omadacycline
Brand: Nuzyra
Prototype: tetracycline
Drug Class: aminomethylcycline tetracycline
Drug Family: antibiotic
Subclass: novel tetracycline analog (aminomethylcycline)
Organ Systems: infectious-diseaserespiratory
Mechanism of Action
Aminomethylcycline modification overcomes tetracycline resistance via ribosomal protection and efflux; unique among tetracycline analogs in having both IV and oral formulations with good bioavailability.
30S ribosomal subunit
Indications
- community-acquired bacterial pneumonia (CABP)
- acute bacterial skin and skin structure infections (ABSSSI)
Contraindications
- tetracycline hypersensitivity
- pregnancy
Adverse Effects
Common
- nausea
- vomiting
- diarrhea
- headache
Serious
- fetal harm
- anaphylaxis
- pseudotumor cerebri
- photosensitivity
Pharmacokinetics (ADME)
| Absorption | IV or oral; oral bioavailability ~34% (fasting); administer oral dose on empty stomach |
| Distribution | large Vd; widely distributed |
| Metabolism | minimal |
| Excretion | fecal (>70%) and renal |
| Half-life | 16.8 hours |
| Onset | rapid |
| Peak | 2.5 hours (oral) |
| Duration | 24 hours (once-daily) |
| Protein Binding | 20% |
| Vd | large |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| antacids/dairy/calcium | chelation reduces absorption; take on empty stomach | major |
| warfarin | INR elevation | moderate |
Nursing Considerations
- Administer oral omadacycline on an empty stomach (at least 4 hours after a meal or at least 2 hours before a meal).
- Separate from dairy, antacids, and iron-containing products by at least 4 hours.
- Nausea is common, especially with the loading dose; advise patients it typically improves after the first few doses.
- Avoid pregnancy — confirm pregnancy status before prescribing.
Clinical Pearls
- Omadacycline has both IV and oral formulations with true oral step-down capability, unlike tigecycline, making it a practical option for outpatient completion of CABP and ABSSSI treatment.
- Once-daily dosing (for CABP) or twice-daily (for ABSSSI) with good oral bioavailability distinguishes omadacycline from older tetracyclines with complex dosing requirements.
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Guideline Update pending
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.