piperacillin (Rx)

Brand and Other Names:Pipracil
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

powder for injection

  • 2g
  • 3g
  • 4g
  • 40g
more...

Usual Dosage Range

IV: 3-4 g/dose q4-6hr; not to exceed 24 g/24hr

IM: 2-3 g/dose q6-12hr; not to exceed 24 g/24 hr

Urinary Tract, Uncomplicated

6-8 g/day IV/IM (100 to 125 mg/kg/day) divided q6-12 hr 

Community-Acquired Pneumonia

6-8 g/day IV/IM (100 to 125 mg/kg/day) divided q6-12 hr 

Acute Cholangitis

4 g IV q6hr

Moderate Infections

2-3 g/dose IV/IM q6-12hr; not to exceed 2 g IM/site

Severe Infections

3-4 g IV/IM q4-6hr; not to exceed 24 g/24 hr

Uncomplicated Gonorrhea

2 g once with 1 g probenecid 30 min before injection

Pseudomonas Infections

4 g IV/IM q4hr

Renal Impairment

CrCl 20-40 mL/min: 3-4 g q8hr

CrCl <20 mL/min: 3-4 g q12hr

Other Indications & Uses

Extended spectrum: Acinetobacter spp., Alcaligenes xylosoxidans, Bacteroides spp., Citrobacter diversus, Citrobacter freundii, E. coli, Fusobacteriae, H. influenzae, Klebsiella spp., N. gonorrhoeae, Peptococcus spp., Peptostreptococcus spp., indole-pos. Proteus spp., Providencia spp., Pseudomonas spp., Serratia spp., Streptococcus faecalis, Yersinia enterolitica

Dosage Forms & Strengths

powder for injection

  • 2g
  • 3g
  • 4g
  • 40g
more...

Usual Dosage Range

Neonates: 100 mg/kg IV/IM q12hr 

Infants and Children: 200-300 mg/kg/day IV/IM divided q4-6hr

Cystic Fibrosis

350-500 mg/kg/day IV/IM divided q4-6hr  

Adjust dose for renal impairment

Usual dosage range

IV: 2-4 g q6-8hr

IM: 1-2 g q8-12hr

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Interactions

Interaction Checker

and piperacillin

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            <1%

            Seizure

            Rash

            Hemolytic anemia

            Postive Coombs reaction

            Prolonged prothrombin time

            Interstitial nephritis

            Hypersensitivity

            Anaphylaxis

            Thrombophlebitis

            Injection site pain

            Headache

            Fever

            Intestinal infection due to pseudomonas

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            Warnings

            Contraindications

            Allergy to penicillins, cephalosporins, imipenem

            Cautions

            Risk of bleeding complications, especially in renal impairment

            Monitor renal, hepatic & especially hematopoietic functions during prolonged treatment

            Hypersensitivity reactions reported; discontinue therapy and institute appropriate therapy if allergic reaction occurs

            Found to be an independent risk factor for renal failure and was associated with delayed recovery of renal function as compared to other beta-lactam antibacterial drugs; if alternative treatment options are inadequate or unavailable, monitor renal function during treatment

            Combined use of piperacillin/tazobactam and vancomycin may be associated with an increased incidence of acute kidney injury

            Serious skin reactions, including toxic epidermal necrolysis and Stevens-Johnson syndrome, acute exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms (DRESS) reported; monitor closely if rash develops; discontinue if lesions progress

            Hematological effects (including bleeding, leukopenia and neutropenia) have occurred.

            Monitor hematologic tests during prolonged therapy

            Use may result in fungal or bacterial superinfection; valuate patients for Clostridium difficile if diarrhea occurs

            Dosage adjustment recommended in patients with renal impairment or receiving hemodialysis

            Use with caution in patients with history of seizure disorder; high levels, that may result from renal impairment, may increase risk of seizures

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            Pregnancy & Lactation

            Pregnancy

            Piperacillin and tazobactam cross the placenta in humans; however, there are insufficient data in pregnant women to inform a drug-associated risk for major birth defects and miscarriage; no fetal structural abnormalities observed in rats or mice when piperacillin/tazobactam was administered intravenously during organogenesis at doses 1 to 2 times and 2 to 3 times human dose, respectively, based on body-surface area’ however, fetotoxicity in presence of maternal toxicity was observed in developmental toxicity and peri/postnatal studies conducted in rats (intraperitoneal administration prior to mating and throughout gestation or from gestation day 17 through lactation day 21) at doses less than the maximum recommended human daily dose based on body-surface area

            Lactation

            Piperacillin is excreted in human milk; tazobactam concentrations in human milk not studied; no information available on effects of piperacillin and tazobactam on breastfed child or on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from therapy or from underlying maternal condition.

            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 biosynthesis of cell wall mucopeptides and stage of active multiplication; has antipseudomonal activity

            Pharmacokinetics

            Half-Life: 36-80 min, dose dependent, higher in renal insufficiency

            Protein Bound: 16%

            Absorption: 70-80% (IM)

            Peak Plasma Time: 30-50 min (IM)

            Absorption: 70-80% (IM)

            Distribution: Crosses placenta

            Metabolism: Liver

            Excretion: Urine (primarily); feces (partially)

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            Administration

            IV Compatibilities

            Solution: compatible with common solvents

            Additive: clindamycin, flucloxacillin, fluconazole, hydrocortisone, linezolid, ofloxacin, KCl, verapamil

            Syringe: heparin

            Y-site (partial list): allopurinol, bivalirudin, ciprofloxacin, diltiazem, esmolol, famotidine, heparin, hydromorphone, linezolid, lorazepam, magnesium sulfate, meperidine, midazolam, morphine, ranitidine, verapamil, zidovudine

            IV Incompatibilities

            Solution: aminoglycosides

            Additive: aminoglycosides, ciprofloxacin

            Y-site: aminoglycosides, amiodarone, amphotericin B cholesteryl SO4, cisatracurium(?), filgrastim, fluconazole, gatifloxacin, gemcitabine, ondansetron, sargramostim, vinorelbine

            IV/IM Preparation

            IV: reconstitute each gram w/ 5 mL SWI, BWI, NS, D5W or other compatible diluents

            Slight darkening does not indicate potency loss

            IV/IM Administration

            Slow direct inj over 3-5 min, OR

            Intermittent infusion in at least 50 mL over 20-30 min

            IM: upper outer quadrant of buttock

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            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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