cefotetan (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 20mg/mL
  • 40mg/mL

powder for injection

  • 1g
  • 2g
  • 10g

Skin & Skin Structure (Mild to Moderate)

2 g IV q24hr

Skin & Skin Structure (Severe)

2 g IV q12hr

Urinary Tract

500 mg IV/IM q12hr; 1-2 g IV/IM q24hr; 1-2 g IV/IM q12hr

Other Infection Sites

1-2 g IV/IM q12hr

Severe Infection

2 g IV q12hr

Life-Threatening Infection

3 g IV q12hr

Surgery Infection Prophylaxis

Colorectal, non-perforated appendectomy, hysterectomy: 1-2 g IV

Ruptured viscus: 1-2 g IV q12hr

Renal Impairment

CrCl 10-30 mL/min: Give qDay

CrCl <10 mL/min: Give q48hr

Other Indications & Uses

Dosage and route of administration depends on condition of patient, severity of infection, and susceptibility of causative organism

Bacteroides spp., C. perfringens, E. coli, H. influenzae, Klebsiella spp., M. morganii, N. gonorrhoeae, P. mirabilis, Peptococcus spp., Peptostreptococcus spp., Serratia spp., Staphylococci, group A beta-hemolytic Streptococcus, S. agalactiae, S. epidermidis, S. pyogenes

Dosage Forms & Strengths

injectable solution

  • 20mg/mL
  • 40mg/mL

powder for injection

  • 1g
  • 2g
  • 10g

Severe Infection (Off-label)

40-80 mg/kg/day IV/IM divided q12hr  

Skin & skin structure (mild to moderate)

2 g IV q24hr

Skin & skin structure (severe)

2 g IV q12hr

Urinary tract

500 mg IV/IM q12hr; 1-2 g IV/IM q24hr; 1-2 g IV/IM q12hr

Other infection sites

1-2 g IV/IM q12hr

Severe infection

2 g IV q12hr

Life-threatening infection

3 g IV q12hr

Surgery infection prophylaxis

Colorectal, non-perforated appendectomy, hysterectomy: 1-2 g IV

Ruptured viscus: 1-2 g IV q12hr

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Interactions

Interaction Checker

and cefotetan

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (1)

            • dronabinol

              cefotetan increases toxicity of dronabinol by aldehyde dehydrogenase inhibition. Contraindicated. Dronabinol oral solution (Syndros) contains 50% (w/w) dehydrated alcohol 5.5% (w/w) propylene glycol, which can produce disulfiramlike reactions if coadministered with cefotetan. Discontinue cefotetan at least 14 days before starting dronabinol solution and do not administer cefotetan within 7 days of completing treatment with dronabinol solution.

            Serious - Use Alternative (9)

            • argatroban

              cefotetan increases effects of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • BCG vaccine live

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

            • bivalirudin

              cefotetan increases effects of bivalirudin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • cholera vaccine

              cefotetan, 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.

            • dalteparin

              cefotetan increases effects of dalteparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • enoxaparin

              cefotetan increases effects of enoxaparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • fondaparinux

              cefotetan increases effects of fondaparinux by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • heparin

              cefotetan increases effects of heparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • warfarin

              cefotetan increases effects of warfarin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            Monitor Closely (5)

            • bazedoxifene/conjugated estrogens

              cefotetan 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.

            • dienogest/estradiol valerate

              cefotetan 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.

            • ethanol

              cefotetan, ethanol. Mechanism: decreasing metabolism. Use Caution/Monitor. Risk of disulfiram like reaction; avoid EtOH during and for 2 days following Rx.

            • probenecid

              probenecid will increase the level or effect of cefotetan by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

            • sodium picosulfate/magnesium oxide/anhydrous citric acid

              cefotetan decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

            Minor (9)

            • chloramphenicol

              chloramphenicol decreases effects of cefotetan by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • chlorpropamide

              cefotetan will increase the level or effect of chlorpropamide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

            • choline magnesium trisalicylate

              cefotetan will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

            • fenoprofen

              cefotetan will increase the level or effect of fenoprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

            • furosemide

              cefotetan increases toxicity of furosemide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of nephrotoxicity.

            • meclofenamate

              cefotetan will increase the level or effect of meclofenamate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

            • pyridoxine

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

            • rose hips

              rose hips will increase the level or effect of cefotetan by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

            • willow bark

              cefotetan will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

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            Adverse Effects

            1-10%

            Diarrhea (1%)

            Hepatic enzyme elevation (1%)

            Hypersensitivity reaction (1%)

            <1%

            Prolongation of bleeding time

            Neutropenia

            Thrombocytopenia

            Immune-mediated hemolytic anemia

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            Warnings

            Contraindications (additional)

            Documented hypersensitivity

            Coagulation disorders

            Cautions (additional)

            Reduce dosage by 1/2 if <10-30 mL/min creatinine clearance and by 1/4 if <10 mL/min; (high doses may cause CNS toxicity); bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy

            Associated with rare but potentially fatal hemolytic anemia - monitor as needed

            Current US formulation does not allow direct IV or IM administration

            Inappropriate for pediatric mild-moderate infections (AAP)

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            Pregnancy & Lactation

            Pregnancy

            Available data from published observational studies and case reports over several decades with drug use in pregnant women have not established a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes

            Animal data

            • In animal reproduction studies, no adverse developmental effects were observed when pregnant rats and monkeys were treated, during period of organogenesis, at doses up to approximately 3 and 2 times maximum recommended human dose (MRHD), respectively
            • Maternal gonorrhea may be associated with preterm birth, low neonatal birth weight, chorioamnionitis, intrauterine growth restriction, small for gestational age and premature rupture of membranes; perinatal transmission of gonorrhea to offspring can result in infant blindness, joint infections and bloodstream infections

            Lactation

            Published literature reports that drug is present in human milk at low levels following intravenous administration; there is no information regarding effects of cefotetan on milk production or the breastfed infant; 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 drug 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

            Second-generation cephalosporin used as single-drug therapy to provide broad gram-negative coverage and anaerobic coverage. Also provides some coverage of gram-positive bacteria. Half-life is 3.5 h. Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins; inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell wall death

            Pharmacokinetics

            Half-Life: 2.8-4.6 hr

            Peak Plasma Time: 1.5-3 hr (IM)

            Protein Bound: 76-90%

            Distribution: Body fluids & tissue, including bile, sputum, prostatic & peritoneal fluids, low in CSF

            Metabolism: Liver

            Excretion: urine primarily unchanged; feces (20%)

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            Administration

            IV Incompatibilities

            Additive: aminoglycosides, heparin, tetracyclines

            Syringe: doxapram, promethazine

            Y-site: cisatracurium(?), promethazine, vancomycin, vinorelbine

            IV Compatibilities

            Solution: D5W, NS

            Y-site: allopurinol, amifostine, aztreonam, bivalirudin, dexmedetomidine, diltiazem, docetaxel, etoposide PO4, famotidine, fenoldopam, filgrastim, fluconazole, fludarabine, gatifloxacin, gemcitabine, granisetron, heparin, Hextend, reg insulin, linezolid, melphalan, meperidine, morphine SO4, paclitaxel, propofol, remifentanil, sargramostim, tacrolimus, teniposide, theophylline, thiotepa

            IV Preparation (for powder)

            Solution: add 10 mL diluent to 1 g vial; withdraw 10.5 mL (95 mg/mL)

            IV Administration

            Intermittent infusion over 20-60 min

            Do not administer with other drugs

            Canadian (but not US) formulations allow for IV inj or deep IM

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Cefotan injection
            -
            2 gram vial
            Cefotan injection
            -
            1 gram vial
            cefotetan injection
            -
            1 gram vial
            cefotetan injection
            -
            2 gram vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

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            Patient Education
            cefotetan intravenous

            CEFOTETAN - INJECTION

            (sef-oh-TEE-tan)

            COMMON BRAND NAME(S): Cefotan

            USES: Cefotetan is an antibiotic used to treat a wide variety of bacterial infections. It may also be used before and during certain surgeries to help prevent infection. This medication is known as a cephalosporin antibiotic. It works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for virus infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

            HOW TO USE: Read and learn all preparation and usage instructions supplied by the manufacturer. Follow all instructions for proper mixing with the correct IV fluids. Consult your pharmacist for details. Before using, check the product visually for particles or discoloration. If either is present, do not use the liquid.If you are using the frozen pre-mixed solution, thaw the container at room temperature or in the refrigerator. If the bag is thawed in the refrigerator, let it sit at room temperature at least 1 hour before using. Do not thaw by putting in a water bath or microwaving. After thawing, shake well and squeeze the container to check for leaks. Discard solution if the container leaks. Do not re-freeze the solution after thawing.This medication is given by injection into a muscle or vein as directed by your doctor.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day. The dosage is based on your medical condition and response to treatment.Continue to use this medication until the full prescribed treatment period is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Learn how to store and discard needles and medical supplies safely. Consult your pharmacist for details.

            SIDE EFFECTS: Swelling, redness, pain, or soreness at the injection site may occur. This medication may also rarely cause loss of appetite, nausea, vomiting, diarrhea, or headache. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these rare but very serious side effects occur: dark urine, easy bruising/bleeding, fast/pounding/irregular heartbeat, seizures, unusual weakness, yellowing eyes/skin, mental/mood changes (such as confusion).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before using cefotetan, tell your doctor or pharmacist if you are allergic to it; or to other cephalosporins; or to penicillins; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, stomach/intestinal diseases (e.g., colitis), use/abuse of alcohol.Avoid alcoholic beverages while taking this medication and for at least 3 days after finishing this medicine. Drinking alcohol may result in severe stomach upset/cramps, nausea, vomiting, headache, and flushing.Cefotetan may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, older adults may be at greater risk for side effects while using this drug.Tell your doctor if you are pregnant before using this medication.This medication passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: aminoglycoside antibiotics (e.g., tobramycin, gentamicin), "blood thinners" (e.g., warfarin), chloramphenicol.This medication may interfere with certain medical/laboratory tests (e.g., urine glucose tests, serum or urine creatinine tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: trouble breathing, seizures.

            NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.Laboratory and/or medical tests (e.g., complete blood count) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Before mixing, store at room temperature away from light and moisture. Do not refrigerate or freeze the dry powder. Different brands/packaging of this medication may have different storage requirements. Read the package labeling or ask your pharmacist for the storage requirements before and after mixing for the product you are using. Do not store in the bathroom.Store the pre-mixed solution containers in the freezer at or below -4 degrees F (-20 degrees C). (For thawing instructions, see How to Use section.) If stored at room temperature, use/discard the thawed solution within 24 hours.Consult the package instructions or your pharmacist for other storage details. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised October 2020. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

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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.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.