tigecycline
tigecycline
Pharmacologic class: Glycylcycline antibiotic
Therapeutic class: Anti-infective
Pregnancy risk category D
Action
Inhibits protein translation in bacteria by binding to 30S ribosomal subunit and blocking entry of amino-acyl tRNA molecules into ribosomal A site, which in turn prevents incorporation of amino acid residues into elongating peptide chains
Availability
Powder for injection (lyophilized): 50 mg/5 ml in single-dose vial
Indications and dosages
➣ Treatment of skin, skin-structure infections, and complicated intra-abdominal infections caused by susceptible organisms
Adults age 18 and older: 100 mg I.V. initially, followed by 50 mg I.V. every 12 hours for 5 to 14 days, depending on infection site and severity and patient's clinical and bacteriologic process
➣ Community-acquired bacterial pneumonia caused by susceptible organisms
Adults age 18 and older: Initially, 100 mg I.V., followed by 50 mg I.V. q 12 hours for 7 to 14 days, depending on infection site and severity and patient's clinical and bacteriologic process
Dosage adjustment
• Severe hepatic impairment
Contraindications
• Hypersensitivity to drug or its components
Precautions
Use cautiously in:
• mild to moderate hepatic impairment, complicated intra-abdominal infections secondary to perforation, ventilator-associated pneumonia
• pregnant and breastfeeding patients
• children younger than age 18.
Administration
• Reconstitute with 5.3 ml of normal saline solution injection or 5% dextrose injection to yield a concentration of 10 mg/ml (50 mg).
• Swirl vial gently until drug dissolves. Immediately withdraw 5 ml of reconstituted solution from vial and add to 100-ml I.V. bag for infusion. Maximum concentration in I.V. bag should be 1 mg/ml.
• Discard reconstituted solution that isn't yellow or orange.
• Administer through dedicated I.V. line or Y-site. If same I.V. line is used for sequential infusion of several drugs, flush before and after infusion, using either normal saline solution injection or 5% dextrose injection. Use infusion solution compatible with tigecycline and other drugs given through same line.
• Administer over 30 to 60 minutes.
• Don't give amphotericin B, chlorpromazine, methylprednisolone, or voriconazole simultaneously through same Y-site.
Adverse reactions
CNS: headache, dizziness, insomnia, asthenia, pseudotumor cerebri
CV: hypertension, hypotension, phlebitis
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, increased GI enzymes, pseudomembranous colitis, pancreatitis
Hematologic: anemia, leukocytosis, thrombocytopenia
Hepatic: hepatic dysfunction, hepatic failure
Metabolic: antianabolic action (with increased BUN, azotemia, acidosis, and hyperphosphatemia)
Musculoskeletal: back pain
Respiratory: increased cough, dyspnea
Skin: pruritus, rash, sweating, photosensitivity
Other: abscess, fever, infection, pain, peripheral edema, abnormal healing, superinfection, permanent tooth discoloration (during tooth development), increase in all-cause mortality, hypersensitivity reaction (including anaphylaxis)
Interactions
Drug-drug. Hormonal contraceptives: reduced contraceptive efficacy
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, amylase, aspartate aminotransferase, bilirubin, blood glucose, blood urea nitrogen: increased
Blood protein, potassium, WBCs: decreased
Patient monitoring
• Monitor prothrombin time or other suitable anticoagulation tests if patient is receiving warfarin concomitantly.
Closely monitor liver function tests; watch for signs and symptoms of hepatic impairment.
Patient teaching
Instruct patient to immediately report rash and other signs or symptoms of allergic reaction.
• Tell patient to complete full course of therapy, even if he feels better.
• Advise patient taking oral hormonal contraceptives to use alternative birth control method during therapy.
• Caution female with childbearing potential to avoid pregnancy because drug may harm fetus.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
tigecycline
(tye-gi-sye-kleen) tigecycline,Tygacil
(trade name)Classification
Therapeutic: anti infectivesPharmacologic: glycylcyclines
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (blood levels)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| IV | rapid | end of infusion | 12 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- somnolence
Dermatologic
- stevens-johnson syndrome (life-threatening)
Gastrointestinal
- pancreatitis (life-threatening)
- pseudomembranous colitis (life-threatening)
- nausea (most frequent)
- vomiting (most frequent)
- altered taste
- anorexia
- dry mouth
- hepatotoxicity
- jaundice
Genitourinary
- ↑ serum creatinine
Endocrinologic
- hyperglycemia
- hypoglycemia
Fluid and Electrolyte
- hypocalcemia
- hyponatremia
Respiratory
- pneumonia
Local
- injection site reactions
Miscellaneous
- death (life-threatening)
- allergic reactions
Interactions
Drug-Drug interaction
May ↓ the effectiveness of hormonal contraceptives.Effects on warfarin are unknown (monitoring recommended).Route/Dosage
Hepatic Impairment
Intravenous (Adults >18 yr) Child-Pugh C—100 mg initially, then 25 mg every 12 hr.Availability
Nursing implications
Nursing assessment
- Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
- Obtain specimens for culture and sensitivity before initiating therapy. 1st dose may be given before receiving results.
- Before initiating therapy, obtain a history of tetracycline hypersensitivity; may also have an allergic response to tigecycline.
- Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
- Assess patient for signs of pancreatitis (nausea, vomiting, abdominal pain, increased serum lipase or amylase) periodically during therapy. May require discontinuation of therapy.
- Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia.
- Lab Test Considerations: May cause anemia, leukocytosis, and thrombocythemia.
- May cause ↑ serum alkaline phosphatase, amylase, bilirubin, LDH, AST, and ALT.
- May cause hyperglycemia, hypokalemia, hypoproteinemia, hypocalcemia, hyponatremia, and ↑ BUN level.
Potential Nursing Diagnoses
Risk for infection (Indications)Implementation
- May cause yellow-brown discoloration and softening of teeth and bones if administered prenatally or during early childhood. Not recommended for children under 8 yr of age or during pregnancy or lactation unless used for the treatment of anthrax.
Intravenous Administration
- Intermittent Infusion: Reconstitute each vial with 5.3 mL of 0.9% NaCl or D5W to achieve a concentration of 10 mg/mL. Diluent: Dilute further in 100 mL of D5W, LR, or 0.9% NaCl. Reconstituted solution should be yellow to orange in color. Do not administer solutions that are discolored or contain particulate matter. Infusion is stable for up to 24 hr at room temperature or for up to 48 hr if refrigerated.Concentration: Final concentration of infusion should be ≤1 mg/mL.
- Rate: Infuse over 30–60 min. Flush line before and after infusion with 0.9% NaCl or D5W.
- Y-Site Compatibility: acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B liposome, ampicillin, ampicillin/sulbactam, argatroban, azithromycin, aztreonam, bivalirudin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, ciprofloxacin, cisatracurium, cisplatin, clindamycin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, daptomycin, daunorubicin hydrochloride, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doripenem, doxorubicin hydrochloride, doxorubicin liposome, droperidol, enalaprilat, epinephrine, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrocortisone, hydromorphone, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, lansoprazole, leucovorin, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, methohexital, methotrexate, methyldopate, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, mitomycin, mitoxantrone, morphine, moxifloxacin, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, pemetrexed, pemtamidine, pentazocine, pentobarbital, phenobarbital, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propofol, propranolol, ranitidine, remifentanil, rocuronium, sodium acetate, sodium bicarbonate, sodium phosphates, streptozocin, succinylcholine, sufentanil, tacrolimus, telavancin, tenioposide, theophylline, thiopental, thiotepa, ticarcillin/clavulanate, tirofiban, tobramycin, topotecan, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, vinblastine, vincristine, vinorelbine, zidovudine, zoledronic acid
- Y-Site Incompatibility: amiodarone, amphotericin B colloidal, amphotericin B lipid complex, bleomycin, chloramphenicol, chlorpromazine, dantrolene, diazepam, epirubicin, esomeprazole, hydralazine, idarubicin, nicardipine, phenytoin, quinupristin/dalfopristin, verapamil
Patient/Family Teaching
- Advise patient that full course of therapy should be completed, even if feeling better. Skipping doses or not completing full course of therapy may result in decreased effectiveness and increased risk of bacterial resistance.
- Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
- Advise patient to report the signs of superinfection (black, furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools). Skin rash, pruritus, and urticaria should also be reported.
- Advise female patient to use a nonhormonal method of contraception while taking tigecycline and until next menstrual period.
Evaluation/Desired Outcomes
- Resolution of signs and symptoms of infection.