Teicoplanin is available as a lyophilized powder in single-use vials containing teicoplanin 100, 200, or 400 mg.3412; 3413; 3414; 3415; 3416 Each vial also contains sodium chloride and sodium hydroxide to adjust the pH.3412; 3413; 3414; 3415; 3416 Some vials of teicoplanin are packaged with an accompanying ampul of water for injection for use as a diluent.3413; 3414; 3416
To prepare teicoplanin for injection or infusion, the 100-mg vials should be reconstituted with 1.7 mL3415 and most 200- and 400-mg vials should be reconstituted with 3.14 mL of sterile water for injection, either from a separate vial or from the accompanying ampul of diluent, when provided; the diluent should be injected slowly down the side of the vial wall.3412; 3413; 3414; 3415 Vials should be rolled gently until the powder is completely dissolved and should not be shaken.3412; 3413; 3414; 3415; 3416 Care should be taken to avoid the formation of foam; if foam develops, the solution should be allowed to stand for 15 minutes until it subsides.3412; 3413; 3414; 3415; 3416 The resulting reconstituted solutions contain teicoplanin 100 mg/1.5 mL, 200 mg/3 mL, or 400 mg/3 mL.3412; 3413; 3414; 3415; 3416 Errors in reconstitution can result in the formation of a stable foam and the delivery of doses that are smaller than intended.3413; 3414; 3416 Reconstituted teicoplanin solutions should be extracted slowly from the vial using a syringe (e.g., a 5-mL syringe with a 23-gauge needle).3412; 3413; 3414; 3415; 3416
The reconstituted solution may be administered by direct injection without further dilution or administered as an intravenous infusion after dilution in a compatible infusion solution.3412; 3413; 3414; 3415; 3416 Most manufacturers recommend dilution of the reconstituted solution in sodium chloride 0.9%, Ringer’s injection, Ringer’s injection, lactated, dextrose 5 or 10%, dextrose 4% in sodium chloride 0.18%, or dextrose 5% in sodium chloride 0.45%.3412; 3413; 3414; 3415; 3416 Some manufacturers also state that teicoplanin can be prepared in compounded sodium lactate solution3413; 3414 and Hartmann's solution.3416 Specific product labeling should be consulted.
Equivalency
Each milligram of teicoplanin is equivalent to not less than 1000 international units.3412; 3414; 3415
pH
The pH of teicoplanin (Sanofi-Aventis) 133.3-mg/mL reconstituted solution ranges from 7.2 to 7.8.3414
Tonicity
Teicoplanin (Sanofi-Aventis) 133.3-mg/mL reconstituted solution is isotonic.3414
Trade Name(s)
Targocid
Teicoplanin may be administered after reconstitution either intramuscularly, with a maximum of 3 mL in a single site, or by direct intravenous injection over 3 to 5 minutes.3412; 3413; 3414; 3416 The drug also may be administered as an intravenous infusion over 30 minutes after dilution in a compatible infusion solution.3412; 3413; 3414; 3415; 3416 Only intravenous infusion should be used to administer the drug in neonates.3412; 3415
Teicoplanin should not be administered intraventricularly.3412; 3413; 3414; 3415; 3416 Safety and efficacy of administration of teicoplanin by the intrathecal route has not been evaluated.3413; 3416
Manufacturers state that teicoplanin should not be admixed with aminoglycosides due to incompatibility.3412; 3413; 3414; 3415; 3416 Some manufacturers state that administration of teicoplanin must occur separately from other parenteral antibiotics if combination therapy is used.3412; 3415
Intact vials of teicoplanin should be stored below 25°C.3414; 3415; 3416 Reconstituted and diluted solutions of teicoplanin ideally should be used immediately after preparation, but may be stored under refrigeration at 2 to 8°C for at least 24 hours;3412; 3413; 3414; 3415; 3416 specific product labeling should be consulted. Several manufacturers state that teicoplanin should not be stored in syringes.3413; 3414; 3416
Teicoplanin forms dextrose aldehyde adducts when diluted in dextrose-containing solutions. Equilibrium is reached faster at room temperature (7 days) than with refrigerated storage (30 days). The equilibrium concentration of the adduct is directly related to the dextrose concentration. The reaction is reversible with dilution.2046
The stability of catheter flush solutions composed of teicoplanin 133 mg/mL in water for injection, or heparin sodium 10 units/mL or 100 units/mL, was evaluated in Hickman catheters at 25°C over 24 hours. No decomposition products formed, and no loss was found. Indeed, a small (11%) increase in teicoplanin concentration was observed which was attributed to loss of water.2165
Syringes
Several manufacturers state that teicoplanin should not be stored in syringes.3413; 3414; 3416
Y-Site Injection Compatibility (1:1 Mixture)
Additional Compatibility Information
Peritoneal Dialysis Solutions
Some manufacturers state that teicoplanin can be administered in peritoneal dialysis solutions containing 1.36 or 3.86% dextrose.3412; 3415
Teicoplanin (Marion Merrell Dow) 0.025 mg/mL in Dianeal PD-2 with dextrose 1.5% in polyvinyl chloride (PVC) containers was physically and chemically stable for 24 hours at 25°C exposed to light, exhibiting no loss; additional storage for 8 hours at 37°C resulted in losses of 6% or less. Under refrigeration at 4°C protected from light, no loss occurred in 7 days. Additional storage for 16 hours at 25°C followed by 8 hours at 37°C resulted in about 7% loss.1989
Ceftazidime (Glaxo) 0.1 mg/mL admixed with teicoplanin (Marion Merrell Dow) 0.025 mg/mL in Dianeal PD-2 with dextrose 1.5% in PVC containers did not result in a stable mixture. Large (but variable) teicoplanin losses generally in the 20% range were noted in as little as 2 hours at 25°C exposed to light. Ceftazidime losses of about 9% occurred in 16 hours. Refrigeration and protection from light of the peritoneal dialysis admixture reduced losses of both drugs to negligible levels. Even so, admixing these 2 drugs was not recommended because of the high levels of teicoplanin loss at room temperature.1989
Teicoplanin (Merrell Dow) 25 mg/L in Dianeal 137 with dextrose 1.36% (Baxter) was evaluated for stability over 42 days. Stored at 4°C, teicoplanin retained stability with a loss of less than 5% in 42 days. At 20°C, 10% loss occurred in about 25 days with 17% loss in 42 days. At an elevated temperature of 37°C, a much greater rate of decomposition occurs with over 40% loss occurring in 42 days.2145
Manufacturers state that teicoplanin should not be admixed with aminoglycosides due to incompatibility;3412; 3413; 3414; 3415; 3416 however, several manufacturers state that the drugs are compatible when combined in dialysis fluid.3412; 3415 Specific product labeling should be consulted.
For a list of references cited in the text of this monograph, search the monograph titled References.