eravacycline: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
eravacycline: clinical details
Prescribing considerations
- Reserve antibacterial: involve microbiology or infectious-diseases expertise and use culture and susceptibility information where available.
- Clinical trial evidence was limited in immunocompromised patients, people with high baseline illness severity and those with concurrent bacteraemia.
- Assess tetracycline hypersensitivity, interacting products, pregnancy, breastfeeding and hepatic impairment.
- Consider antibiotic-associated colitis with diarrhoea during or after treatment; avoid medicines that inhibit peristalsis when suspected.
- Review for superinfection and stop eravacycline if pancreatitis is suspected.
Contraindications and cautions
- Hypersensitivity to eravacycline or any listed excipient
- Hypersensitivity to tetracycline-class antibiotics
Monitoring
- Prothrombin time or another suitable coagulation test, including fibrinogen, before and regularly during treatment
- Clinical response and microbiology results
- Infusion site for phlebitis, thrombophlebitis, pain, erythema or swelling
- Diarrhoea, hypersensitivity, pancreatitis and evidence of superinfection
- Adverse reactions in severe hepatic impairment, particularly with obesity or strong CYP3A inhibition
Clinical pharmacology
A fully synthetic fluorocycline that inhibits bacterial protein synthesis through 30S ribosomal binding. It is metabolised mainly through CYP3A4- and FMO-mediated oxidation, is a substrate of P-gp and OATP1B1/3, and is eliminated through urinary and faecal routes.
Formulation and product differences
- The selected UK product is a single-use powder for concentrate for intravenous infusion.
- It requires aseptic reconstitution followed by dilution with sodium chloride solution.
- Discard the prepared solution if cloudy or visibly particulate.
- Unopened vials require refrigerated storage and protection from light.
eravacycline preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 100 mg
eravacycline interactions
The clinical team should review prescription, non-prescription and herbal products before eravacycline is given.
Strong CYP3A inducers, including rifampicin, carbamazepine, phenytoin, phenobarbital and St John’s wort
May reduce eravacycline exposure and effectiveness, requiring specialist management.
Strong CYP3A inhibitors, including itraconazole, ritonavir and clarithromycin
May increase exposure, particularly with severe liver impairment or obesity, so adverse-effect monitoring may be needed.
OATP1B1 or OATP1B3 inhibitors, including atazanavir, ciclosporin, lopinavir and saquinavir
An interaction cannot be excluded, and eravacycline concentrations may rise.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.