $42.47 GENERIC, Allscripts Healthcare Solutions 54569030506
30.0 $45.95 GENERIC, Pharma Pac 52959003130
30.0 $47.79 GENERIC, Alpharma USPD 63874011230
30.0 $67.43 GENERIC, Direct Dispensing Inc 57866011706
30.0 $72.83 GENERIC, Southwood Pharmaceuticals Inc 58016013930
30.0 $85.08 GENERIC, Nucare Pharmaceuticals Inc 66267005030
32.0 $10.98 GENERIC, Prescript Pharmaceuticals 00247000532
40.0 $11.24 GENERIC, Physicians Total Care 54868015404
40.0 $12.88 GENERIC, Prescript Pharmaceuticals 00247000540
40.0 $41.16 GENERIC, Pharmaceutical Corporation of America 51655002551
40.0 $56.63 GENERIC, Allscripts Healthcare Solutions 54569030502
40.0 $60.00 GENERIC, Pharma Pac 52959003140
40.0 $60.69 GENERIC, Alpharma USPD 63874011240
40.0 $68.10 GENERIC, Direct Dispensing Inc 57866011703
40.0 $97.11 GENERIC, Southwood Pharmaceuticals Inc 58016013940
40.0 $110.92 GENERIC, Nucare Pharmaceuticals Inc 66267005040
50.0 $121.39 GENERIC, Southwood Pharmaceuticals Inc 58016013950
56.0 $16.69 GENERIC, Prescript Pharmaceuticals 00247000556
56.0 $135.96 GENERIC, Southwood Pharmaceuticals Inc 58016013956
60.0 $16.02 GENERIC, Physicians Total Care 54868015409
60.0 $134.53 GENERIC, Nucare Pharmaceuticals Inc 66267005060
60.0 $145.67 GENERIC, Southwood Pharmaceuticals Inc 58016013960
60.0 $179.42 GENERIC, Pharma Pac 52959003160
100.0 $27.18 GENERIC, Prescript Pharmaceuticals 00247000500
100.0 $174.20 GENERIC, American Health Packaging 62584023601
100.0 $242.78 GENERIC, Southwood Pharmaceuticals Inc 58016013900
120.0 $291.34 GENERIC, Southwood Pharmaceuticals Inc 58016013902
150.0 $364.17 GENERIC, Southwood Pharmaceuticals Inc 58016013903
200.0 $485.56 GENERIC, Southwood Pharmaceuticals Inc 58016013989
300.0 $728.34 GENERIC, Southwood Pharmaceuticals Inc 58016013973
500.0 $87.98 GENERIC, Physicians Total Care 54868015400
500.0 $122.47 GENERIC, Prescript Pharmaceuticals 00247000598
500.0 $556.93 GENERIC, Alpharma USPD 63874011250
powder for reconstitution - oral - 125 mg/5 ml
100.0 ml $4.53 GENERIC, Physicians Total Care 54868053802
100.0 ml $5.33 GENERIC, Prescript Pharmaceuticals 00247039300
100.0 ml $8.93 GENERIC, Stada Pharmaceuticals Inc 64860030613
100.0 ml $13.37 GENERIC, Alpharma USPD 63874016610
100.0 ml $15.00 GENERIC, Southwood Pharmaceuticals Inc 58016101901
100.0 ml $21.00 GENERIC, Southwood Pharmaceuticals Inc 58016102101
200.0 ml $6.88 GENERIC, Physicians Total Care 54868053801
200.0 ml $7.31 GENERIC, Prescript Pharmaceuticals 00247039379
200.0 ml $15.75 GENERIC, Stada Pharmaceuticals Inc 64860030640
200.0 ml $29.00 GENERIC, Alpharma USPD 63874016620
powder for reconstitution - oral - 250 mg/5 ml
100.0 ml $6.19 GENERIC, Physicians Total Care 54868138501
100.0 ml $14.07 GENERIC, Prescript Pharmaceuticals 00247000400
100.0 ml $18.89 GENERIC, Allscripts Healthcare Solutions 54569102400
100.0 ml $18.90 GENERIC, Stada Pharmaceuticals Inc 64860030713
100.0 ml $25.92 GENERIC, Alpharma USPD 63874015510
200.0 ml $21.00 GENERIC, Southwood Pharmaceuticals Inc 58016104601
200.0 ml $24.80 GENERIC, Prescript Pharmaceuticals 00247000479
200.0 ml $24.95 GENERIC, Southwood Pharmaceuticals Inc 58016104501
200.0 ml $31.50 GENERIC, Stada Pharmaceuticals Inc 64860030740
200.0 ml $31.50 GENERIC, Allscripts Healthcare Solutions 54569102500
200.0 ml $33.54 GENERIC, Physicians Total Care 54868138502
200.0 ml $52.89 GENERIC, Alpharma USPD 63874015520
tablet - oral - monohydrate 500 mg
20.0's $11.69 GENERIC, Physicians Total Care 54868015501
tablet - oral - hydrochloride 500 mg
4.0's $15.88 Keftab, Physicians Total Care 54868111201
10.0's $37.90 Keftab, Physicians Total Care 54868111202
10.0's $37.91 Keftab, PD-RX Pharmaceuticals 55289033310
20.0's $68.77 Keftab, Pharma Pac 52959008620
20.0's $71.91 Keftab, PD-RX Pharmaceuticals 55289033320
24.0's $86.28 Keftab, PD-RX Pharmaceuticals 55289033324