TICAR
Clinical safety rating: caution
Comprehensive clinical and safety monograph for TICAR (TICAR).
Ticarcillin is a beta-lactam antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to cell lysis and death. It is a time-dependent bactericidal agent.
| Metabolism | Ticarcillin is not significantly metabolized; it is primarily eliminated unchanged by the kidneys via glomerular filtration and tubular secretion. Minor hydrolysis of the beta-lactam ring occurs non-enzymatically. |
| Excretion | Ticarcillin is primarily excreted unchanged in urine via glomerular filtration and tubular secretion, accounting for 90-95% of the dose. Biliary/fecal excretion is minimal (<5%). |
| Half-life | Terminal elimination half-life is approximately 1.2 hours in adults with normal renal function. In renal impairment, half-life may extend to 15-20 hours; dose adjustment required for CrCl <60 mL/min. |
| Protein binding | 45-65% bound to plasma proteins (primarily albumin). |
| Volume of Distribution | Volume of distribution is approximately 0.2-0.3 L/kg (12-20 L in adults), indicating distribution primarily into extracellular fluid. Penetration into CSF is poor unless meninges inflamed. |
| Bioavailability | Bioavailability: not applicable orally (ticarcillin is degraded by gastric acid; only IV or IM routes used). |
| Onset of Action | Intravenous administration: clinical effect within 30-60 minutes (bactericidal activity immediate upon achieving therapeutic concentrations). Intramuscular: onset 1-2 hours. |
| Duration of Action | Duration of bactericidal concentrations is about 4-6 hours with normal renal function. Requires frequent dosing (every 4-6 hours) due to short half-life. Prolonged in renal impairment. |
| Molecular Weight | 428.44 |
3 g IV every 4 hours for pseudomonal infections; 3 g IV every 6 hours for less severe infections.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 30-60 mL/min: 2 g IV every 4 hours; CrCl 10-30 mL/min: 2 g IV every 8 hours; CrCl <10 mL/min: 2 g IV every 12 hours. |
| Liver impairment | No specific dose adjustments recommended for hepatic impairment. |
| Pediatric use | Neonates <7 days: 75 mg/kg IV every 12 hours; Neonates 7-28 days: 75 mg/kg IV every 8 hours; Infants and children: 100-200 mg/kg/day divided every 4-6 hours, maximum 12 g/day. |
| Geriatric use | Adjust dose based on renal function; consider initial dose reduction in elderly patients with decreased renal function. |
| 1st trimester | Use only if clearly needed; animal studies show no harm but no adequate human studies. |
| 2nd trimester | Safe with caution; crosses placenta but no documented teratogenicity. |
| 3rd trimester | Avoid prolonged use near term due to risk of kernicterus in neonates; sulfonamides displace bilirubin. |
Clinical note
Comprehensive clinical and safety monograph for TICAR (TICAR).
| Placental transfer | Crosses placenta readily; fetal serum concentrations can reach 20-100% of maternal levels. |
| Breastfeeding | Ticarcillin is excreted into breast milk in low concentrations; use with caution in nursing mothers due to potential for hypersensitivity or diarrhea in infant. |
| Lactation Rating |
■ FDA Black Box Warning
No FDA boxed warning exists for ticarcillin alone; however, when combined with clavulanate (Timentin), there is a warning for increased risk of severe allergic reactions (anaphylaxis) in patients with penicillin hypersensitivity.
| Serious Effects |
Hypersensitivity to penicillinsHypersensitivity to cephalosporins (cross-allergy potential)
| Precautions | Hypersensitivity reactions (anaphylaxis) in penicillin-allergic patients, Renal impairment: dose adjustment required due to excretion, Electrolyte disturbances: hypokalemia and hypernatremia (high sodium content), Bleeding abnormalities: may prolong bleeding time due to platelet dysfunction, Superinfection with resistant organisms, Neurological toxicity (seizures) at high doses in renal failure |
| Food/Dietary | No significant food interactions. High sodium content may be relevant for patients on sodium-restricted diets. |
Loading safety data…
| L1 (Safe) |
| Teratogenic Risk | TICAR (ticarcillin) is a penicillin antibiotic classified as FDA Pregnancy Category B. Animal reproduction studies have not demonstrated fetal risk, but there are no adequate and well-controlled studies in pregnant women. In the first trimester, theoretical risk is low; second and third trimesters: generally considered safe when indicated, with no known teratogenic effects. |
| Fetal Monitoring | Monitor maternal renal function, complete blood count, and signs of hypersensitivity or superinfection. Assess fetal well-being if maternal infection is severe. No specific fetal monitoring required beyond standard prenatal care. |
| Fertility Effects | No known adverse effects on fertility in animal studies or human data. Antibiotic use may alter vaginal flora, but no direct impact on reproductive capacity reported. |
| Clinical Pearls | TICAR (ticarcillin disodium) is a carboxypenicillin beta-lactam antibiotic. Not effective against MRSA. Use with caution in patients with bleeding disorders or electrolyte imbalances due to high sodium content (5.6 mEq Na+ per gram). Incompatible with aminoglycosides in IV solutions; administer separately. Reduce dose in renal impairment (CrCl <60 mL/min). |
| Patient Advice | Take this medication exactly as prescribed; do not skip doses. · Report any signs of allergic reaction (rash, hives, difficulty breathing) immediately. · May cause diarrhea; contact your doctor if severe or persistent. · Inform your doctor of any history of bleeding problems or kidney disease. · This medication contains sodium; follow any dietary sodium restrictions advised by your doctor. |