Intravenous Complicated intra-abdominal infections, Complicated skin and skin structure infections
Adult: Initially, 100 mg, followed by 50 mg 12 hourly via infusion over 30-60 minutes. Treatment duration: 5-14 days, according to the severity, site of infection, and patient’s clinical response.
Intravenous Community-acquired pneumonia
Adult: Initially, 100 mg, followed by 50 mg 12 hourly via infusion over 30-60 minutes. Treatment duration: 7-14 days, according to the severity, site of infection, and patient’s clinical response.
Hepatic Impairment
Severe: Initially, 100 mg, followed by 25 mg 12 hourly.
Reconstitution
Reconstitute vial labelled as containing 50 mg with 5.3 mL of NaCl 0.9% inj or dextrose 5% inj to achieve a concentration of 50 mg/5 mL. Gently swirl to dissolve. Further dilute reconstituted vial(s) to a 100 mL infusion bag up to Max final concentration of 1 mg/mL.
Incompatibility
Y-site: Amphotericin B, diazepam, omeprazole, esomeprazole, or any IV solution that may result in a pH above 7.
Contraindications
Hypersensitivity to tigecycline or tetracycline.
Special Precautions
Patient with intestinal perforation. Hepatic impairment. Pregnancy and lactation. Not indicated for the treatment of hospital-acquired or ventilator-associated pneumonia, diabetic foot infections. Reserve the use of tigecycline in situations when alternative treatments are not suitable.
Adverse Reactions
Significant: Anti-anabolic effects (e.g. increased BUN, azotaemia, acidosis, hyperphosphataemia); coagulopathy (e.g. prolongation of PT and aPTT, decreased fibrinogen); photosensitivity, pseudotumour cerebri; superinfection including C. difficile-associated diarrhoea (prolonged use). Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain, dyspepsia, anorexia. General disorders and administration site conditions: Injection site reactions. Hepatobiliary disorders: Jaundice, increased ALT, AST, alkaline phosphatase and bilirubin. Infections and infestations: Abscess. Nervous system disorders: Headache, dizziness. Skin and subcutaneous tissue disorders: Pruritus, rash. Vascular disorders: Thrombophlebitis. Potentially Fatal: Anaphylaxis and anaphylactoid reactions, acute pancreatitis, hepatic failure.
This drug may cause dizziness, if affected, do not drive or operate machinery. Avoid direct exposure to sunlight.
Monitoring Parameters
Monitor baseline blood coagulation parameters, including fibrinogen; LFT; development of superinfection, at baseline and regularly during treatment. Monitor for signs and symptoms of hypersensitivity reactions during administration.
Drug Interactions
May increase warfarin serum levels. May decrease efficacy of oral contraceptives.
Action
Description: Mechanism of Action: Tigecycline, a synthetic derivative of minocycline, is a glycylcycline antibiotic which inhibits protein synthesis by binding to the 30s ribosomal of susceptible bacteria. It is generally considered as bacteriostatic agent with bactericidal activity against S. pneumonia and L. pneumophilia. Tigecycline antibacterial activity covers facultative gram-positive and gram-negative bacteria including methicillin-resistant staphylococci. Pharmacokinetics: Distribution: Widely distributed into the tissues; crosses the placenta. Volume of distribution: 7-9 L/kg. Plasma protein binding: 71-89%. Metabolism: Not extensively metabolised in the liver via glucuronidation, N-acetylation, and epimerisation, resulting in trace amount of glucuronide, N-acetyl metabolite, and tigecycline epimer. Excretion: Via faeces (59%, mainly as unchanged drug); urine (33%; 22% of the total dose as unchanged drug). Elimination half-life: 27 hours (single dose); 42 hours (following multiple doses).
Chemical Structure
Tigecycline Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 54686904, Tigecycline. https://pubchem.ncbi.nlm.nih.gov/compound/Tigecycline. Accessed Feb. 26, 2024.
Storage
Unopened vial: Store below 30°C. Reconstituted solution: Store below 25°C for up to 24 hours or between 2-8°C for up to 48 hours.
J01AA12 - tigecycline ; Belongs to the class of tetracyclines. Used in the systemic treatment of infections.
References
Anon. Tigecycline. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 25/10/2023.Anon. Tigecycline. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 25/10/2023.Buckingham R (ed). Tigecycline. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 25/10/2023.Joint Formulary Committee. Tigecycline. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 25/10/2023.Pfizer New Zealand Limited. Tygacil 50 mg Powder for Injection data sheet 1 February 2023. Medsafe. http://www.medsafe.govt.nz. Accessed 25/10/2023.Tigecycline Fresenius Kabi 50 mg Powder for Solution for Infusion (Fresenius Kabi Ltd.). MHRA. https://products.mhra.gov.uk. Accessed 25/10/2023.Tigecycline. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 25/10/2023.Tygacil (Pfizer [Malaysia] SDN. BHD.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 25/10/2023.Tygacil Injection, Powder, Lyophilised, for Solution (Wyeth Pharmaceuticals LLC, a subsidiary of Pfizer Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 25/10/2023.
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