TIMENTIN IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for TIMENTIN IN PLASTIC CONTAINER (TIMENTIN IN PLASTIC CONTAINER).
Timentin is a combination of ticarcillin, a penicillin-class beta-lactam antibiotic, and clavulanate, a beta-lactamase inhibitor. Ticarcillin inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), while clavulanate irreversibly inhibits beta-lactamases, preventing degradation of ticarcillin.
| Metabolism | Hepatic metabolism is minimal; primarily renal excretion (glomerular filtration and tubular secretion) as unchanged drug. Clavulanate is extensively metabolized in the liver. |
| Excretion | Renal: ~70-80% of ticarcillin and ~60-70% of clavulanate excreted unchanged in urine within 6 hours. Biliary/fecal: Minor (<5%). |
| Half-life | Ticarcillin: ~1.2 hours; Clavulanate: ~1.0 hours. Prolonged in renal impairment (ticarcillin up to 15 hours in ESRD). |
| Protein binding | Ticarcillin: ~45% bound to albumin; Clavulanate: ~25% bound to albumin. |
| Volume of Distribution | Ticarcillin: ~0.2 L/kg; Clavulanate: ~0.3 L/kg. Distributing into extracellular fluid; low CNS penetration unless inflamed meninges. |
| Bioavailability | IV: 100% bioavailable. Not administered via other routes due to poor absorption. |
| Onset of Action | IV: Immediate (within 1 hour) for bactericidal effect. Peak serum concentrations achieved at end of infusion. |
| Duration of Action | Therapeutic levels persist ~4-6 hours; dosing every 4-6 hours required. Duration extended in renal failure. |
| Molecular Weight | Ticarcillin: 416.4 Da; Clavulanic acid: 199.2 Da |
3.1 g (ticarcillin 3 g + clavulanate 0.1 g) IV every 4 to 6 hours; maximum 18 g per day.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl >60 mL/min: 3.1 g IV q4-6h; CrCl 30-60 mL/min: 2 g IV q4h (ticarcillin 2 g); CrCl 10-30 mL/min: 2 g IV q8h; CrCl <10 mL/min: 2 g IV q12h; hemodialysis: 2 g IV q12h, supplemented with 3.1 g after each dialysis. |
| Liver impairment | No dose adjustment required for hepatic impairment. |
| Pediatric use | Children >3 months: 50 mg/kg (as ticarcillin) IV q4-6h (max 3.1 g per dose); neonates: 75 mg/kg IV q8h (for <1 week), q6h (for 1-4 weeks) based on ticarcillin component. |
| Geriatric use | Use with caution due to age-related renal decline; adjust dose based on renal function. |
| 1st trimester | Animal reproduction studies have not been conducted with ticarcillin/clavulanate; however, penicillins are generally considered safe in pregnancy. Use only if clearly needed. |
| 2nd trimester | Penicillins are generally considered safe in the second trimester. No known fetal risk. |
| 3rd trimester | Penicillins are generally considered safe in the third trimester. No known fetal risk. |
Clinical note
Comprehensive clinical and safety monograph for TIMENTIN IN PLASTIC CONTAINER (TIMENTIN IN PLASTIC CONTAINER).
| Placental transfer | Ticarcillin and clavulanic acid cross the placenta; fetal serum concentrations reach approximately 30-50% of maternal levels. |
| Breastfeeding | Ticarcillin and clavulanic acid are excreted into breast milk in low concentrations. Use with caution in nursing mothers. May cause diarrhea or allergic reaction in the infant. |
■ FDA Black Box Warning
Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients on penicillin therapy. These reactions are more likely to occur in individuals with a history of penicillin hypersensitivity and/or sensitivity to multiple allergens.
| Serious Effects |
Hypersensitivity to ticarcillin, clavulanate, or any penicillinHistory of severe allergic reaction to beta-lactam antibiotics
| Precautions | Serious hypersensitivity reactions (anaphylaxis) may occur; cross-allergenicity with cephalosporins. Clostridium difficile-associated diarrhea (CDAD). Bleeding abnormalities have been reported in high doses; monitor prothrombin time. Neurotoxicity (seizures) in renal impairment due to high CNS concentrations. Electrolyte imbalance due to high sodium content (4.75 mEq Na/g ticarcillin). Hypokalemia. Dosage adjustment required in renal impairment. Pseudomembranous colitis. |
| Food/Dietary | No significant food interactions; can be taken without regard to meals. |
Loading safety data…
| Lactation Rating | L2 (Probably Compatible) |
| Teratogenic Risk | FDA Pregnancy Category B. No evidence of teratogenicity in animal studies; however, adequate human studies in pregnant women are lacking. Use only if clearly needed. First trimester: Theoretical risk based on animal data; avoid if possible. Second and third trimesters: Generally considered safe; no known fetal harm from penicillins. |
| Fetal Monitoring | Monitor maternal renal function and complete blood counts during prolonged therapy. Fetal monitoring per standard obstetric care; no specific fetal monitoring required for this drug. |
| Fertility Effects | No known adverse effects on fertility in animal studies. No human data available; expected to have minimal to no impact on fertility based on drug class. |
| Clinical Pearls | Timentin (ticarcillin/clavulanate) is a beta-lactam/beta-lactamase inhibitor combination with antipseudomonal activity. Note: Contains 4.51 mEq of sodium per gram of ticarcillin; monitor sodium load in patients with hypertension or heart failure. Not effective against MRSA or ESBL-producing organisms. Dose adjustment required in renal impairment (CrCl <60 mL/min). Contraindicated in patients with hypersensitivity to penicillins. |
| Patient Advice | Complete the full course of therapy even if you feel better. · Inform your doctor if you have a history of allergies to penicillin, cephalosporins, or other beta-lactam antibiotics. · Report any signs of allergic reaction such as rash, itching, swelling, or difficulty breathing. · This medication may cause diarrhea; if it becomes severe or bloody, contact your healthcare provider. · If you are on a low-sodium diet, note that this medication contains sodium. |