TICAR

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TICAR (TICAR).

How it works

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.

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TICAR (TICAR).

Breastfeeding	Ticarcillin is excreted into breast milk in low concentrations; the milk-to-plasma ratio is approximately 0.01-0.05. It is considered compatible with breastfeeding due to minimal oral bioavailability and low infant exposure. However, monitor for potential disruption of infant gut flora or hypersensitivity reactions.
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.

Warnings & precautions

■ 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.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to ticarcillin or any beta-lactam antibiotic","History of anaphylactic reaction to penicillins or cephalosporins (relative contraindication)"]

Clinical Precautions

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"]

Clinical Tips & Counseling

Drug interactions

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TICAR

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TICAR (TICAR).

How it works

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TICAR (TICAR).

Breastfeeding	Ticarcillin is excreted into breast milk in low concentrations; the milk-to-plasma ratio is approximately 0.01-0.05. It is considered compatible with breastfeeding due to minimal oral bioavailability and low infant exposure. However, monitor for potential disruption of infant gut flora or hypersensitivity reactions.
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.

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to ticarcillin or any beta-lactam antibiotic","History of anaphylactic reaction to penicillins or cephalosporins (relative contraindication)"]