Piperacillin-tazobactam Stability after dilution

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    • #48632

      Tobias Jenkins

      I would like to clarify from the experts on the beyond use date of Piperacillin Tazobactam once diluted. many references such as the micromedex and Global Rph give the BUD as 7 days (2-4 C).
      [When further diluted in a compatible intravenous solution (0.9% Sodium Chloride, 5% Dextrose, 6% Dextran in Saline), chemical stability has been demonstrated for up to 24 hours at room temperature and up to one week at refrigerator temperatures – Micromedex]

      But some official sources still mention it as 48 hours only (eg.: https://www.ema.europa.eu/en/documents/referral/tazocin-article-30-referral-annex-iii_en.pdf)

      Are there differences in this according to the product (brand) Used?
      we are presently using Tazocin from Wyeth.
    • #48636

      Mariah Nelson

      I have to give an extended answer because it would be both a YES and a NO in this case and also be dependent on the specific brand or generic the study is performed with, and the regulatory environment where you operate. I hope I can provide you enough direction to help support the longer dating I am giving you in the stability study. 

      BUD = beyond use date (relates to microbial growth risk)
      Stability = based on the physical and chemical characteristics
      PACKAGE INSERTS: these are often never updated after marketing of the product, and many times I have experienced the stability as listed to be short, or very commonly “6 hours” which sounds a lot like a USP 797 single dose vial BUD.  I have also seen very specific language in package inserts that read “stability was demonstrated to 24 hours” which (to me) means they only conducted a 24 hour study, and would have been beneficial if they kept it going for 48, 72, 96 hours or longer.  I have also seen many without any stability recommendations other than to “use immediately”.
      POST MARKETING STUDIES: as is the case with many drugs, there are post marketing studies, and you have to choose wisely what you will use in your review to settle on an appropriate stability for your organization.  Many times these post marketing studies are very helpful and are found in the resources by Trissel and references in many other tertiary references such as Lexi-Comp, Micromedex, GlobalRPh, etc.  Sometimes the study does not mach your preparation and you have to avoid using it.
      PIPERACILLIN-TAZOSIN SPECIFICS: in the market there exists many generics and the brands ZOSYN and TAZOSYN, both are piparazillin-tazobactam but in this specific drug combination there are some differences across generics, most importantly is the inclusion of the excipient EDTA which is acting as a stabilizer in that it helps the drug be compatible with calcium containing solutions. If the formula does NOT contain EDTA then it will NOT be compatible with lactated ringers.  In your package insert provided I can see it does contain EDTA and is also the branded TAZOSYN.  I was able to find a stability study (attached) for you with very good stability results using TAZOSYN and by the some company that you are using, and this stability is also recognized in the major references as well (so it is not an outlier).  The study used HPLC at multiple time points in different solutions and concentrations, and also reviewed other solution characteristics including color and pH. TAZOSYN was stable 28 days refrigerated (protected from light) and 72 hours room temperature (exposed to light). But remember USP 797 BUD limits of 30 hours room temp and 9 days refrigerated if batching under medium risk USP 797 v2008.  If this was USP 797 v2019 then you cannot get the max 4 days room temp as that is longer than stability 72 hours, but you could use 10 days refrigerated. USP 797 v2019 was suspended for specific reasons that did not include these BUDs and I have seen multiple places already implement them.  
      MANUFACTURER vs STABILITY STUDY (regulatory issues): these are often tricky to reconcile depending the area and attitudes of the regulators.  I like to say “the drug is the drug is the drug” and (baring any major excipients) that is true.  Manufacturers often spend a lot more time on clinical data and there is not much attention paid to stability studies, until scientists follow up with them later. It will depend on your regulatory agencies and inspectors of course, but if they are accepting of USP standards, principles of establishing expiration dates, and understanding extended stability studies, then you have what you need.  You should always be reviewing the studies and having them on file to show evidence of your review.  Document everything in your master formula with the references and this should be enough to use the stability longer compared to the labeling of the manufacturer.  

    • #48639

      Regarding your question about piperacillin/tazobactam BUD after reconstitution, first i think BUD is not the most accurate term to use we can say as its shelf life or stability after reconstitution as like Mariah demonstrated BUD is more related to microbial growth rather than the chemical and physical stability of the drug.
      Best in this case i guess to get back to the leaflet of each specific product as based on each company test about their own product, even if general recommendations gave other extended time, it’s rather to use the product specific consideration when available
      In the attachments you will find FDA specific leaflet for ZOSYN which states “ Discard unused portion after 24 hours if stored at room temperature (20°C to 25°C [68°F to 77°F]), or after 48 hours if stored at refrigerated temperature (2°C to 8°C [36°F to 46°F]).” Page 5 of the attachment.
      There’s another package leaflet at https://www.medicines.org.uk/emc/files/pil.1267.pdf that is revised lately 1/2020 stating “Chemical and physical in-use stability has been demonstrated for up to 12 hours when stored in a refrigerator at 2-8°C, when reconstituted with one of the compatible solvents for reconstitution “ page 7 of the attachment from medicines.org.uk (emc).
      Another source that mentioned after reconstitution stability is lexicomp.com which states “ Discard any unused portion after 24 hours if stored at 20°C to 25°C (68°F to 77°F) or after 48 hours if stored at 2°C to 8°C (36°F to 46°F). Do not freeze vials after reconstitution. Stability in D5W or NS has been demonstrated for up to 24 hours at room temperature and up to 1 week at refrigerated temperature. Stability in an ambulatory IV infusion pump has been demonstrated for a period of 12 hours at room temperature.”, you will find a screen shot attachment regarding lexicomp page.

      Hope you find this useful,
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Piperacillin-tazobactam Stability after dilution
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