How should Tigecycline be diluted for intravenous administration?

Tigecycline Dilution for Intravenous Administration

Tigecycline should be reconstituted with 5.3 mL of 0.9% sodium chloride or 5% dextrose to achieve a concentration of 10 mg/mL, then further diluted to a final concentration of 1 mg/mL in 100 mL of 0.9% sodium chloride or 5% dextrose for intravenous infusion. 1

Reconstitution and Dilution Process

• Reconstitute each 50 mg vial of tigecycline with 5.3 mL of 0.9% sodium chloride injection or 5% dextrose solution to achieve a concentration of 10 mg/mL 1, 2
• Swirl the vial gently until the powder is completely dissolved 2
• Withdraw the reconstituted solution from the vial and add to a 100 mL IV bag to achieve a final concentration of 1 mg/mL 1, 2
• The reconstituted solution should appear yellow to orange in color; if not, the solution should be discarded 2

Administration Guidelines

• Administer tigecycline intravenously over approximately 30-60 minutes through a dedicated IV line or a Y-site 2
• If the same IV line is used for sequential infusion of several drugs, flush the line before and after tigecycline infusion with either 0.9% sodium chloride injection or 5% dextrose solution 2

Stability Considerations

• The reconstituted solution can be stored at room temperature (not exceeding 25°C/77°F) for up to 24 hours (6 hours in the vial and the remaining time in the IV bag) 2
• When protected from light, tigecycline stability can be enhanced with the addition of ascorbic acid (3 mg/mL) and pyruvate (60 mg/mL) in saline solution at pH 7.0, which can maintain stability for up to 7 days 3
• Tigecycline is relatively unstable after standard reconstitution, which may limit its use in ambulatory infusions 3

Dosing Information

• For adults: Initial loading dose of 100 mg IV, followed by 50 mg IV every 12 hours 1
• For children 12-18 years: 100 mg loading dose, then 50 mg twice daily 1
• For children 8-11 years: 1.2 mg/kg twice daily (maximum 50 mg twice daily) 1
• Not recommended for children under 8 years due to risk of teeth discoloration 1, 4

Important Clinical Considerations

• Tigecycline is not licensed for the treatment of non-tuberculous mycobacterial infections in the UK 1
• Drug levels cannot currently be performed in the UK 1
• Higher mortality rates have been observed in patients treated with tigecycline compared to comparator antibiotics in clinical studies 1
• Tigecycline may prolong prothrombin time (PT) and activated partial thromboplastin time (aPTT) 1
• Tigecycline is contraindicated in patients with hypersensitivity to tigecycline or tetracyclines 1

Special Populations

• No dose adjustment is required in patients with renal impairment or mild to moderate hepatic impairment 5
• Tigecycline is not recommended during pregnancy or breast-feeding due to evidence of fetal harm in animal studies 1

Following these dilution and administration guidelines will help ensure proper delivery of tigecycline while maximizing its stability and therapeutic efficacy.