Tygacil - patient leaflet, side effects, dosage

1. What Tygacil is and what it is used for

Tygacil is an antibiotic of the glycylcycline group that works by stopping the growth of bacteria that cause infections.

Your doctor has prescribed Tygacil because you or your child at least 8 years old has one of the following types of serious infections:

• Complicated infection of the skin and soft tissues (the tissue below the skin), excluding diabetic

foot infections.

• Complicated infection in the abdomen

Tygacil is only used when your doctor thinks other antibiotics are not suitable.

2. What you need to know before you receive Tygacil

Do not use Tygacil

• If you are allergic to tigecycline, or any of the other ingredients of this medicine (listed in section 6). If you are allergic to tetracycline class antibiotics (e.g., minocycline, doxycycline, etc.), you may be allergic to tigecycline.

Warnings and precautions

Talk to your doctor or nurse before receiving Tygacil:

• If you have poor or slow wound healing.
• If you are suffering from diarrhoea before you are given Tygacil. If you develop diarrhoea

during or after your treatment, tell your doctor at once. Do not take any diarrhoea medicine without first checking with your doctor.

• If you have or previously had any side effects due to antibiotics belonging to the tetracycline class (e.g., skin sensitization to sun light, staining on developing teeth, pancreas inflammation, and alteration of certain laboratory values aimed at measuring how well your blood clots).
• If you have, or previously had liver problems. Depending on the condition of your liver, your doctor may reduce the dose to avoid potential side effects.
• If you have blockage of the bile ducts (cholestasis).
• If you suffer from a bleeding disorder or are in treatment with anticoagulant drugs, as this medicine can interfere with blood coagulation.

During treatment with Tygacil:

• Tell your doctor immediately if you develop symptoms of an allergic reaction.
• Tell your doctor immediately if you develop severe abdominal pain, nausea, and vomiting.

These may be symptoms of acute pancreatitis (inflamed pancreas which may result in severe abdominal pain, nausea, and vomiting).

• In certain serious infections, your doctor may consider to use Tygacil in combination with other antibiotics.
• Your doctor will monitor you closely for the development of any other bacterial infections. If you develop another bacterial infection, your doctor may prescribe a different antibiotic specific for the type of infection present.
• Although antibiotics including Tygacil fight certain bacteria, other bacteria and fungi may continue to grow. This is called overgrowth. Your doctor will monitor you closely for any potential infections and treat you if necessary.

Children

Tygacil is not to be used in children less than 8 years of age due to the lack of data on safety and efficacy in this age group and because it may induce permanent dental defects such as staining on the developing teeth.

Other medicines and Tygacil

Tell your doctor if you are taking, have recently taken or might take any other medicines.

Tygacil may prolong certain tests that measure how well your blood is clotting. It is important that you tell your doctor if you are taking medicines to avoid an excess of blood clotting (named anticoagulants). If this were the case, your doctor will monitor you closely.

Tygacil may interfere with the contraceptive pill (birth control pill). Talk to your doctor about the need for an additional method of contraception while receiving Tygacil.

Tygacil may increase the effect of medicines used to suppress the immune system (such as tacrolimus or cyclosporine). It is important that you tell your doctor if you are taking these medicines so you can be closely monitored.

Pregnancy and breast-feeding

Tygacil may cause foetal harm. If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before receiving Tygacil.

It is not known if Tygacil passes into breast milk in humans. Ask your doctor for advice before breast-feeding your baby.

Driving and using machines

Tygacil may cause side effects such as dizziness. This may impair your ability to drive or operate machinery.

Tygacil contains sodium

Tygacil contains less than 1 mmol sodium (23 mg) per 5 ml of solution, that is to say essentially ‘sodium-free’.

• 3. How Tygacil is given

Tygacil will be given to you by a doctor or a nurse.

The recommended dose in adults is 100 mg given initially, followed by 50 mg every 12 hours. This dose is given intravenously (directly into your blood stream) over a period of 30 to 60 minutes.

The recommended dose in children aged 8 to <12 years is 1.2 mg/kg given every 12 hours intravenously to a maximum dose of 50 mg every 12 hours.

The recommended dose in adolescents aged 12 to <18 years is 50 mg given every 12 hours.

A course of treatment usually lasts for 5 to 14 days. Your doctor will decide how long you should be treated.

If you receive more Tygacil than you should

If you are concerned that you may have been given too much Tygacil, talk to your doctor or nurse immediately.

If you miss a dose of Tygacil

If you are concerned that you may have missed a dose, talk to your doctor or nurse immediately.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Pseudomembranous colitis may occur with most antibiotics including Tygacil. This consists of severe, persistent or bloody diarrhoea associated with abdominal pain or fever, which can be a sign of serious bowel inflammation, which may occur during or after your treatment.

Very common side effects are (may affect more than 1 in 10 people):

• Nausea, vomiting, diarrhoea.

Common side effects are (may affect up to 1 in 10 people):

• Abscess (collection of pus), infections
• Laboratory measurements of decreased ability to form blood clots
• Dizziness
• Vein irritations from the injection, including pain, inflammation, swelling and clotting
• Abdominal pain, dyspepsia (stomach ache and indigestion), anorexia (loss of appetite)
• Increases in liver enzymes, hyperbilirubinaemia (excess of bile pigment in the blood)
• Pruritus (itching), rash
• Poor or slow wound healing
• Headache
• Increase in amylase, which is an enzyme found in the salivary glands and pancreas, increased blood urea nitrogen (BUN).
• Pneumonia
• Low blood sugar
• Sepsis (severe infection in the body and blood stream)/septic shock (serious medical condition which can lead to multiple organ failure and death as a result of sepsis)
• Injection site reaction (pain, redness, inflammation)
• Low protein levels in the blood

Uncommon side effects are (may affect up to 1 in 100 people):

• Acute pancreatitis (inflamed pancreas which may result in severe abdominal pain, nausea, and

vomiting)

• Jaundice (yellow coloration of the skin), inflammation of the liver
• Low platelet levels in the blood (which may lead to an increased bleeding tendency and bruising/haematoma)

Rare side effects are (may affect up to 1 in 1,000 people):

• Low fibrinogen levels in the blood (a protein involved in blood clotting)

Not known side effects are (frequency cannot be estimated from the available data):

• Anaphylaxis/a­naphylactoid reactions (that may range from mild to severe, including a sudden, generalised allergic reaction that may lead to a life-threatening shock [e.g. difficulty in breathing, drop of blood pressure, fast pulse]).
• Liver failure
• Skin rash, which may lead to severe blistering and peeling of the skin (Stevens-Johnson Syndrome)

5. How to store Tygacil

Keep this medicine out of the sight and reach of children.

Store below 25°C. Do not use this medicine after the expiry date which is stated on the vial. The expiry date refers to the last day of that month.

Storage after preparation

Once the powder has been made into a solution and diluted ready for use, it should be given to you immediately.

The Tygacil solution should be yellow to orange in colour after dissolving; if it is not, the solution should be discarded.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Tygacil contains

The active substance is tigecycline. Each vial contains 50 mg of tigecycline.

The other ingredients are lactose monohydrate, hydrochloric acid, and sodium hydroxide.

What Tygacil looks like and contents of the pack

Tygacil is supplied as a powder for solution for infusion in a vial and looks like an orange powder or cake before it is diluted. These vials are distributed to the hospital in a ten tray pack. The powder should be mixed in the vial with a small amount of solution. The vial should be gently swirled until the medicine is dissolved. Thereafter, the solution should be immediately withdrawn from the vial and added to a 100 ml intravenous bag or other suitable infusion container in the hospital.

Marketing Authorisation Holder Pfizer Europe MA EEIG Boulevard de la Plaine 17 1050 Bruxelles Belgium

Manufacturer Wyeth Lederle S.r.l. Via Franco Gorgone Z.I. 95100 Catania (CT) Italy

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:

België/Belgiqu­e/Belgien Luxembourg/Lu­xemburg Pfizer S.A. / N.V. Tél/Tel: +32 (0)2 554 62 11	Lietuva Pfizer Luxembourg SARL filialas Lietuvoje Tel. + 370 52 51 4000
Etnrapun 11(|)aii3ep..'I­iOKceMÔypr CAPI, K.'ioii EtnrapwH Ten :: +359 2 970 4333	Magyarország Pfizer Kft. Tel: +36 1 488 3700
Česká Republika Pfizer s.r.o. Tel: +420–283–004–111	Malta Vivian Corporation Ltd. Tel: +35621 344610
Danmark Pfizer ApS Tlf: +45 44 201 100	Nederland Pfizer BV Tel: +31 (0)10 406 43 01
Deutschland Pfizer Pharma PFE GmbH Tel: +49 (0)800 8535555	Norge Pfizer AS Tlf: +47 67 526 100
Eesti Pfizer Luxembourg SARL Eesti filiaal Tel: +372 666 7500	Österreich Pfizer Corporation Austria Ges.m. b.H. Tel: +43 (0)1 521 15–0 Polska
E/./.áňa Pfizer EAAA1 A.E.,	Pfizer Polska Sp. z o.o., Tel.: +48 22 335 61 00

Tip..: +30 210 67 85 800

España Pfizer, S.L. Tel:+34 91 490 99 00	Portugal Laboratórios Pfizer, Lda. Tel: (+351) 21 423 55 00
France Pfizer Tél +33 (0)1 58 07 34 40	România Pfizer Romania S.R.L Tel: +40 (0) 21 207 28 00
Hrvatska Pfizer Croatia d.o.o. Tel: +385 1 3908 777	Slovenija Pfizer Luxembourg SARL Pfizer, podružnica za svetovanje s področja farmacevtske dejavnosti, Ljubljana Tel.: + 386 (0) 1 52 11 400

Latvija

Pfizer Luxembourg SARL filiale Latvija

Tel.: + 371 670 35 775

This leaflet was last revised in {MM/YYYY}.

Detailed information on this medicine is available on the European Medicines Agency website: http://www. ema. europa.eu.

The following information is intended for healthcare professionals only:

Instructions for use and handling (

see also 3. How Tygacil is given in this leaflet)

The powder should be reconstituted with 5.3 ml of sodium chloride 9 mg/ml (0.9 %) solution for injection, dextrose 50 mg/ml (5 %) solution for injection, or Lactated Ringer’s solution for injection to achieve a concentration of 10 mg/ml of tigecycline. The vial should be gently swirled until the active substance is dissolved. Thereafter, 5 ml of the reconstituted solution should be immediately withdrawn from the vial and added to a 100 ml intravenous bag for infusion or other suitable infusion container (e.g. glass bottle).

For a 100 mg dose, reconstitute using two vials into a 100 ml intravenous bag for infusion or other suitable infusion container (e.g. glass bottle).

Note: The vial contains a 6 % overage. Thus, 5 ml of reconstituted solution is equivalent to 50 mg of the active substance. The reconstituted solution should be yellow to orange in colour; if not, the solution should be discarded. Parenteral products should be inspected visually for particulate matter and discolouration (e.g. green or black) prior to administration.

Tigecycline should be administered intravenously through a dedicated line or through a Y-site. If the same intravenous line is used for sequential infusion of several active substances, the line should be flushed before and after infusion of tigecycline with either sodium chloride 9 mg/ml (0.9 %) solution for injection or dextrose 50 mg/ml (5 %) solution for injection. Injection should be made with an infusion solution compatible with tigecycline and any other medicinal product(s) via this common line.

Compatible intravenous solutions include: sodium chloride 9 mg/ml (0.9 %) solution for injection, dextrose 50 mg/ml (5 %) solution for injection, and Lactated Ringer’s solution for injection.

When administered through a Y-site, compatibility of tigecycline diluted in sodium chloride 0.9 % for injection is demonstrated with the following medicinal products or diluents: amikacin, dobutamine, dopamine HCl, gentamicin, haloperidol, Lactated Ringer’s, lidocaine HCl, metoclopramide, morphine, norepinephrine, piperacillin/ta­zobactam (EDTA formulation), potassium chloride, propofol, ranitidine HCl, theophylline, and tobramycin.

Tygacil must not be mixed with other medicinal products for which compatibility data are not available.

Once reconstituted and diluted in the bag or other suitable infusion container (e.g. glass bottle) tigecycline should be used immediately.

For single use only, any unused solution should be discarded.

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