piperacillin (Rx)Brand and Other Names:Pipracil

 
 
 

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

piperacillin and

No Results

     
     activity indicator 
    No Interactions Found
    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

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: distributed 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 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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            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.
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            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
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            OR Other Restrictions
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