Piperacillin and Tazobactam and Sodium Chloride 250 mg/50mL; 2 g/50mL Injection, Solution — NDC 0264-3446-11 (Billing 00264-3446-11)
This is a package of Piperacillin and Tazobactam and Sodium Chloride 250 mg/50mL; 2 g/50mL Injection, Solution from B. Braun Medical Inc., marketed since Sep 2025 and currently FDA-listed. It is this product's only package size.
NDC database record
One package, one record: these facts belong to NDC 0264-3446-11 alone.
- Record
- FDA NDC Directory package listing · Human prescription drug
- Code segments
- 0264 labeler · 3446 product · 11 package
- Package marketed since
- Sep 30, 2025
- Sample package
- No — commercial package
- Listing certified through
- Dec 31, 2027
- Barcode (UPC-A, from the NDC)
- 3 0264344611 6
- FDA record last changed
- Oct 1, 2026
Identity & classification
Regulatory identifiers FDA, NLM and CMS codes for this package
Drug-database identifiers Medi-Span GPI and First Databank GCN / HICL / AHFS classification
- GSN (GCN sequence number): 087567
- GCN: 57535
- GPI-14 (Medi-Span): 01990002732110
- HICL (First Databank): 008738
- AHFS class code: 08:12.16.16
- RxCUI (RxNorm): 1659131
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 1, 2026
- FDA label on DailyMed · label index refreshed Oct 5, 2026
- RxNorm (NLM RxNav) · catalog refreshed Oct 1, 2026
- Medi-Span GPI (licensed)
- First Databank (licensed) · refreshed Oct 1, 2026
RxNorm drug class
This medicine belongs to the beta Lactamase Inhibitor class.
Where does this data come from?
- RxClass (NLM) · catalog refreshed Oct 1, 2026
Clinical
Piperacillin and tazobactam injection is used to treat certain infections caused by bacteria. Piperacillin is in a class of medications called penicillin antibiotics. It works by killing bacteria that cause infection. Tazobactam is in a class called beta-lactamase inhibitor. It works by preventing bacteria from destroying piperacillin. Antibiotics such as piperacillin and tazobactam injection will not work for colds, flu, or other viral infections. Taking or using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.
Read the full MedlinePlus article ↗- It treats certain bacterial infections, including complicated appendicitis and peritonitis, hospital-acquired pneumonia, skin infections, female pelvic infections, and community-ac...
- It is given through an IV, usually over 30 minutes, by a healthcare professional. It is often given every 6 to 8 hours. Your doctor decides the dose and length of treatment based o...
- Diarrhea, constipation, nausea, headache, trouble sleeping, and rash are the most common. Most are mild. Tell your nurse or doctor about any rash that spreads, breathing trouble, u...
- Probably not. It should not be used if you have had an allergic reaction to penicillins, cephalosporins, or beta-lactamase inhibitors. Make sure your care team knows your full alle...
Patient education
Supplement & herbal interactions
Where does this data come from?
- MedlinePlus (NLM) · refreshed Oct 1, 2026
- FDA label on DailyMed · label index refreshed Oct 5, 2026
Ask a licensed pharmacist directly — free, answered by our team.
Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per mL | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | Not in the retail survey — common for institutional, discontinued, or low-volume packs. | |
| Medicaid paysCMS SDUD · 12 mo | No recent Medicaid claims on file for this NDC — rare and low-volume NDCs are suppressed in the public data. | |
| Medicare drug plans payPart D · Q2 2026 | $7.37 | $8,844.00 / 1200 ml |
| Medicare Part B allowsASP · J2543 | $1.218 / J2543 unit | — |
Where does this data come from?
- CMS NADAC weekly file
- CMS ASP pricing files · refreshed Sep 20, 2026
- CMS Medicaid State Drug Utilization Data · refreshed Oct 5, 2026
- CMS Part D plan pricing files · refreshed Sep 24, 2026
- VA National Acquisition Center price file
Billing & reimbursement
Where does this data come from?
- CMS ASP NDC-HCPCS crosswalk · refreshed Sep 22, 2026
- DMEPDAC NDC-HCPCS crosswalk
- openFDA NSDE billing units · refreshed Sep 7, 2026
Packaging — all sizes for this product
| Package NDC | Description | Marketing start | Marketing end | Status |
|---|---|---|---|---|
| 00264-3446-11 You're viewing this Main listing | 24 CONTAINER in 1 CASE / 50 mL in 1 CONTAINER | 2025-09-30 | — | Active |
Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Zosyn in Galaxy Containers 250 mg/50mL; 2 g/50mL 00206-8860-02 | Wyeth | 50 ml | — | — | Discontinued | — |
| Piperacillin and Tazobactam and Sodium Chloride 250 mg/50mL; 2 g/50mLthis 00264-3446-11 | B. | 50 ml | — | — | FDA listed | — |
| Zosyn 2 g/50mL; .25 g/50mL 00338-9632-24 | Baxter | 50 ml | — | — | FDA listed | — |
| Piperacillin and Tazobactam 2 g/10mL; .25 g/10mL 00409-3383-02 | Hospira, | 10 vials | — | AP | Discontinued | — |
| Piperacillin and Tazobactam 2 g/10mL; .25 g/10mL 00781-3110-95 | Sandoz | 10 vials | — | AP | FDA listed | — |
| Piperacillin and Tazobactam 2 g/10mL; .25 g/10mL 00781-9210-95 | Sandoz | 10 vials | — | AP | Discontinued | — |
| Piperacillin and Tazobactam 2 g/10mL; .25 g/10mL 35369-0502-02 | Shandong | 10 vials | — | AP | FDA listed | — |
| Piperacillin and Tazobactam 2 g/1; .25 g 44567-0801-10 | WG | 10 vials | — | AP | FDA listed | — |
| Piperacillin and Tazobactam 2 g/1; .25 g 55150-0119-30 | Eugia | 10 vials | — | AP | FDA listed | — |
| Piperacillin and Tazobactam 2 g/10mL; .25 g/10mL 60505-6156-04 | Apotex | 10 vials | — | AP | FDA listed | — |
| Piperacillin and Tazobactam 2 g/10mL; .25 g/10mL 63323-0309-20 | Fresenius | 10 vials | — | AP | FDA listed | — |
| Piperacillin and Tazobactam 2 g/10mL; .25 g/10mL 63323-0981-21 | Fresenius | 10 vials | — | AP | FDA listed | — |
| Piperacillin and Tazobactam 2 g/10mL; .25 g/10mL 65219-0434-20 | Fresenius | 10 vials | — | AP | FDA listed | — |
| Piperacillin and Tazobactam 2 g/10mL; .25 g/10mL 68001-0506-30 | BluePoint | 10 vials | — | AP | FDA listed | — |
| Piperacillin And Tazobactam 2 g/10mL; .25 g/10mL 81284-0151-10 | Provepharm | 10 vials | — | AP | FDA listed | — |
| piperacillin and tazobactam 2 g/10mL; .25 g/10mL 83270-0301-10 | ONESOURCE | 10 vials | — | AP | FDA listed | — |
| Piperacillin and Tazobactam 2 g/10mL; .25 g/10mL 83634-0104-20 | Avenacy, | 10 vials | — | AP | FDA listed | — |
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 1, 2026
- FDA Orange Book · refreshed Oct 3, 2026
- CMS NADAC weekly file
Availability & generic status
We did not find an FDA-approved generic match for this exact strength, form and route.
Where does this data come from?
- FDA Orange Book · refreshed Oct 3, 2026
Inactive Ingredients / Excipients
Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.
🧪 Avoiding an ingredient? See Piperacillin / Sodium Chloride / Tazobactam inactive ingredients by manufacturer: every current product's list side by side, so you can ask your pharmacy for the version that does not list it.
💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.
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0.5 mg / 50 mL
UNII 7FLD91C86K
Edetate disodium is a chemical compound that binds and removes certain metal ions. In medicines, it acts as a preservative and stabilizer by preventing metals like calcium from interfering with the product's shelf life and consistency.
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225 mg / 50 mL
UNII 451W47IQ8X
Sodium chloride is common table salt. It's used in medicines as a buffer to maintain proper pH, as a filler to add bulk, or to adjust the osmotic balance in liquid formulations.
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100 mg / 50 mL
UNII 1Q73Q2JULR
Sodium citrate is a salt derived from citric acid. It works as a buffer to maintain the medicine's pH level and may also help improve taste or act as a preservative in the formulation.
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UNII 059QF0KO0R
Water is a liquid solvent that dissolves and mixes ingredients together in liquid medicines, syrups, and injections. It helps distribute the active drug evenly throughout the product.
4 inactive ingredients listed in the exact product block matched to this NDC.
Where does this data come from?
ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.- FDA label on DailyMed · label index refreshed Oct 5, 2026
- FDA openFDA NDC Directory · synced Oct 1, 2026
Inactive ingredient FAQ
Are inactive ingredients the same for every manufacturer?
Why might an inactive ingredient be missing?
Can inactive ingredients matter?
Manufacturer & labeler
More NDCs from B. Braun Medical Inc. labeler code 00264
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- Meropenem and Sodium Chloride 500 mg/50mL Injection, Solution NDC 0264-3183-11
- Meropenem and Sodium Chloride 1 g/50mL Injection, Solution NDC 0264-3185-11
- CEFEPIME HYDROCHLORIDE AND DEXTROSE 1 g/50mL Injection, Solution NDC 0264-3193-11
- CEFEPIME HYDROCHLORIDE AND DEXTROSE 2 g/50mL Injection, Solution NDC 0264-3195-11
- Heparin Sodium in Sodium Chloride 5000 [USP'U]/100mL Injection NDC 0264-3301-10
- Piperacillin and Tazobactam and Sodium Chloride 375 mg/50mL; 3 g/50mL Injection, Solution NDC 0264-3448-11
- Piperacillin and Tazobactam and Sodium Chloride 500 mg/100mL; 4 g/100mL Injection, Solution NDC 0264-3450-22
- Heparin Sodium in Sodium Chloride 10000 [USP'U]/100mL Injection NDC 0264-3462-20
- Acetaminophen 10 mg/mL Injection NDC 0264-4050-80
- Acetaminophen 10 mg/mL Injection NDC 0264-4100-90
- Magnesium Sulfate in Water magnesium sulfate heptahydrate 2 g/50mL Injection, Solution NDC 0264-4204-52
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 1, 2026
- Drugs@FDA
Full prescribing information FDA SPL
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, is a combination of piperacillin, a penicillin-class antibacterial and tazobactam, a beta-lactamase inhibitor, indicated for the treatment of: Intra-abdominal infections in adult and pediatric patients 2 months of age and older ( 1.1 ) Nosocomial pneumonia in adult and pediatric patients 2 months of age and older ( 1.2 ) Skin and skin structure infections in adults ( 1.3 ) Female pelvic infections in adults ( 1.4 ) Community-acquired pneumonia in adults ( 1.5 ) Usage to Reduce Development of Drug-Resistant Bacteria To reduce the development of drug-resistant bacteria and maintain the effectiveness of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection and other antibacterial drugs, Piperacillin and Tazobactam for Injection and Sodium Chloride Injection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
( 1.6 )
1.1Intra-abdominal Infections Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of appendicitis (complicated by rupture or abscess) and peritonitis caused by beta-lactamase producing isolates of Escherichia coli or the following members of the Bacteroides fragilis group: B. fragilis, B. ovatus, B. thetaiotaomicron, or B. vulgatus .
1.2Nosocomial Pneumonia Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin and tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa (Nosocomial pneumonia caused by P. aeruginosa should be treated in combination with an aminoglycoside) [see Dosage and Administration (2) ].
1.3Skin and Skin Structure Infections Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is indicated in adults for the treatment of uncomplicated and complicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by beta-lactamase producing isolates of Staphylococcus aureus .
1.4Female Pelvic Infections Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is indicated in adults for the treatment of postpartum endometritis or pelvic inflammatory disease caused by beta-lactamase producing isolates of Escherichia coli .
1.5Community-acquired Pneumonia Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is indicated in adults for the treatment of community-acquired pneumonia (moderate severity only) caused by beta-lactamase producing isolates of Haemophilus influenzae .
1.6Usage to Reduce Development of Drug-Resistant Bacteria To reduce the development of drug-resistant bacteria and maintain the effectiveness of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection and other antibacterial drugs, Piperacillin and Tazobactam for Injection and Sodium Chloride Injection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy.
In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION If a dose of Piperacillin and Tazobactam for Injection and Sodium Chloride injection is required that is not equal to 2.25 g, 3.375 g, or 4.5 g, this product is not recommended for use and an alternative formulation of piperacillin and tazobactam for injection should be considered ( 2.1 ). Adult Patients With Indications Other Than Nosocomial Pneumonia; The usual daily dosage of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, for intravenous use for adults is 3.375 g every 6 ( six ) hours.
( 2.2 ) Adult Patients with Nosocomial Pneumonia: Initial presumptive treatment of patients with nosocomial pneumonia should start with Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, for intravenous use at a dosage of 4.5 g every 6 ( six ) hours plus an aminoglycoside. (2.3 ) Adult Patients with Renal Impairment: Dosage in patients with renal impairment (creatinine clearance ≤40 mL/min) and dialysis patients should be reduced, based on the degree of renal impairment. ( 2.4 ) Pediatric Patients by Indication and Age: See Table below ( 2.5 ) Recommended Dosage of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection for Pediatric Patients 2 months of Age and Older, Weighing up to 40 Kg and With Normal Renal Function Age Appendicitis and /or Peritonitis Nosocomial Pneumonia 2 months to 9 months 90 mg/kg (80 mg piperacillin and 10 mg tazobactam) every 8 ( eight ) hours 90 mg/kg (80 mg piperacillin and 10 mg tazobactam) every 6 ( six ) hours Older than 9 months 112.5 mg/kg (100 mg piperacillin and 12.5 mg tazobactam) every 8 ( eight) hours 112.5 mg/kg (100 mg piperacillin and 12.5 mg tazobactam) every 6 ( six) hours Administer Piperacillin and Tazobactam for Injection and Sodium Chloride Injection by intravenous infusion over 30 minutes to both adult and pediatric patients 2 months of age and older.
( 2.2 , 2.3 , 2.4 , 2.5 ) Piperacillin and Tazobactam for Injection and Sodium Chloride Injection and aminoglycosides should be reconstituted and administered separately. Co-administration via Y-site can be done under certain conditions. ( 2.7 ) See the full prescribing information for the preparation and administration instructions for Piperacillin and Tazobactam for Injection and Sodium Chloride Injection single-dose DUPLEX ® Container.
2.1Important Administration Instructions If a dose of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is required that does not equal 2.25 g, 3.375 g, or 4.5 g, this product is not recommended for use and an alternative formulation of piperacillin and tazobactam for injection should be considered.
2.2Recommended Dosage in Adult Patients With Indications Other Than Nosocomial Pneumonia The usual total daily dosage of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection for adult patients with indications other than nosocomial pneumonia is 3.375 g every 6 ( six ) hours, to be administered by intravenous infusion over 30 minutes. The usual duration of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection treatment is from 7 to 10 days.
2.3Recommended Dosage in Adult Patients With Nosocomial Pneumonia Initial presumptive treatment of adult patients with nosocomial pneumonia should start with Piperacillin and Tazobactam for Injection and Sodium Chloride Injection at a dosage of 4.5 g every 6 ( six ) hours plus an aminoglycoside, administered by intravenous infusion over 30 minutes. The recommended duration of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection treatment for nosocomial pneumonia is 7 to 14 days. Treatment with the aminoglycoside should be continued in patients from whom P. aeruginosa is isolated.
2.4Recommended Dosage in Adult Patients With Renal Impairment In adult patients with renal impairment (creatinine clearance ≤ 40 mL/min) and dialysis patients (hemodialysis and CAPD), the intravenous dose of Piperacillin and Tazobactam… [Excerpted — this section continues on DailyMed.]
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS Piperacillin and Tazobactam for Injection USP and Sodium Chloride Injection USP is supplied as a white to off-white powder and a clear, colorless solution in a single-dose DUPLEX ® Container consisting of: 2.25 g Piperacillin and Tazobactam for Injection USP (2 g of piperacillin and 0.25 g of tazobactam) and 50 mL of 0.45% Sodium Chloride Injection USP. 3.375 g Piperacillin and Tazobactam for Injection USP (3 g of piperacillin and 0.375 g of tazobactam) and 50 mL of 0.3% Sodium Chloride Injection USP.
4.5g Piperacillin and Tazobactam for Injection USP (4 g of piperacillin and 0.5 g of tazobactam) and 100 mL of 0.45% Sodium Chloride Injection USP. Piperacillin and Tazobactam for Injection and Sodium Chloride Injection in a single-dose DUPLEX ® Container consisting of: 2.25 g Piperacillin and Tazobactam for Injection USP and 50 mL of 0.45% Sodium Chloride Injection USP ( 3 ) 3.375 g Piperacillin and Tazobactam for Injection USP and 50 mL of 0.3% Sodium Chloride Injection USP ( 3 ) 4.5 g Piperacillin and Tazobactam for Injection USP and 100 mL of 0.45% Sodium Chloride Injection USP ( 3 )
⛔ Contraindications ▾
4 CONTRAINDICATIONS Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is contraindicated in patients with a history of allergic reactions to any of the penicillins, cephalosporins, or betalactamase inhibitors. Patients with a history of allergic reactions to any of the penicillins, cephalosporins, or beta-lactamase inhibitors. ( 4 )
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS Serious hypersensitivity reactions (anaphylactic/anaphylactoid) reactions have been reported in patients receiving piperacillin and tazobactam. Discontinue Piperacillin and Tazobactam for Injection and Sodium Chloride Injection if a reaction occurs. ( 5.1 ) Piperacillin and tazobactam may cause severe cutaneous adverse reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, and acute generalized exanthematous pustulosis.
Discontinue Piperacillin and Tazobactam for Injection and Sodium Chloride Injection for progressive rashes. ( 5.2 ) Hemophagocytic lymphohistiocytosis (HLH) has been reported with the use of piperacillin and tazobactam. If HLH is suspected, discontinue Piperacillin and Tazobactam for Injection and Sodium Chloride Injection immediately.
( 5.3 ) Rhabdomyolysis: If signs or symptoms of rhabdomyolysis are observed, discontinue Piperacillin and Tazobactam for Injection and Sodium Chloride Injection and initiate appropriate therapy. ( 5.4 ) Hematological effects (including bleeding, leukopenia and neutropenia) have occurred. Monitor hematologic tests during prolonged therapy.
( 5.5 ) As with other penicillins, piperacillin and tazobactam may cause neuromuscular excitability or seizures. Patients receiving higher doses, especially in the presence of renal impairment may be at greater risk. Closely monitor patients with renal impairment or seizure disorders for signs and symptoms of neuromuscular excitability or seizures.
( 5.6 ) Nephrotoxicity in critically ill patients has been observed; the use of piperacillin and tazobactam was found to be an independent risk factor for renal failure and was associated with delayed recovery of renal function as compared to other beta-lactam antibacterial drugs in a randomized, multicenter, controlled trial in critically ill patients. Based on this study, alternative treatment options should be considered in the critically ill population. If alternative treatment options are inadequate or unavailable, monitor renal function during treatment with Piperacillin and Tazobactam for Injection and Sodium Chloride Injection.
( 5.7 ) High Sodium Load and Electrolyte Effects: Piperacillin and Tazobactam for Injection and Sodium Chloride Injection contains a total of 220 mg, 256 mg, 440 mg of sodium per 2.25 g, 3.375 g, and 4.5 g product, respectively. Consider an alternative formulation of piperacillin-tazobactam in patients requiring restricted sodium intake. Periodic electrolyte determinations should be performed in patients with low potassium reserves.
( 5.8 ) Clostridioides difficile -Associated Diarrhea: Evaluate patients if diarrhea occurs. ( 5.9 )
5.1Hypersensitivity Adverse Reactions Serious and occasionally fatal hypersensitivity (anaphylactic/anaphylactoid) reactions (including shock) have been reported in patients receiving therapy with piperacillin and tazobactam. These reactions are more likely to occur in individuals with a history of penicillin, cephalosporin, or carbapenem hypersensitivity or a history of sensitivity to multiple allergens. Before initiating therapy with Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, careful inquiry should be made concerning previous hypersensitivity reactions.
If an allergic reaction occurs, Piperacillin and Tazobactam for Injection and Sodium Chloride Injection should be discontinued and appropriate therapy instituted.
5.2Severe Cutaneous Adverse Reactions Piperacillin and tazobactam may cause severe cutaneous adverse reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, and acute generalized exanthematous pustulosis. If patients develop a skin rash they should be monitored closely and Piperacillin and Tazobactam for Injection and Sodium Chloride Injection discontinued if lesions progress.
5.3Hemophagocytic Lymphohistiocytosis Cases of hemopha… [Excerpted — this section continues on DailyMed.]
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS The following clinically significant adverse reactions are described elsewhere in the labeling: Hypersensitivity Adverse Reactions [see Warnings and Precautions (5.1) ] Severe Cutaneous Adverse Reactions [see Warnings and Precautions (5.2) ] Hemophagocytic Lymphohistiocytosis [see Warnings and Precautions (5.3) ] Rhabdomyolysis [see Warnings and Precautions (5.4) ] Hematologic Adverse Reactions [see Warnings and Precautions (5.5) ] Central Nervous System Adverse Reactions [see Warnings and Precautions (5.6) ] Nephrotoxicity in Critically Ill Patients [see Warnings and Precautions (5.7) ] High Sodium Load and Electrolyte Effects [see Warnings and Precautions (5.8) ] Clostridioides difficile -Associated Diarrhea [see Warnings and Precautions (5.9) ] The most common adverse reactions (incidence >5%) are diarrhea, constipation, nausea, headache, and insomnia.
( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact B. Braun Medical Inc. at 1-833-425-1464 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
6.1Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The safety of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection has been established from adequate and well-controlled studies of piperacillin and tazobactam. Below is a display of the adverse reactions of piperacillin and tazobactam in these adequate and well controlled studies.
Clinical Trials in Adult Patients During the initial clinical investigations, 2621 patients worldwide were treated with piperacillin and tazobactam in phase 3 trials. In the key North American monotherapy clinical trials (n=830 patients), 90% of the adverse events reported were mild to moderate in severity and transient in nature. However, in 3.2% of the patients treated worldwide, piperacillin and tazobactam was discontinued because of adverse events primarily involving the skin (1.3%), including rash and pruritus; the gastrointestinal system (0.9%), including diarrhea, nausea, and vomiting; and allergic reactions (0.5%).
Table 4: Adverse Reactions from Piperacillin and Tazobactam Monotherapy Clinical Trials System Organ Class Adverse Reaction Gastrointestinal disorders Diarrhea (11.3%) Constipation (7.7%) Nausea (6.9%) Vomiting (3.3%) Dyspepsia (3.3%) Abdominal pain (1.3%) General disorders and administration site conditions Fever (2.4%) Injection site reaction (≤1%) Rigors (≤1%) Immune system disorders Anaphylaxis (≤1%) Infections and infestations Candidiasis (1.6%) Pseudomembranous colitis (≤1%) Metabolism and nutrition disorders Hypoglycemia (≤1%) Musculoskeletal and connective tissue disorders Myalgia (≤1%) Arthralgia (≤1%) Nervous system disorders Headache (7.7%) Psychiatric disorders Insomnia (6.6%) Skin and subcutaneous tissue disorders Rash (4.2%, including maculopapular, bullous, and urticarial) Pruritus (3.1%) Purpura (≤1%) Vascular disorders Phlebitis (1.3%) Thrombophlebitis (≤1%) Hypotension (≤1%) Flushing (≤1%) Respiratory, thoracic and mediastinal disorders Epistaxis (≤1%) Nosocomial Pneumonia Trials Two trials of nosocomial lower respiratory tract infections were conducted.
In one study, 222 patients were treated with piperacillin and tazobactam in a dosing regimen of 4.5 g every 6 hours in combination with an aminoglycoside and 215 patients were treated with imipenem/cilastatin (500 mg/500 mg every 6 hours) in combination with an aminoglycoside. In this trial, treatment-emergent adverse events were reported by 402 patients, 204 (91.9%) in the piperacillin and tazobactam group and 198 (92.1%) in the imipenem/cilastatin group. Twenty-five (11.0%) patients in the piperacillin and tazobactam group and 14 (6.5%) in the imipenem/cilastatin group (p > 0.05) discontinued treatment due to an adverse event.
The second t… [Excerpted — this section continues on DailyMed.]
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS Piperacillin and Tazobactam for Injection and Sodium Chloride Injection administration can significantly reduce tobramycin concentrations in hemodialysis patients. Monitor tobramycin concentrations in these patients. ( 7.1 ) Probenecid prolongs the half-lives of piperacillin and tazobactam and should not be co-administered with Piperacillin and Tazobactam for Injection and Sodium Chloride Injection unless the benefit outweighs the risk.
( 7.2 ) Co-administration of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection with vancomycin may increase the incidence of acute kidney injury. Monitor kidney function in patients receiving Piperacillin and Tazobactam for Injection and Sodium Chloride Injection and vancomycin. ( 7.3 ) Monitor coagulation parameters in patients receiving Piperacillin and Tazobactam for Injection and Sodium Chloride Injection and heparin or oral anticoagulants.
( 7.4 ) Piperacillin and Tazobactam for Injection and Sodium Chloride Injection may prolong the neuromuscular blockade of vecuronium and other non-depolarizing neuromuscular blockers. Monitor for adverse reactions related to neuromuscular blockade. ( 7.5 )
7.1Aminoglycosides Piperacillin may inactivate aminoglycosides by converting them to microbiologically inert amides. In vivo inactivation : When aminoglycosides are administered in conjunction with piperacillin to patients with end-stage renal disease requiring hemodialysis, the concentrations of the aminoglycosides (especially tobramycin) may be significantly reduced and should be monitored. Sequential administration of piperacillin and tazobactam and tobramycin to patients with either normal renal function or mild to moderate renal impairment has been shown to modestly decrease serum concentrations of tobramycin but no dosage adjustment is considered necessary.
In vitro inactivation : Due to the in vitro inactivation of aminoglycosides by piperacillin, piperacillin and tazobactam and aminoglycosides are recommended for separate administration. Piperacillin and Tazobactam for Injection and Sodium Chloride Injection and aminoglycosides should be reconstituted, and administered separately when concomitant therapy with aminoglycosides is indicated. Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, which contains EDTA, is compatible with amikacin and gentamicin for simultaneous Y-site infusion in certain diluents and at specific concentrations.
Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is not compatible with tobramycin for simultaneous Y-site infusion [see Dosage and Administration (2.7) ].
7.2Probenecid Probenecid administered concomitantly with Piperacillin and Tazobactam for Injection and Sodium Chloride Injection prolongs the half-life of piperacillin by 21% and that of tazobactam by 71% because probenecid inhibits tubular renal secretion of both piperacillin and tazobactam. Probenecid should not be co-administered with Piperacillin and Tazobactam for Injection and Sodium Chloride Injection unless the benefit outweighs the risk.
7.3Vancomycin Studies have detected an increased incidence of acute kidney injury in patients concomitantly administered piperacillin and tazobactam and vancomycin as compared to vancomycin alone [see Warnings and Precautions (5.7) ]. Monitor kidney function in patients concomitantly administered with Piperacillin and Tazobactam for Injection and Sodium Chloride Injection and vancomycin. No pharmacokinetic interactions have been noted between piperacillin and tazobactam and vancomycin.
7.4Anticoagulants Coagulation parameters should be tested more frequently and monitored regularly during simultaneous administration of high doses of heparin, oral anticoagulants, or other drugs that may affect the blood coagulation system or the thrombocyte function [see Warnings and Precautions (5.5) ].
7.5Vecuronium Piperacillin when used concomitantly with vecuronium has been implicated in the… [Excerpted — this section continues on DailyMed.]
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS Dosage in patients with renal impairment (creatinine clearance ≤40 mL/min) should be reduced based on the degree of renal impairment. ( 2.4 , 8.6 )
8.1Pregnancy Risk Summary Piperacillin and tazobactam cross the placenta in humans. However, there are insufficient data with piperacillin and/or tazobactam in pregnant women to inform a drug-associated risk for major birth defects and miscarriage. No fetal structural abnormalities were observed in rats or mice when piperacillin and tazobactam was administered intravenously during organogenesis at doses 1 to 2 times and 2 to 3 times the human dose of piperacillin and tazobactam, respectively, based on body-surface area (mg/m 2 ).
However, fetotoxicity in the presence of maternal toxicity was observed in developmental toxicity and peri/postnatal studies conducted in rats (intraperitoneal administration prior to mating and throughout gestation or from gestation day 17 through lactation day 21) at doses less than the maximum recommended human daily dose based on body-surface area (mg/m 2 ) (see Data). The background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Data Animal Data In embryo-fetal development studies in mice and rats, pregnant animals received intravenous doses of piperacillin and tazobactam up to 3000/750 mg/kg/day during the period of organogenesis. There was no evidence of teratogenicity up to the highest dose evaluated, which is 1 to 2 times and 2 to 3 times the human dose of piperacillin and tazobactam, in mice and rats respectively, based on body-surface area (mg/m 2 ). Fetal body weights were reduced in rats at maternally toxic doses at or above 500/62.5 mg/kg/day, minimally representing 0.4 times the human dose of both piperacillin and tazobactam based on body-surface area (mg/m 2 ).
A fertility and general reproduction study in rats using intraperitoneal administration of tazobactam or the combination piperacillin and tazobactam prior to mating and through the end of gestation, reported a decrease in litter size in the presence of maternal toxicity at 640 mg/kg/day tazobactam (4 times the human dose of tazobactam based on body-surface area), and decreased litter size and an increase in fetuses with ossification delays and variations of ribs, concurrent with maternal toxicity at ≥640/160 mg/kg/day piperacillin and tazobactam (0.5 times and 1 times the human dose of piperacillin and tazobactam, respectively, based on body-surface area).
Peri/postnatal development in rats was impaired with reduced pup weights, increased stillbirths, and increased pup mortality concurrent with maternal toxicity after intraperitoneal administration of tazobactam alone at doses ≥320 mg/kg/day (2 times the human dose based on body surface area) or of the combination piperacillin and tazobactam at doses ≥640/160 mg/kg/day (0.5 times and 1 times the human dose of piperacillin and tazobactam, respectively, based on body-surface area) from gestation day 17 through lactation day 21.
8.2Lactation Risk Summary Piperacillin is excreted in human milk; tazobactam concentrations in human milk have not been studied. No information is available on the effects of piperacillin and tazobactam on the breast- fed child or on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Piperacillin and Tazobactam for Injection and Sodium Chloride Injection and any potential adverse effects on the breast-fed child from Piperacillin and Tazobactam for Injection and Sodium Chloride Injection or from the underlying maternal condition.
8.4Pediatric Use The safety and effectiveness of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection for intra-abdominal infections, and no… [Excerpted — this section continues on DailyMed.]
🤰 Pregnancy ▾
8.1Pregnancy Risk Summary Piperacillin and tazobactam cross the placenta in humans. However, there are insufficient data with piperacillin and/or tazobactam in pregnant women to inform a drug-associated risk for major birth defects and miscarriage. No fetal structural abnormalities were observed in rats or mice when piperacillin and tazobactam was administered intravenously during organogenesis at doses 1 to 2 times and 2 to 3 times the human dose of piperacillin and tazobactam, respectively, based on body-surface area (mg/m 2 ).
However, fetotoxicity in the presence of maternal toxicity was observed in developmental toxicity and peri/postnatal studies conducted in rats (intraperitoneal administration prior to mating and throughout gestation or from gestation day 17 through lactation day 21) at doses less than the maximum recommended human daily dose based on body-surface area (mg/m 2 ) (see Data). The background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Data Animal Data In embryo-fetal development studies in mice and rats, pregnant animals received intravenous doses of piperacillin and tazobactam up to 3000/750 mg/kg/day during the period of organogenesis. There was no evidence of teratogenicity up to the highest dose evaluated, which is 1 to 2 times and 2 to 3 times the human dose of piperacillin and tazobactam, in mice and rats respectively, based on body-surface area (mg/m 2 ). Fetal body weights were reduced in rats at maternally toxic doses at or above 500/62.5 mg/kg/day, minimally representing 0.4 times the human dose of both piperacillin and tazobactam based on body-surface area (mg/m 2 ).
A fertility and general reproduction study in rats using intraperitoneal administration of tazobactam or the combination piperacillin and tazobactam prior to mating and through the end of gestation, reported a decrease in litter size in the presence of maternal toxicity at 640 mg/kg/day tazobactam (4 times the human dose of tazobactam based on body-surface area), and decreased litter size and an increase in fetuses with ossification delays and variations of ribs, concurrent with maternal toxicity at ≥640/160 mg/kg/day piperacillin and tazobactam (0.5 times and 1 times the human dose of piperacillin and tazobactam, respectively, based on body-surface area).
Peri/postnatal development in rats was impaired with reduced pup weights, increased stillbirths, and increased pup mortality concurrent with maternal toxicity after intraperitoneal administration of tazobactam alone at doses ≥320 mg/kg/day (2 times the human dose based on body surface area) or of the combination piperacillin and tazobactam at doses ≥640/160 mg/kg/day (0.5 times and 1 times the human dose of piperacillin and tazobactam, respectively, based on body-surface area) from gestation day 17 through lactation day 21.
🧒 Pediatric Use ▾
8.4Pediatric Use The safety and effectiveness of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection for intra-abdominal infections, and nosocomial pneumonia have been established in pediatric patients 2 months of age and older. Use of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection in pediatric patients 2 months of age and older with intra-abdominal infections including appendicitis and/or peritonitis is supported by evidence from well-controlled studies and pharmacokinetic studies in adults and in pediatric patients.
This includes a prospective, randomized, comparative, open-label clinical trial with 542 pediatric patients 2 to 12 years of age with intra-abdominal infections (including appendicitis (complicated by rupture or abscess) and/or peritonitis), in which 273 pediatric patients received piperacillin and tazobactam [see Adverse Reactions (6.1) and Clinical Pharmacology (12.3) ]. Use of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection in pediatric patients 2 months of age and older with nosocomial pneumonia is supported by evidence from well-controlled studies in adults with nosocomial pneumonia, a simulation study performed with a population pharmacokinetic model, and a retrospective, cohort study of pediatric patients with nosocomial pneumonia in which 140 pediatric patients were treated with Piperacillin and Tazobactam for Injection and 267 patients treated with comparators (which included ticarcillinclavulanate, carbapenems, ceftazidime, cefepime, or ciprofloxacin) [see Adverse Reactions (6.1) and Clinical Pharmacology (12.3) ].
Because of the limitations of the available strengths and administration requirements (i.e., administration of fractional doses is not recommended) of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, and to avoid unintentional overdose, this product is not recommended for use if a dose of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, that does not equal 2.25 g, 3.375 g, or 4.5 g is required, and an alternative formulation of piperacillin and tazobactam for injection should be considered [see Dosage and Administration (2.5) ].
The safety and effectiveness of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection have not been established in pediatric patients less than 2 months of age [see Clinical Pharmacology (12) and Dosage and Administration (2) ]. Dosage of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection in pediatric patients with renal impairment has not been determined.
🧓 Geriatric Use ▾
8.5Geriatric Use Patients over 65 years are not at an increased risk of developing adverse effects solely because of age. However, dosage should be adjusted in the presence of renal impairment [see Dosage and Administration (2) ]. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Piperacillin and Tazobactam for Injection and Sodium Chloride Injection contains a total of 220 mg, 256 mg, 440 mg of sodium per 2.25 g, 3.375 g, and 4.5 g product, respectively. At the usual recommended doses, patients would receive between 1,320 and 1,760 mg/day of sodium. The geriatric population may respond with a blunted natriuresis to salt loading.
This may be clinically important with regard to such diseases as congestive heart failure [see Warnings and Precautions (5.8) ]. This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function [see Warnings and Precautions (5.7) ].
🆘 Overdosage ▾
10 OVERDOSAGE There have been postmarketing reports of overdose with piperacillin and tazobactam. The majority of those events experienced, including nausea, vomiting, and diarrhea, have also been reported with the usual recommended dosages. Patients may experience neuromuscular excitability or seizures if higher than recommended doses are given intravenously (particularly in the presence of renal failure) [see Warnings and Precautions (5.6) ].
Treatment should be supportive and symptomatic according to the patient's clinical presentation. Excessive serum concentrations of either piperacillin or tazobactam may be reduced by hemodialysis. Following a single 3.375 g dose of piperacillin and tazobactam, the percentage of the piperacillin and tazobactam dose removed by hemodialysis was approximately 31% and 39%, respectively [see Clinical Pharmacology (12) ].
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is an antibacterial drug [see Microbiology (12.4) ].
12.2Pharmacodynamics The pharmacodynamic parameter for piperacillin and tazobactam that is most predictive of clinical and microbiological efficacy is time above MIC.
12.3Pharmacokinetics The mean and coefficients of variation (CV%) for the pharmacokinetic parameters of piperacillin and tazobactam after multiple intravenous doses are summarized in Table 6. C max : maximum observed concentration, AUC: Area under the curve, CL=clearance, CL R = Renal clearance V=volume of distribution, T 1/2 = elimination half-life Table 6: Mean (CV%) Piperacillin and Tazobactam PK Parameters Piperacillin Piperacillin and Tazobactam Dose Piperacillin and tazobactam were given in combination, infused over 30 minutes.
C max (mcg/mL) AUC Numbers in []parentheses are coefficients of variation [CV%]. (mcg∙h/mL) CL (mL/min) V (L) T 1/2 (h) CL R (mL/min) 2.25 g 134 131 [14] 257 17.4 0.79 -- 3.375 g 242 242 [10] 207 15.1 0.84 140 4.5 g 298 322 [16] 210 15.4 0.84 -- Tazobactam Piperacillin and Tazobactam Dose C max (mcg/mL) AUC (mcg∙h/mL) CL (mL/min) V (L) T 1/2 (h) CL R (mL/min) 2.25 g 15 16.0 [21] 258 17.0 0.77 -- 3.375 g 24 25.0 [8] 251 14.8 0.68 166 4.5 g 34 39.8 [15] 206 14.7 0.82 -- Peak plasma concentrations of piperacillin and tazobactam are attained immediately after completion of an intravenous infusion of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection.
Piperacillin plasma concentrations, following a 30-minute infusion of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, were similar to those attained when equivalent doses of piperacillin were administered alone. Steady-state plasma concentrations of piperacillin and tazobactam were similar to those attained after the first dose due to the short half-lives of piperacillin and tazobactam. Distribution Both piperacillin and tazobactam are approximately 30% bound to plasma proteins.
The protein binding of either piperacillin or tazobactam is unaffected by the presence of the other compound. Protein binding of the tazobactam metabolite is negligible. Piperacillin and tazobactam are widely distributed into tissues and body fluids including intestinal mucosa, gallbladder, lung, female reproductive tissues (uterus, ovary, and fallopian tube), interstitial fluid, and bile.
Mean tissue concentrations are generally 50% to 100% of those in plasma. Distribution of piperacillin and tazobactam into cerebrospinal fluid is low in subjects with non-inflamed meninges, as with other penicillins (see Table 7). Table 7: Piperacillin and Tazobactam Concentrations in Selected Tissues and Fluids after Single 4 g/0.5 g 30-min Intravenous Infusion of Piperacillin and Tazobactam Tissue or Fluid N Each subject provided a single sample.
Sampling period Time from the start of the infusion (h) Mean PIP Concentration Range (mg/L) Tissue:Plasma Range Tazo Concentration Range (mg/L) Tazo Tissue:Plasma Range Skin 35 0.5 – 4.5 34.8 – 94.2 0.60 – 1.1 4.0 – 7.7 0.49 –
0.93Fatty Tissue 37 0.5 – 4.5 4.0 – 10.1 0.097 – 0.115 0.7 – 1.5 0.10 –
0.13Muscle 36 0.5 – 4.5 9.4 – 23.3 0.29 – 0.18 1.4 – 2.7 0.18 –
0.30Proximal Intestinal Mucosa 7 1.5 – 2.5 31.4 0.55 10.3
1.15Distal Intestinal Mucosa 7 1.5 – 2.5 31.2 0.59 14.5
2.1Appendix 22 0.5 – 2.5 26.5 – 64.1 0.43 – 0.53 9.1 – 18.6 0.80 –
1.35Elimination Metabolism Piperacillin is metabolized to a minor microbiologically active desethyl metabolite. Tazobactam is metabolized to a single metabolite that lacks pharmacological and antibacterial activities. Excretion Following single or multiple Piperacillin and Tazobactam for Injection and Sodium Chloride Injection doses to healthy subjects, the plasma half-life of piperacillin and of tazobactam ranged from 0.7 to 1.2 hours and was unaffected by dose or duration of infusion.
Both piperacillin and tazobactam are elimina… [Excerpted — this section continues on DailyMed.]
🧬 Mechanism of Action ▾
12.1Mechanism of Action Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is an antibacterial drug [see Microbiology (12.4) ].
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING Piperacillin and Tazobactam for Injection USP and Sodium Chloride Injection USP is a white to off-white powder and a clear, colorless solution supplied in a single-dose DUPLEX ® Container (packaged 24 single-dose units per case) in the following strengths described in Table 8 below: Table 8: Strengths, Volume of Diluent, National Drug Code (NDC), Total Sodium for Piperacillin and Tazobactam for Injection and Sodium Chloride Injection Strength (piperacillin and tazobactam) Piperacillin Tazobactam Volume of Diluent NDC Total Sodium REF 2.25 g 2 g 0.25 g 50 mL of 0.45% Sodium Chloride 0264- 3446-11 9.6 mEq (220 mg) 3446-11 3.375 g 3 g 0.375 g 50 mL of 0.3% Sodium Chloride 0264- 3448-11 11.1 mEq (256 mg) 3448-11 4.5 g 4 g 0.5 g 100 mL of 0.45% Sodium Chloride 0264- 3450-22 19.1 mEq (440 mg) 3450-22 Prior to reconstitution, store Piperacillin and Tazobactam for Injection USP and Sodium Chloride Injection USP at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). [See USP Controlled Room Temperature.] Do not remove the foil strip until ready to use to protect from light.
After removal of the foil strip, product must be used within 7 days, but not beyond the labeled expiration date. Protect from light after removal of foil strip. Storage conditions for reconstituted Piperacillin and Tazobactam for Injection are described in another section of labeling [see Dosage and Administration (2.5) ].
Do not freeze.
📋 Description ▾
11 DESCRIPTION Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is an injectable antibacterial combination product consisting of the semisynthetic antibacterial piperacillin sodium and the beta-lactamase inhibitor tazobactam sodium for intravenous administration. Piperacillin sodium is derived from D(-)-α-aminobenzyl-penicillin. The chemical name of piperacillin sodium is sodium (2 S ,5 R ,6 R )-6-[( R )-2-(4-ethyl-2,3-dioxo-1-piperazine-carboxamido)-2-phenylacetamido]-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylate.
The chemical formula is C 23 H 26 N 5 NaO 7 S and the molecular weight is 539.5. The chemical structure of piperacillin sodium is: Tazobactam sodium, a derivative of the penicillin nucleus, is a penicillanic acid sulfone. Its chemical name is sodium (2 S, 3 S, 5 R )-3-methyl-7-oxo-3-(1 H -1,2,3-triazol-1-ylmethyl)-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylate-4,4-dioxide.
The chemical formula is C 10 H 11 N 4 NaO 5 S and the molecular weight is 322.3. The chemical structure of tazobactam sodium is: Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is supplied as a sterile powder for injection and a sterile solution in a single-dose DUPLEX ® Container with a strength of 2.25 g, 3.375 g, or 4.5 g in the following presentations: 2.25 g: contains 2 grams of piperacillin (equivalent to 2.085 g of piperacillin sodium), 0.25 g of tazobactam (equivalent to 0.269 g of tazobactam sodium), 0.5 mg of edetate sodium dihydrate (EDTA), and 100 mg of sodium citrate dihydrate in the powder chamber.
The diluent chamber contains 225 mg of sodium chloride and 50 mL of water for injection. 3.375 g: contains 3 grams of piperacillin (equivalent to 3.127 g of piperacillin sodium) and 0.375 g of tazobactam (equivalent to 0.402 g of tazobactam sodium), 0.75 mg of EDTA, and 150 mg of sodium citrate dihydrate in the powder chamber. The diluent chamber contains 150 mg of sodium chloride and 50 mL of water for injection.
4.5g: contains 4 grams of piperacillin (equivalent to 4.170 g of piperacillin sodium), 0.5 g of tazobactam (equivalent to 0.538 g of tazobactam sodium), 1 mg of EDTA, and 200 mg of sodium citrate dihydrate. The diluent chamber contains 450 mg of sodium chloride and 100 mL of water for injection. Piperacillin and Tazobactam for Injection and Sodium Chloride Injection contains a total of 9.6 mEq (220 mg), 11.1 mEq (256 mg), and 19.1 mEq (440 mg) of sodium (Na+) per 2.25 g, 3.375 g, and 4.5 g product, respectively [see Warnings and Precautions (5.8) and Use in Specific Populations (8.5) ] .
The reconstituted solution has a pH between 5.0 and 7.0. The osmolality of the reconstituted solution of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is approximately 318 mOsmol/kg for the 2.25 g strength, approximately 348 mOsmol/kg for the 3.375 g strength, and approximately 318 mOsmol/kg for the 4.5 g strength. Piperacillin and Tazobactam for Injection and Sodium Chloride Injection Meets USP Monograph Organic Impurities Procedure 3.
The DUPLEX ® Container is a flexible dual chamber container. After removing the peelable foil strip, activating the seals, and thoroughly mixing, the reconstituted drug product is hyperosmotic and is intended for single intravenous use. The product (diluent and drug) contact layer is a mixture of thermoplastic rubber and a polypropylene copolymer that contains no plasticizers.
Not made with natural rubber latex, PVC or Di(2-ethylhexyl)phthalate (DEHP). Chemical Structure illustration of piperacillin sodium Chemical structure illustration of tazobactam sodium
💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION Serious Hypersensitivity Reactions Advise patients, their families, or caregivers that serious hypersensitivity reactions, including serious allergic cutaneous reactions, could occur with use of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection that require immediate treatment. Ask them about any previous hypersensitivity reactions to Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, other beta-lactams (including cephalosporins), or other allergens [see Warnings and Precautions (5.2) ].
Hemophagocytic Lymphohistiocytosis Prior to initiation of treatment with Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, inform patients that excessive immune activation may occur with Piperacillin and Tazobactam for Injection and Sodium Chloride Injection and that they should report signs or symptoms such as fever, rash, or lymphadenopathy to a healthcare provider immediately [see Warnings and Precautions (5.3) ]. High Sodium Load Piperacillin and Tazobactam for Injection and Sodium Chloride Injection contains a high sodium load.
Instruct patients to inform their healthcare provider if they develop symptoms of difficulty breathing, swelling, or increased weight [see Warnings and Precautions (5.8) ]. Diarrhea Advise patients, their families, or caregivers that diarrhea is a common problem caused by antibacterial drugs, including Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, which usually ends when the drug is discontinued. Sometimes after starting treatment with antibacterial drugs, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the drug.
If this occurs, patients should contact their physician as soon as possible [see Warnings and Precautions (5.9) ]. Antibacterial Resistance Patients should be counseled that antibacterial drugs including Piperacillin and Tazobactam for Injection and Sodium Chloride Injection should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold).
When Piperacillin and Tazobactam for Injection and Sodium Chloride Injection is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Piperacillin and Tazobactam for Injection and Sodium Chloride Injection or other antibacterial drugs in the future.
Pregnancy and Lactation Patients should be counseled that Piperacillin and Tazobactam for Injection and Sodium Chloride Injection can cross the placenta in humans and is excreted in human milk [see Use in Specific Populations ( 8.1 , 8.2 )].
🧬 Pharmacokinetics ▾
12.3Pharmacokinetics The mean and coefficients of variation (CV%) for the pharmacokinetic parameters of piperacillin and tazobactam after multiple intravenous doses are summarized in Table 6. C max : maximum observed concentration, AUC: Area under the curve, CL=clearance, CL R = Renal clearance V=volume of distribution, T 1/2 = elimination half-life Table 6: Mean (CV%) Piperacillin and Tazobactam PK Parameters Piperacillin Piperacillin and Tazobactam Dose Piperacillin and tazobactam were given in combination, infused over 30 minutes.
C max (mcg/mL) AUC Numbers in []parentheses are coefficients of variation [CV%]. (mcg∙h/mL) CL (mL/min) V (L) T 1/2 (h) CL R (mL/min) 2.25 g 134 131 [14] 257 17.4 0.79 -- 3.375 g 242 242 [10] 207 15.1 0.84 140 4.5 g 298 322 [16] 210 15.4 0.84 -- Tazobactam Piperacillin and Tazobactam Dose C max (mcg/mL) AUC (mcg∙h/mL) CL (mL/min) V (L) T 1/2 (h) CL R (mL/min) 2.25 g 15 16.0 [21] 258 17.0 0.77 -- 3.375 g 24 25.0 [8] 251 14.8 0.68 166 4.5 g 34 39.8 [15] 206 14.7 0.82 -- Peak plasma concentrations of piperacillin and tazobactam are attained immediately after completion of an intravenous infusion of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection.
Piperacillin plasma concentrations, following a 30-minute infusion of Piperacillin and Tazobactam for Injection and Sodium Chloride Injection, were similar to those attained when equivalent doses of piperacillin were administered alone. Steady-state plasma concentrations of piperacillin and tazobactam were similar to those attained after the first dose due to the short half-lives of piperacillin and tazobactam. Distribution Both piperacillin and tazobactam are approximately 30% bound to plasma proteins.
The protein binding of either piperacillin or tazobactam is unaffected by the presence of the other compound. Protein binding of the tazobactam metabolite is negligible. Piperacillin and tazobactam are widely distributed into tissues and body fluids including intestinal mucosa, gallbladder, lung, female reproductive tissues (uterus, ovary, and fallopian tube), interstitial fluid, and bile.
Mean tissue concentrations are generally 50% to 100% of those in plasma. Distribution of piperacillin and tazobactam into cerebrospinal fluid is low in subjects with non-inflamed meninges, as with other penicillins (see Table 7). Table 7: Piperacillin and Tazobactam Concentrations in Selected Tissues and Fluids after Single 4 g/0.5 g 30-min Intravenous Infusion of Piperacillin and Tazobactam Tissue or Fluid N Each subject provided a single sample.
Sampling period Time from the start of the infusion (h) Mean PIP Concentration Range (mg/L) Tissue:Plasma Range Tazo Concentration Range (mg/L) Tazo Tissue:Plasma Range Skin 35 0.5 – 4.5 34.8 – 94.2 0.60 – 1.1 4.0 – 7.7 0.49 –
0.93Fatty Tissue 37 0.5 – 4.5 4.0 – 10.1 0.097 – 0.115 0.7 – 1.5 0.10 –
0.13Muscle 36 0.5 – 4.5 9.4 – 23.3 0.29 – 0.18 1.4 – 2.7 0.18 –
0.30Proximal Intestinal Mucosa 7 1.5 – 2.5 31.4 0.55 10.3
1.15Distal Intestinal Mucosa 7 1.5 – 2.5 31.2 0.59 14.5
2.1Appendix 22 0.5 – 2.5 26.5 – 64.1 0.43 – 0.53 9.1 – 18.6 0.80 –
1.35Elimination Metabolism Piperacillin is metabolized to a minor microbiologically active desethyl metabolite. Tazobactam is metabolized to a single metabolite that lacks pharmacological and antibacterial activities. Excretion Following single or multiple Piperacillin and Tazobactam for Injection and Sodium Chloride Injection doses to healthy subjects, the plasma half-life of piperacillin and of tazobactam ranged from 0.7 to 1.2 hours and was unaffected by dose or duration of infusion.
Both piperacillin and tazobactam are eliminated via the kidney by glomerular filtration and tubular secretion. Piperacillin is excreted rapidly as unchanged drug with 68% of the administered dose excreted in the urine. Tazobactam and its metabolite are eliminated primarily by renal excretion with 80% of the administered dose excreted as unchanged drug and the remainder as the single m… [Excerpted — this section continues on DailyMed.]
🧬 Pharmacodynamics ▾
12.2Pharmacodynamics The pharmacodynamic parameter for piperacillin and tazobactam that is most predictive of clinical and microbiological efficacy is time above MIC.
🧪 Nonclinical Toxicology ▾
13 NONCLINICAL TOXICOLOGY
13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenesis Long-term carcinogenicity studies in animals have not been conducted with piperacillin and/or tazobactam. Mutagenesis Piperacillin and tazobactam were negative in microbial mutagenicity assays, the unscheduled DNA synthesis (UDS) test, a mammalian point mutation (Chinese hamster ovary cell HPRT) assay, and a mammalian cell (BALB/c-3T3) transformation assay. In vivo , piperacillin and tazobactam did not induce chromosomal aberrations in rats.
Fertility Reproduction studies have been performed in rats and have revealed no evidence of impaired fertility when piperacillin and tazobactam is administered intravenously up to a dose of 1280/320 mg/kg piperacillin and tazobactam, which is similar to the maximum recommended human daily dose based on body-surface area (mg/m 2 ).
📄 Carcinogenesis, Mutagenesis, Impairment of Fertility ▾
13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenesis Long-term carcinogenicity studies in animals have not been conducted with piperacillin and/or tazobactam. Mutagenesis Piperacillin and tazobactam were negative in microbial mutagenicity assays, the unscheduled DNA synthesis (UDS) test, a mammalian point mutation (Chinese hamster ovary cell HPRT) assay, and a mammalian cell (BALB/c-3T3) transformation assay. In vivo , piperacillin and tazobactam did not induce chromosomal aberrations in rats.
Fertility Reproduction studies have been performed in rats and have revealed no evidence of impaired fertility when piperacillin and tazobactam is administered intravenously up to a dose of 1280/320 mg/kg piperacillin and tazobactam, which is similar to the maximum recommended human daily dose based on body-surface area (mg/m 2 ).
📚 References ▾
15 REFERENCES Jensen J-US, Hein L, Lundgren B, et al. BMJ Open 2012; 2:e000635. doi:10.1136.
📄 Package Label / Principal Display Panel ▾
PRINCIPAL DISPLAY PANEL – 2.25 g Container Piperacillin and Tazobactam for Injection USP and Sodium Chloride Injection USP 2.25 g* 50 mL NDC 0264-3446-11 DUPLEX ® CONTAINER U SE ONLY AFTER MIXING CONTENTS OF BOTH CHAMBERS. FOR INTRAVENOUS INFUSION. SINGLE-DOSE * Each dry powder chamber provides 2 g piperacillin (equivalent to 2.085 g of piperacillin sodium), 0.25 g tazobactam (equivalent to 0.268 g of tazobactam sodium), 0.5 mg of edetate disodium dihydrate, and 100 mg of sodium citrate dihydrate.
Contains no preservative. After reconstitution each 50 mL single-dose DUPLEX ® unit contains Piperacillin and Tazobactam for Injection (equivalent to 2 g of piperacillin and 0.25 g of tazobactam) and 50 mL of 0.45% sodium chloride injection. Total sodium content of 220 mg (9.6 mEq).
Approximate osmolality: 318 mOsmol/kg. Dosage: see Prescribing Information. Prior to Reconstitution: Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). [See USP Controlled Room Temperature.] Use only if container and seals are intact.
Do not peel foil strip until ready for use in order to protect from light. After foil strip removal, product must be used within 7 days, but not beyond the labeled expiration date. Protect from light after removal of foil strip.
Reconstitute Prior to Administration: Hold container with set port in a downward direction and fold the diluent chamber just below the solution meniscus. To activate seal, squeeze folded diluent chamber until seal between diluent and drug chamber opens, releasing diluent into drug chamber. Agitate the reconstituted solution until the drug powder is completely dissolved.
Fold the container a second time and squeeze until seal between drug chamber and set port opens. After Reconstitution: Use only if prepared solution is clear and free from particulate matter. Use within 24 hours if stored at room temperature or within 7 days if stored under refrigeration.
Do not use in a series connection. Do not introduce additives into this container. Prior to administration check for minute leaks by squeezing container firmly.
If leaks are found, discard container and solution as sterility may be impaired. Do not freeze. Discard unused portion.
Not made with natural rubber latex, PVC or DEHP. REF 3446-11 Rx only Manufactured for: B. Braun Medical Inc.
Exp : Lot No: NDC No. (01)10302643446113 Prepared in Italy. API from Italy.
Y37-002-612 LD-804-2 F50000403335 PEEL HERE Drug Chamber Discard unit if foil strip is damaged. Peel foil strip only when ready for use. Visually inspect drug prior to reconstitution.
See package insert for complete directions for reconstitution and administration. LD-617-1 X27-001-488 3446-11 Container Label 50 mL Drug Chamber Label
PRINCIPAL DISPLAY PANEL – 3.375 g Container Piperacillin and Tazobactam for Injection USP and Sodium Chloride Injection USP 3.375 g* 50 mL NDC 0264-3448-11 DUPLEX ® CONTAINER USE ONLY AFTER MIXING CONTENTS OF BOTH CHAMBERS. FOR INTRAVENOUS INFUSION. SINGLE-DOSE * Each dry powder chamber provides 3 g piperacillin (equivalent to 3.127 g of piperacillin sodium), 0.375 g tazobactam (equivalent to 0.402 g of tazobactam sodium), 0.75 mg of edetate disodium dihydrate, and 150 mg of sodium citrate dihydrate.
Contains no preservative. After reconstitution each 50 mL single-dose DUPLEX ® unit contains Piperacillin and Tazobactam for Injection (equivalent to 3 g of piperacillin and 0.375 g of tazobactam) and 50 mL of 0.3% sodium chloride injection. Total sodium content of 256 mg (11.1 mEq).
Approximate osmolality: 348 mOsmol/kg. Dosage: see Prescribing Information. Prior to Reconstitution: Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). [See USP Controlled Room Temperature.] Use only if container and seals are intact.
Do not peel foil strip until ready for use in order to protect from light. After foil strip removal, product must be used within 7 days, but not beyond the labeled expiration da… [Excerpted — this section continues on DailyMed.]
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