eravacycline
Brand: Xerava
Prototype: tigecycline
Drug Class: fluorocycline antibiotic
Drug Family: antibiotic
Subclass: novel tetracycline analog (fluorocycline)
Organ Systems: infectious-disease
Mechanism of Action
Novel synthetic fluorocycline; binds 30S ribosomal subunit with high affinity, overcoming most tetracycline resistance mechanisms; active against many MDR gram-positive, gram-negative, and anaerobic organisms.
30S ribosomal subunit
Indications
- complicated intra-abdominal infections (cIAI)
Contraindications
- eravacycline hypersensitivity
- pregnancy
Adverse Effects
Common
- nausea
- vomiting
- infusion-site reactions
Serious
- anaphylaxis
- fetal harm
- pseudotumor cerebri
Pharmacokinetics (ADME)
| Absorption | IV only (at time of approval); oral formulation under study |
| Distribution | large Vd; extensive tissue distribution |
| Metabolism | hepatic (CYP3A4) |
| Excretion | fecal (primarily) and renal |
| Half-life | 20 hours |
| Onset | immediate (IV) |
| Peak | end of infusion |
| Duration | 12 hours |
| Protein Binding | 79% |
| Vd | large |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| CYP3A4 inducers (rifampin) | reduced eravacycline exposure; may require dose adjustment | moderate |
| warfarin | potential INR elevation via gut flora suppression | moderate |
Nursing Considerations
- Administer IV over 60 minutes every 12 hours for 4–14 days depending on clinical response.
- Pre-medicate with an antihistamine 30–60 minutes before infusion if infusion reactions occur.
- Confirm no pregnancy before initiating; contraindicated in pregnancy as with all tetracyclines.
- Monitor hepatic function with prolonged use; dose adjustment required in severe hepatic impairment.
Clinical Pearls
- Eravacycline represents a new generation of tetracycline analogs designed to overcome both ribosomal protection and efflux-pump resistance while reducing the nausea incidence seen with tigecycline.
- Unlike tigecycline, eravacycline does not carry a black box warning for increased mortality, though clinical data are more limited; it is currently restricted to the cIAI indication.
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Guideline Update pending
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.