TIGECYCLINE

TIGECYCLINE (ti-ge-cy'cline) Tygacil Classifications: antibiotic; glycylcycline; Therapeutic: antibiotic Prototype: Tetracycline Pregnancy Category: D

Availability

50 mg injection

Action

Tigecycline inhibits protein production in bacteria by binding to the 30S ribosomal subunit and blocking entry of transfer RNA molecules into the ribosome of the bacteria. This prevents formation of peptide chains in bacteria, thus interfering with their growth.

Therapeutic Effect

Tigecycline is active against a broad spectrum of bacterial pathogens and is bacteriostatic.

Uses

Treatment of complicated skin and skin structure infections and complicated intraabdominal infections.

Contraindications

Hypersensitivity to tigecycline; pregnancy (category D) and during tooth development of the fetus; viral infections.

Cautious Use

Severe hepatic impairment (Child-Pugh class C); hypersensitivity to tetracycline, intestinal perforations, intraabdominal infections; GI disorders; lactation; children <18 y.

Route & Dosage

Complicated Skin and Intraabdominal Infections Adult: IV 100 mg initially, followed by 50 mg q12h over 30–60 min x 5–14 d Hepatic Impairment Child-Pugh class C: Initial dose 100 mg, followed by 25 mg q12h

Administration

• Note that dosage adjustment is required with severe hepatic impairment.

Intravenous PREPARE: Intermittent: Reconstitute each vial (50 mg) with 5.3 mL of NS or D5W to yield 10 mg/mL. Swirl gently to dissolve; reconstituted solution should be yellow to orange in color. After reconstitution, immediately withdraw exactly 5 mL from each vial and add to 100 mL of NS or D5W for infusion. The maximum concentration in the IV bag should be 1 mg/mL (two 50 mg doses).   ADMINISTER: Intermittent: Give over 30–60 min; when using Y-site, flush IV line with NS or D5W before/after infusion.   INCOMPATIBILITIES Y-site: Amphotericin B, chlorpromazine, methylprednisolone, voriconazole.

• Store in the IV bag at room temperature for up to 6 h, or refrigerated at 2°–8° C (36°–46° F) for up to 24 h.

Adverse Effects (≥1%)

CNS: Asthenia, dizziness, headache, insomnia. CV: Hypertension, hypotension, peripheral edema, phlebitis. GI: Abdominal pain, constipation, diarrhea, dyspepsia, nausea, vomiting. Hematologic/Lymphatic: Abnormal healing, anemia, infection, leukocytosis, thrombocythemia. Metabolic/Nutritional: Alkaline phosphatase increased, ALT increased, amylase increased, AST increased, bilirubinemia, BUN increased, hyperglycemia, hypokalemia, hypoproteinemia, lactic dehydrogenase increased. Musculoskeletal: Back pain. Respiratory: Dyspnea, increased cough, pulmonary physical findings. Skin: Pruritus, rash, sweating. Body as a Whole: Abscess, fever, local reaction to injection, pain.

Interactions

Drug: Increased concentrations of warfarin required close monitoring of INR. Efficacy of oral contraceptives may be decreased when used in combination with tigecycline.

Pharmacokinetics

Distribution: 71–89% protein bound. Metabolism: Negligible. Elimination: Fecal (major) and renal. Half-Life: 27 h (single dose); 42 h (multiple doses).

Nursing Implications

Assessment & Drug Effects

• Monitor for hypersensitivity reaction in those with reported tetracycline allergy.
• Monitor for and report S&S of superinfection (see Appendix F) or pseudomembranous enterocolitis (see Appendix F).
• Lab tests: C&S prior to initiation of therapy; periodic serum electrolytes, LFTs and kidney function tests; PT and INT with concurrent anticoagulant therapy.
• Monitor diabetics for loss of glycemic control.

Patient & Family Education

• Avoid direct exposure to sunlight during and for several days after therapy is terminated to reduce risk of photosensitivity reaction.
• Report to physician loose stools or diarrhea either during or shortly after termination of therapy.
• Use a barrier contraceptive in addition to oral contraceptives if trying to avoid pregnancy.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug