ticarcillin/clavulanate (Rx)

Brand and Other Names:Timentin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

ticarcillin/clavulanate

injection, powder for reconstitution

  • (3g/100mg)/vial
  • (30g/1g)/bulk vial

ready-to-use IV solution

  • (3g/100mg)/100mL

Septicemia

Indicated for septicemia caused by beta-lactamase–producing isolates of Klebsiella spp, Escherichia coli, Staphylococcus aureus, or Pseudomonas aeruginosa

3.1 g IV q4-6hr

Lower Respiratory Infections

Indicated for lower respiratory infections caused by beta-lactamase–producing isolates of S. aureus, Haemophilus influenzae, or Klebsiella spp

3.1 g IV q4-6hr

Bone & Joint Infections

Indicated for bone and joint infections caused by beta-lactamase–producing isolates of S. aureus

3.1 g IV q4-6hr

Skin & Skin Structure Infections

Indicated for skin and skin structure infections caused by beta-lactamase–producing isolates of S. aureus, Klebsiella spp, or E. coli

3.1 g IV q4-6hr

Urinary Tract Infections

Indicated for UTIs (complicated or uncomplicated) caused by beta-lactamase–producing isolates of E. coli, Klebsiella spp, P. aeruginosa (or other Pseudomonas spp), Citrobacter spp, Enterobacter cloacae, Serratia marcescens, or S. aureus

3.1 g IV q4-6hr

Intra-abdominal Infections

Indicated for peritonitis caused by beta-lactamase–producing isolates of E. coli, K. pneumoniae, or Bacteroides fragilis group

3.1 g IV q4-6hr

Gynecologic Infections

Indicated for endometritis caused by beta-lactamase–producing isolates of Prevotella melaninogenicus, Enterobacter spp (including E. cloacae), E. coli, Klebsiella pneumoniae, S. aureus, or Staphylococcus epidermidis

Dose based on ticarcillin component

Moderate: 200 mg/kg/day IV divided q4-6hr  

Severe: 300 mg/kg/day IV divided q4hr

Renal Impairment

Load: 3.1 g IV, THEN reduce maintenance dose based on creatinine clearance

CrCl 30-60 mL/min: 2 g q4hr

CrCl 10-30 mL/min: 2 g q8hr

CrCl <10 mL/min: 2 g q12hr

CrCl<10 mL/min & hepatic impairment: 2 g qDay

Peritoneal dialysis: 3 g q12hr

Hemodialysis: 2 g q12hr; supplement with 3 g after each dialysis session

Dosing Considerations

Treatment duration depends upon infection severity, but is typically 10-14 days; however, in difficult and complicated infections, more prolonged therapy may be required

Dosage Forms & Strengths

ticarcillin/clavulanate

injection, powder for reconstitution

  • (3g/100mg)/vial
  • (30g/1g)/bulk vial

ready-to-use IV solution

  • (3g/100mg)/100mL

Infections

Dose based on ticarcillin component

<3 months: Safety and efficacy not established

<60 kg and >3 months: 200-300 mg/kg/day IV divided q4-6hr; not to exceed 24 g/day

≥60 kg: As adults; 3.1 g IV q4-6hr

Neonates

  • (<7 days old, <2 kg) OR (>7 days old, <1.2 kg): 150 mg/kg/day IV divided q12hr
  • (<7 days old, >2 kg) OR (>7 days old, 1.2-2 kg): 225 mg/kg/day IV divided q8hr
  • >7 days old, >2 kg: 300 mg/kg/day IV divided q8hr

Cystic Fibrosis

300-600 mg/kg/day IV/IM divided q6hr; not to exceed 24 g/day  

Indications

Septicemia caused by beta-lactamase–producing isolates of Klebsiella spp, Escherichia coli, Staphylococcus aureus, or Pseudomonas aeruginosa

Lower respiratory infections caused by beta-lactamase–producing isolates of S. aureus, or Klebsiella spp; note that use is not established for Haemophilus influenzae type B

Bone and joint infections caused by beta-lactamase–producing isolates of S. aureus

Skin and skin structure infections caused by beta-lactamase–producing isolates of S. aureus, Klebsiella spp, or E. coli

UTIs (complicated or uncomplicated) caused by beta-lactamase–producing isolates of E. coli, Klebsiella spp, P. aeruginosa (or other Pseudomonas spp), Citrobacter spp, Enterobacter cloacae, Serratia marcescens, or S. aureus

Peritonitis caused by beta-lactamase–producing isolates of E. coli, K. pneumoniae, or Bacteroides fragilis group

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Interactions

Interaction Checker

and ticarcillin/clavulanate

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      Serious - Use Alternative

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              Serious - Use Alternative (11)

              • BCG vaccine live

                ticarcillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • cholera vaccine

                ticarcillin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              • demeclocycline

                demeclocycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • doxycycline

                doxycycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • minocycline

                minocycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • mycophenolate

                ticarcillin, mycophenolate. Either increases levels of the other by decreasing renal clearance. Avoid or Use Alternate Drug.

              • omadacycline

                omadacycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.

              • oxytetracycline

                oxytetracycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • pexidartinib

                clavulanate and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.

              • pretomanid

                clavulanate, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

              • probenecid

                ticarcillin, probenecid. Either increases levels of the other by decreasing renal clearance. Avoid or Use Alternate Drug.

              Monitor Closely (59)

              • aceclofenac

                ticarcillin, aceclofenac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, aceclofenac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • acemetacin

                ticarcillin, acemetacin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, acemetacin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • acyclovir

                ticarcillin, acyclovir. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • amiloride

                ticarcillin increases effects of amiloride by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.

              • aspirin

                ticarcillin, aspirin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, aspirin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • aspirin rectal

                ticarcillin, aspirin rectal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                ticarcillin, aspirin rectal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • aspirin/citric acid/sodium bicarbonate

                ticarcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                ticarcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • balsalazide

                ticarcillin, balsalazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • bazedoxifene/conjugated estrogens

                ticarcillin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • bendroflumethiazide

                ticarcillin, bendroflumethiazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • bupropion

                ticarcillin increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.

              • cefadroxil

                ticarcillin, cefadroxil. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • cefamandole

                ticarcillin, cefamandole. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • cefotaxime

                ticarcillin, cefotaxime. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • cefpirome

                ticarcillin, cefpirome. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • cefprozil

                ticarcillin, cefprozil. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • ceftibuten

                ticarcillin, ceftibuten. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • celecoxib

                ticarcillin, celecoxib. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, celecoxib. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • cephalexin

                ticarcillin, cephalexin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • chlorothiazide

                ticarcillin, chlorothiazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • chlorpropamide

                ticarcillin, chlorpropamide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • chlorthalidone

                ticarcillin, chlorthalidone. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • choline magnesium trisalicylate

                ticarcillin, choline magnesium trisalicylate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                ticarcillin, choline magnesium trisalicylate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • conjugated estrogens

                ticarcillin will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • cyclopenthiazide

                ticarcillin, cyclopenthiazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • diclofenac

                ticarcillin, diclofenac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, diclofenac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • dienogest/estradiol valerate

                ticarcillin will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

              • diflunisal

                ticarcillin, diflunisal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, diflunisal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • digoxin

                ticarcillin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • drospirenone

                ticarcillin increases effects of drospirenone by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.

              • estradiol

                ticarcillin will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estrogens conjugated synthetic

                ticarcillin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estropipate

                ticarcillin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • ethinylestradiol

                ticarcillin will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • etodolac

                ticarcillin, etodolac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, etodolac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • fenbufen

                ticarcillin, fenbufen. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, fenbufen. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • fenoprofen

                ticarcillin, fenoprofen. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, fenoprofen. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • flurbiprofen

                ticarcillin, flurbiprofen. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, flurbiprofen. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • ganciclovir

                ticarcillin, ganciclovir. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • hydrochlorothiazide

                ticarcillin, hydrochlorothiazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • ibuprofen

                ticarcillin, ibuprofen. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, ibuprofen. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • ibuprofen IV

                ticarcillin, ibuprofen IV. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                ticarcillin, ibuprofen IV. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • indapamide

                ticarcillin, indapamide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • indomethacin

                ticarcillin, indomethacin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, indomethacin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • ketoprofen

                ticarcillin, ketoprofen. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, ketoprofen. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • ketorolac

                ticarcillin, ketorolac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, ketorolac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • ketorolac intranasal

                ticarcillin, ketorolac intranasal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                ticarcillin, ketorolac intranasal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                ticarcillin will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

              • lornoxicam

                ticarcillin, lornoxicam. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, lornoxicam. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • meclofenamate

                ticarcillin, meclofenamate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

                ticarcillin, meclofenamate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

              • mefenamic acid

                ticarcillin, mefenamic acid. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, mefenamic acid. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • meloxicam

                ticarcillin, meloxicam. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, meloxicam. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • mesalamine

                ticarcillin, mesalamine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • mestranol

                ticarcillin will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • methotrexate

                ticarcillin increases levels of methotrexate by decreasing renal clearance. Use Caution/Monitor. Increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with concurrent administration of high or low doses of methotrexate and penicillins.

              • methyclothiazide

                ticarcillin, methyclothiazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • metolazone

                ticarcillin, metolazone. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • mipomersen

                mipomersen, clavulanate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

              • nabumetone

                ticarcillin, nabumetone. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                ticarcillin, nabumetone. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              Minor (22)

              • amikacin

                ticarcillin decreases effects of amikacin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.

              • azithromycin

                azithromycin decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • aztreonam

                aztreonam, ticarcillin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Enterobacteriaceae.

              • balsalazide

                ticarcillin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • biotin

                ticarcillin will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • chloramphenicol

                chloramphenicol decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • clarithromycin

                clarithromycin decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • colestipol

                colestipol decreases levels of ticarcillin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • erythromycin base

                erythromycin base decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • erythromycin lactobionate

                erythromycin lactobionate decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • erythromycin stearate

                erythromycin stearate decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • gentamicin

                ticarcillin decreases effects of gentamicin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.

              • neomycin PO

                ticarcillin decreases effects of neomycin PO by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.

              • pantothenic acid

                ticarcillin will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • paromomycin

                ticarcillin decreases effects of paromomycin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.

              • pyridoxine

                ticarcillin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pyridoxine (Antidote)

                ticarcillin will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • roxithromycin

                roxithromycin decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • streptomycin

                ticarcillin decreases effects of streptomycin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.

              • thiamine

                ticarcillin will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • tobramycin

                ticarcillin decreases effects of tobramycin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.

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              Adverse Effects

              1-10%

              Rash

              Nausea

              Diarrhea

              Phlebitis at injection site

              Increased eosinophils

              Increased AST

              Increased ALT

              Postmarketing Reports

              Hypersensitivity reactions: Skin rash, pruritus, urticaria, arthralgia, myalgia, drug fever, chills, chest discomfort, anaphylactic reactions, and bullous reactions (including erythema multiforme, toxic epidermal necrolysis, and Stevens-Johnson syndrome)

              CNS: Headache, giddiness, neuromuscular hyperirritability, or convulsive seizures

              Gastrointestinal: Disturbances of taste and smell, stomatitis, flatulence, nausea, vomiting and diarrhea, epigastric pain, and pseudomembranous colitis have been reported; onset of pseudomembranous colitis symptoms may occur during or after antibacterial treatment

              Hemic and lymphatic systems: Thrombocytopenia, leukopenia, neutropenia, eosinophilia, reduction of hemoglobin or hematocrit, and prolongation of prothrombin time and bleeding time

              Hepatic function tests: Elevation of AST, ALT, serum alkaline phosphatase, serum LDH, and serum bilirubin; transient hepatitis and cholestatic jaundice reported

              Renal: Hemorrhagic cystitis, elevation of serum creatinine and/or BUN, hypernatremia, reduction in serum potassium, and uric acid

              Local reactions: Pain, burning, swelling, and induration at the injection site, and thrombophlebitis with IV administration

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              Warnings

              Contraindications

              Allergy to penicillins or other beta-lactam antibacterials (eg, cephalosporins, imipenem)

              Cautions

              Serious and occasionally fatal hypersensitivity reactions reported

              Clostridium difficile associated diarrhea reported with use of nearly all antibacterial agents, including ticarcillin

              Seizures reported when dose exceeded, especially in presence of renal impairment

              Risk of bleeding complication

              Potential for microbial overgrowth or bacterial resistance

              Laboratory tests: High urine concentrations of ticarcillin may produce false-positive protein reactions; clavulanate may cause a nonspecific binding of IgG and albumin by RBC leading to a false-positive Coombs test

              Hypokalemia reported

              Monitor renal, hepatic, and hematologic function

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              Pregnancy & Lactation

              Pregnancy Category: B

              Lactation: excreted into breast milk at low concentrations; use caution

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Inhibits cell wall biosynthesis by binding to 1 of more penicillin binding proteins, which subsequently inhibits bacterial cell wall synthesis and has a bactericidal effect

              Absorption

              Absorption: 86% (IM)

              Peak Plasma Time: 30-75 min (IM)

              Peak Plasma Concentration: 324 mcg/mL (immediately after 30 min IV infusion of 3.1 g)

              AUC: 485 mcg•hr/mL (ticarcillin); 8.2 mcg•hr/mL (clavulanic acid)

              Distribution

              Protein Bound: 45 (ticarcillin); 25% (Clavulanate)

              Distributed into bile, low concentrations in CSF

              Metabolism

              Liver

              Elimination

              Half-life: 1.1 hr adults; 4.4 hr neonates; 1 hr infants/children

              Excretion: 60-70% urine (ticarcillin), 35-45% (clavulainic acid), excreted unchanged in first 6 hr after administration

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              Administration

              IV Incompatibilities

              Additive: sodium bicarbonate, aminoglycosides, ciprofloxacin(?)

              Y-site: alatrofloxacin, amphotericin B cholesteryl sulfate, azithromycin, cisatracurium(?), topotecan(?), vancomycin(?)

              IV Compatibilities

              Solution: compatible w/ most common solvents

              Y-site: (partial list) allopurinol, clarithromycin, diltiazem, fluconazole, heparin, meperidine, morphine, ondansetron, propofol

              IV Preparation

              Reconstitute 3.1 g vial with 13 mL SWI or NS; final concentration 200 mg/6.7 mg/mL

              For intermittent IV infusion, further dilute to 10-100 mg/mL (ticarcillin component with compatible IV solution

              Bulk vial 30 g/1 g

              • Not for direct infusion
              • Reconstitute with 76 mL SWI or NS; final concentration 300 mg/10 mg/mL
              • Further dilute before administration to 10-100 mg/mL (ticarcillin component)

              IV Administration

              Intermittent IV infusion over 30 min

              Administer 1 hr apart from aminoglycosides

              Storage

              Reconstituted solution is stable for 6 hr at room temperature and 72 hr when refrigerated

              IV infusion in NS is stable for 24 hr at room temperature and 7 days when refrigerated, or 30 days when frozen

              Darkening indicates loss of potency

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              Images

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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.