Names and pronunciation
(tye-ge-sye′kleen) Tygacil
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Drug reference
(tye-ge-sye′kleen) Tygacil
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Func. class.: Broad-spectrum antiinfective
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Chem. class.: Glycylcyclines
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ACTION: Inhibits protein synthesis and phosphorylation in microorganisms; bacteriostatic structurally similar to the tetracyclines
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USES: Complicated skin/skin-structure infections (Escherichia coli, Enterococcus faecalis [vancomycin-susceptible only], Staphylococcus aureus, Streptococcus agalactiae, S. anginosus group, S. pyogenes, Bacteroides fragilis); complicated intraabdominal infections (Citrobacter freundii, Enterobacter cloacae, E. coli, Klebsiella oxytoca, K. pneumoniae, E. faecalis [vancomycin- susceptible only], S. aureus [methicillin- susceptible only], S. anginosus group, B. fragilis, Bacteroides thetaiotaomicron, B. uniformis, B. vulgatus, Clostridium perfringens, Peptostreptococcus micros); community-acquired pneumonia
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CONTRAINDICATIONS: Preg- nancy, breastfeeding, children <18 yr, hypersensitivity to tigecycline Precautions: Renal/hepatic disease, hypersensitivity to tetracyclines, ventilator- associated/hospital-acquired pneumonias
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Black Box Warning: Lab test interfer- ence due to maltose, mortality Black Box Warning: Increased mortal- ity risk: use only with confirmation of strongly suspected bacterial infection; do not use as a prophylactic • CDAD: diarrhea, abdominal pain, fe ver, fatigue, anorexia; possible anemia, elevated WBC level, low serum albumin; stop product; usually either vancomycin or IV metroNIDAZOLE is given • Signs of anemia: Hct, HB, fatigue T • Blood studies: PT, CBC, AST, ALT, BUN creatinine • Hypersensitivity: rash, itching, pruri tus, angioedema, Stevens-Johnson syn drome, anaphylaxis • GI reactions: Nausea, vomiting, diar- rhea; administer antiemetic, antacids as ordered • Toxicity: pseudotumor cerebri, photo sensitivity, antianabolic actions (azote mia, BUN, hypophosphatemia, metabolic acidosis); tigecycline is structurally simi lar to tetracycline; pancreatitis, hyper amylasemia (may be fatal); if these occur, discontinue, improvement usually occurs after product is discontinued • Overgrowth of infection: fever, mal aise, redness, pain, swelling, drainage, perineal itching, diarrhea, changes in cough or sputum • Pregnancy/breastfeeding: do not use in pregnancy or breastfeeding; may cause fetal harm
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SIDE EFFECTS CNS: Headache, dizziness, insomnia CV: Hypo/hypertension, phlebitis EENT: Tooth discoloration GI: Nausea, vomiting, diarrhea, anorexia, constipation, dyspepsia, abdominal pain, hepatotoxicity, hepatic failure, CDAD HEMA: Anemia, leukocytosis, thrombocy topenia INTEG: Rash, pruritus, sweating, photosensitivity META: Increased ALT, AST, BUN, lactic acid, alk phos, amylase; hyperglycemia, hypo kalemia, hypoproteinemia, bilirubinemia MISC: Back pain, fever, abnormal heal- ing, abdominal pain, abscess, asthenia, infection, pain, peripheral edema, local reactions RESP: Cough, dyspnea SYST: Anaphylaxis, infection
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INTERACTIONS Increase: effect of warfarin, monitor INR Decrease: effect of oral contraceptives Drug/Lab Test Increase: amylase, LFTs, alk phos, BUN, creatinine, LDH, WBC, INR, PTT, PT Decrease: potassium, calcium, sodium, HB/Hct, platelets
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DOSAGE AND ROUTES • Adult: IV infusion 100 mg then 50 mg q12hr, IV INFUSION given over 30- 60 min q12hr; × 5-14 days, depending on infection Hepatic dose • Adult: IV (Child-Pugh C) 100 mg, then 25 mg q12hr
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Available forms: Powder for inj, lyoph- ilized 50 mg
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Administer: • Tigecycline allergy test before using; obtain C&S, do not begin treatment be- fore results or if susceptible organism is strongly suspected Intermittent IV INFUSION route • Reconstitute each vial with 5.3 mL of 0.9% NaCl or D5 (10 mg/mL); swirl to dis- solve; immediately withdraw 5 mL of recon- stituted sol dilute by adding to 100-mL IV bag for infusion (1 mg/mL); may be yellow or orange; if not, sol should be discarded; do not give if particulate matter is present, use a dedicated IV line or Y-site, flush with NS before and after use, give over 1⁄2 hr • Store in tight, light-resistant container at room temperature, diluted sol at room temperature for up to 24 hr, 6 hr in vial, and remaining time in IV bag, ≤48 hr refrigerated Y-site compatibilities: Acyclovir, alfent- anil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B liposome, ampicillin, ampicillin/sulbactam, argatroban, azithromycin, aztreonam, bivalirudin, bumetanide, buprenorphine, butorpha- nol, calcium chloride/gluconate, CARBO- platin, carmustine, caspofungin, ceFAZo- lin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cef- TRIAXone, cefuroxime, cimetidine, cip- rofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cyclo- SPORINE, cytarabine, dacarbazine, DACTINomycin, DAPTOmycin, DAUNOru- bicin hydrochloride, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiaZEM, diphenhydrAMINE, DOBUTa- mine, DOCEtaxel, dolasetron, DOPamine, doripenem, DOXOrubicin hydrochloride, DOXOrubicin liposome, droperidol, enalaprilat, EPINEPHrine, eptifibatide, ertapenem, erythromycin, esmolol, eto- poside, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fos- phenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydro- cortisone, HYDROmorphone, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, lan- soprazole, lepirudin, leucovorin, levo- FLOXacin, lidocaine, linezolid, LORaze- pam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperi- dine, meropenem, mesna, methohexital, methotrexate, methyldopa, metoclo- pramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoMYcin, mito- XANTRONE, morphine, moxifloxacin, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitro- prusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEME- trexed, pemtamidine, pentazocin, PENTo- barbital, PHENobarbital, phenylephrine, piperacillin/tazobactam, potassium ace- tate/chloride/phosphate, procainamide, prochlorperazine, promethazine, propo- fol, propranolol, raNITIdine, remifent- anil, rocuronium, sodium acetate/ bicarbonate/phosphate, streptozocin, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiopental, thio- tepa, ticarcillin/clavulanate, tirofiban, tobramycin, topotecan, trimethoprim/ sulfamethoxazole, vancomycin, vasopres- sin, vecuronium, vinBLAStine, vinCRIS- tine, vinorelbine, zidovudine, zoledronic acid
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Assess:
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Evaluate: • Therapeutic response: decreased tem- perature, absence of lesions, negative C&S
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid sun exposure; sunscreen does not seem to decrease photosensitivity • To avoid pregnancy while taking this product; fetal harm may occur; to avoid breastfeeding • To report infection, increase in tem- perature; to report burning, pain at inj site • To report diarrhea, fatigue, abdominal pain, severe nausea, vomiting
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PHARMACOKINETICS Not extensively metabolized, 22% of unchanged product excreted in urine, terminal half-life 42 hr, primarily biliary excreted, protein binding 71%-89%
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• Adult: IV infusion 100 mg then 50 mg q12hr, IV INFUSION given over 30- 60 min q12hr; × 5-14 days, depending on infection Hepatic dose
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• Adult: IV (Child-Pugh C) 100 mg, then 25 mg q12hr
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