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Drug overview for XERAVA (eravacycline di-hydrochloride):
Generic name: eravacycline di-hydrochloride (ER-a-va-SYE-kleen)
Drug class: Tetracyclines
Therapeutic class: Anti-Infective Agents
Eravacycline dihydrochloride, a synthetic fluorocycline, is a tetracycline anti-infective.
No enhanced Uses information available for this drug.
Generic name: eravacycline di-hydrochloride (ER-a-va-SYE-kleen)
Drug class: Tetracyclines
Therapeutic class: Anti-Infective Agents
Eravacycline dihydrochloride, a synthetic fluorocycline, is a tetracycline anti-infective.
No enhanced Uses information available for this drug.
DRUG IMAGES
XERAVA 50 MG VIAL
The following indications for XERAVA (eravacycline di-hydrochloride) have been approved by the FDA:
Indications:
Infectious disease of abdomen
Professional Synonyms:
Intra-abdominal infection
Indications:
Infectious disease of abdomen
Professional Synonyms:
Intra-abdominal infection
The following dosing information is available for XERAVA (eravacycline di-hydrochloride):
Dosage of eravacycline dihydrochloride is expressed in terms of eravacycline.
Eravacycline dihydrochloride is administered by IV infusion.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| XERAVA 50 MG VIAL | Maintenance | Adults infuse 1 mg/kg over 60 minute(s) by intravenous route every 12 hours |
| XERAVA 100 MG VIAL | Maintenance | Adults infuse 1 mg/kg over 60 minute(s) by intravenous route every 12 hours |
No generic dosing information available.
The following drug interaction information is available for XERAVA (eravacycline di-hydrochloride):
There are 2 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| Live Typhoid Vaccine/Antimicrobials SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1) CLINICAL EFFECTS: Vaccination may be ineffective. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3) DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3) |
VIVOTIF |
| Selected Retinoids (Systemic)/Tetracyclines SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Both systemic tetracyclines(1-4,14) and systemic retinoids(5-14) have been independently associated with medication-induced intracranial hypertension. CLINICAL EFFECTS: The concurrent use of oral retinoids(5-12) with tetracyclines has been associated with pseudotumor cerebri (benign intracranial hypertension). Early signs of pseudotumor cerebri include papilledema (inflammation of the optic nerve), headache, nausea, vomiting, and visual disturbances such as blurred vision, double vision, and loss of vision.(15) PREDISPOSING FACTORS: Women of childbearing age who are overweight or have a previous history of intracranial hypertension are at a greater risk of developing intracranial hypertension.(15) PATIENT MANAGEMENT: The UK(5) and US(6) manufacturers of acitretin state state that concurrent use with tetracyclines is contraindicated. The UK manufacturer of isotretinoin states that concurrent use with tetracyclines is contraindicated.(7) The US manufacturer of isotretinoin states that the concurrent use of tetracyclines should be avoided.(8) The US manufacturer of minocycline states that the administration of isotretinoin should be avoided shortly before, during and shortly after minocycline therapy.(2) The UK manufacturers of oral tretinoin and alitretinoin states that concurrent use with tetracyclines is contraindicated.(9,11) The Canadian manufacturer of palovarotene states that coadministration of tetracycline derivatives should be avoided.(12) Patients who present with symptoms of pseudotumor cerebri should be screened for papilledema. If papilledema is present, they should discontinue the drug and be referred to a neurologist for further treatment.(5-13) DISCUSSION: The concurrent use of isotretinoin and tetracyclines has been associated with pseudotumor cerebri.(5-13) A review of ocular side effects from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the Food and Drug Administration, and medical journals from 1979 to 2003 found 6 patients who developed intracranial hypertension while taking concurrent minocycline or tetracycline with tretinoin, acitretin, or etretinate.(13) |
ABSORICA, ABSORICA LD, ACCUTANE, ACITRETIN, AMNESTEEM, CLARAVIS, ISOTRETINOIN, RETINOIC ACID, SOHONOS, TRETINOIN, TRETINOIN ACID, ZENATANE |
There are 7 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Topical Tretinoin/Tetracyclines SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The exact mechanism is unknown. CLINICAL EFFECTS: Concurrent use of topical tretinoin with tetracyclines may increase the risk of phototoxicity(1) in some patients.(2) PREDISPOSING FACTORS: Patients using topical tretinoin for the treatment of photodamage may be predisposed to photosensitivity.(2) PATIENT MANAGEMENT: Concurrent use of topical tretinoin and tetracycline is standard practice in the treatment of acne.(3) However, patients taking tetracyclines should not use topical tretinoin (e.g Renova) for the treatment of photodamage.(1,2) DISCUSSION: The concurrent use of topical tretinoin and tetracyclines may result in an increased risk of phototoxicity.(1,2) |
KATARYA, KATARYAXN, KETARYA, KEVARYA, KUTARYAXM, KUTARYAXMPA, KUVARYA, KUVARYE, MECORIX, MECORIX HP, MECORIX PLUS, MEKAM, MEKAM HP, MELIDU, MELONDIS, MELONDIS PLUS, MOLEXI, MYTHIUS, REFISSA, RENOVA, RENOVA PUMP, TRETINOIN, TRI-LUMA, YAXATARXYN, YOKATAR |
| Cholera Vaccine Live/Selected Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Antibiotics with activity against Vibrio cholerae may attenuate the immunization response to the live cholera vaccine.(1) CLINICAL EFFECTS: Concurrent or recent antibiotic use may make the cholera vaccine ineffective.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of live cholera vaccine states that it should not be administered to patients who have received antibiotics within 14 days prior to vaccination.(1) If antimalarial prophylaxis with chloroquine is required, administer the live cholera vaccine at least 10 days before beginning chloroquine.(1) Antibiotics linked to this monograph are: macrolides, quinolones, tetracyclines, ampicillin, cefprozil, chloramphenicol, furazolidone, sulfamethoxazole-trimethoprim, and sulfametrole-trimethoprim.(2,3) DISCUSSION: Antibiotics with activity against Vibrio cholerae may attenuate the immunization response to the live cholera vaccine, rendering the vaccine ineffective. |
VAXCHORA ACTIVE COMPONENT, VAXCHORA VACCINE |
| Aminolevulinic Acid/Selected Photosensitizers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Aminolevulinic acid, anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are all known photosensitizers.(1) CLINICAL EFFECTS: Concurrent use of aminolevulinic acid in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer states that aminolevulinic acid should be avoided in patients receiving photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides for 24 hours before and after administration of aminolevulinic acid.(1) DISCUSSION: Because of the risk of increased photosensitivity, the US manufacturer states that aminolevulinic acid should be avoided in patients receiving photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides for 24 hours before and after administration of aminolevulinic acid.(1) |
AMINOLEVULINIC ACID HCL, GLEOLAN |
| Eravacycline/Strong CYP3A4 Inducers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Strong inducers of CYP3A4 may induce the metabolism of eravacycline.(1) CLINICAL EFFECTS: Concurrent use of a strong inducer of CYP3A4 may result in decreased levels of eravacycline and may lead to decreased efficacy of eravacycline and increase the risk of treatment failure.(1) PREDISPOSING FACTORS: Induction effects may be more likely with regular use of the inducer for longer than 1-2 weeks. PATIENT MANAGEMENT: For the treatment of complicated intra-abdominal infections, the US manufacturer of eravacycline recommends dose adjustment of eravacycline to 1.5 mg/kg every 12 hours for a total duration of 4 to 14 days with concurrent use of a strong CYP3A4 inducer. No dose adjustment is warranted with concurrent use of a weak or moderate CYP3A4 inducer.(1) Standard dosing of eravacycline is 1 mg/kg every 12 hours for 4 to 14 days for complicated intra-abdominal infections.(1) DISCUSSION: Concurrent use of rifampin (a strong inducer of CYP3A4) decreased eravacycline area-under-curve (AUC) by 35% and increased eravacycline clearance by 54%.(1) Strong inducers of CYP3A4 include: apalutamide, barbiturates, carbamazepine, encorafenib, enzalutamide, fosphenytoin, ivosidenib, lumacaftor, mitotane, phenobarbital, phenytoin, primidone, rifampin, rifapentine, and St. John's wort.(2-4) |
ASA-BUTALB-CAFFEINE-CODEINE, ASCOMP WITH CODEINE, BRAFTOVI, BUTALB-ACETAMINOPH-CAFF-CODEIN, BUTALBITAL, BUTALBITAL-ACETAMINOPHEN, BUTALBITAL-ACETAMINOPHEN-CAFFE, BUTALBITAL-ASPIRIN-CAFFEINE, CARBAMAZEPINE, CARBAMAZEPINE ER, CARBATROL, CEREBYX, DILANTIN, DILANTIN-125, DONNATAL, EPITOL, EQUETRO, ERLEADA, FIORICET, FIORICET WITH CODEINE, FOSPHENYTOIN SODIUM, LYSODREN, MITOTANE, MYSOLINE, ORKAMBI, PENTOBARBITAL SODIUM, PHENOBARBITAL, PHENOBARBITAL SODIUM, PHENOBARBITAL-BELLADONNA, PHENOBARBITAL-HYOSC-ATROP-SCOP, PHENOHYTRO, PHENYTEK, PHENYTOIN, PHENYTOIN SODIUM, PHENYTOIN SODIUM EXTENDED, PRIFTIN, PRIMIDONE, RIFADIN, RIFAMPIN, SEZABY, TEGRETOL, TEGRETOL XR, TENCON, TIBSOVO, XTANDI |
| Porfimer/Selected Photosensitizers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Porfimer causes photosensitivity due to residual drug which is present in all parts of the skin. Anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are other known photosensitizers.(1) CLINICAL EFFECTS: Concurrent use of porfimer in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1) PREDISPOSING FACTORS: Patients with any hepatic impairment and patients with severe renal impairment have reduced drug elimination and may remain photosensitive for 90 days or longer.(1) PATIENT MANAGEMENT: The US manufacturer of porfimer states that concurrent use of porfimer with photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides should be avoided.(1) Since the photosensitive effect of porfimer may persist for at least 30 days (and for 90 days in some patients), it would be prudent to avoid other photosensitizing agents for at least 30 days after administration of porfimer. DISCUSSION: All patients who have received porfimer become photosensitive. It is unknown what the risk of photosensitivity reactions is when porfimer is used concurrently with other photosensitizing agents. When porfimer was used in clinical trials, photosensitivity reactions occurred in about 20% of cancer patients and in 69% of high-grade dysplasia in Barretts esophagus patients. Most of the reactions were mild to moderate erythema, but they also included swelling, pruritus, burning sensation, feeling hot, or blisters. The majority of reactions occurred within 90 days of porfimer administration.(1) |
PHOTOFRIN |
| Methoxsalen/Selected Photosensitizers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Methoxsalen causes photosensitivity due to residual drug which is present in all parts of the skin from photopheresis. Anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are other known photosensitizers.(1) CLINICAL EFFECTS: Concurrent use of methoxsalen in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of methoxsalen states that concurrent use of methoxsalen with anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides should be avoided.(1) DISCUSSION: All patients who have received methoxsalen become photosensitive. It is unknown what the risk of photosensitivity reactions is when methoxsalen is used concurrently with other photosensitizing agents.(1) |
METHOXSALEN, UVADEX |
| Fecal Microbiota Spores/Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fecal microbiota spores is a suspension of live bacterial spores, which may be compromised by concurrent use of antibiotics.(1) CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota spores.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota spores. Antibacterial treatment should be completed for 2 to 4 days before initiating treatment with fecal microbiota spores.(1) DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota spores. |
VOWST |
There are 3 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Contraceptives/Tetracyclines; Tigecycline SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Not established. CLINICAL EFFECTS: Reduced pharmacologic effects of oral contraceptives with resultant breakthrough bleeding and pregnancy may occur. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Current guidelines suggest that additional precautions are not necessary when non-enzyme inducing antibiotics are used concurrently with hormonal contraceptives; however, some patients may still prefer to use an additional method of contraception. DISCUSSION: Evidence for this interaction is limited and conflicting; however, the CDC and the Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit no longer recommend use of a backup contraceptive method during use of a non-enzyme inducing antibiotic. Pregnancy has been reported following the addition of tetracycline to oral contraceptive therapy.(1) In contrast, a study in 7 healthy women found no effect of tetracycline on ethinyl estradiol or norethindrone levels.(2) A study in 24 healthy women found no significant effects of doxycycline on ethinyl estradiol, norethindrone, or progesterone levels. However, the authors noted that there large inter-patient and inter-patient variability in these levels and that the interaction may just manifest itself in a small proportion of women.(3) |
2-METHOXYESTRADIOL, AFIRMELLE, ALTAVERA, ALYACEN, AMETHIA, AMETHYST, APRI, ARANELLE, ASHLYNA, AUBRA, AUBRA EQ, AUROVELA, AUROVELA 24 FE, AUROVELA FE, AVIANE, AYUNA, AZURETTE, BALCOLTRA, BALZIVA, BEYAZ, BLISOVI 24 FE, BLISOVI FE, BRIELLYN, CAMILA, CAMRESE, CAMRESE LO, CAZIANT, CHARLOTTE 24 FE, CHATEAL EQ, CRYSELLE, CYRED, CYRED EQ, DASETTA, DAYSEE, DEBLITANE, DESOGESTR-ETH ESTRAD ETH ESTRA, DIETHYLSTILBESTROL, DOLISHALE, DROSPIRENONE-ETH ESTRA-LEVOMEF, DROSPIRENONE-ETHINYL ESTRADIOL, ELINEST, ELLA, EMZAHH, ENPRESSE, ENSKYCE, ERRIN, ESTARYLLA, ESTRADIOL, ESTRADIOL BENZOATE, ESTRADIOL CYPIONATE, ESTRADIOL HEMIHYDRATE, ESTRADIOL HEMIHYDRATE MICRO, ESTRADIOL MICRONIZED, ESTRADIOL VALERATE, ESTRIOL, ESTRIOL MICRONIZED, ESTRONE, ETHINYL ESTRADIOL, ETHYNODIOL-ETHINYL ESTRADIOL, FALMINA, FEIRZA, FEMLYV, FINZALA, GEMMILY, HAILEY, HAILEY 24 FE, HAILEY FE, HEATHER, ICLEVIA, INCASSIA, ISIBLOOM, JAIMIESS, JASMIEL, JENCYCLA, JOLESSA, JOYEAUX, JULEBER, JUNEL, JUNEL FE, JUNEL FE 24, KAITLIB FE, KALLIGA, KARIVA, KELNOR 1-35, KELNOR 1-50, KURVELO, LARIN, LARIN 24 FE, LARIN FE, LAYOLIS FE, LEENA, LESSINA, LEVONEST, LEVONORG-ETH ESTRAD ETH ESTRAD, LEVONORG-ETH ESTRAD-FE BISGLYC, LEVONORGESTREL-ETH ESTRADIOL, LEVORA-28, LO LOESTRIN FE, LO-ZUMANDIMINE, LOESTRIN, LOESTRIN FE, LOJAIMIESS, LORYNA, LOW-OGESTREL, LUTERA, LYLEQ, LYZA, MARLISSA, MERZEE, MIBELAS 24 FE, MICROGESTIN, MICROGESTIN FE, MILI, MINZOYA, MONO-LINYAH, NATAZIA, NECON, NEXTSTELLIS, NIKKI, NORA-BE, NORETHIN-ETH ESTRA-FERROUS FUM, NORETHINDRON-ETHINYL ESTRADIOL, NORETHINDRONE, NORETHINDRONE-E.ESTRADIOL-IRON, NORGESTIMATE-ETHINYL ESTRADIOL, NORTREL, NYLIA, OCELLA, ORTHO TRI-CYCLEN, ORTHO-NOVUM, PHILITH, PIMTREA, PORTIA, RECLIPSEN, RIVELSA, SAFYRAL, SETLAKIN, SHAROBEL, SIMLIYA, SIMPESSE, SLYND, SPRINTEC, SRONYX, SYEDA, TARINA 24 FE, TARINA FE, TARINA FE 1-20 EQ, TAYTULLA, TILIA FE, TRI-ESTARYLLA, TRI-LEGEST FE, TRI-LINYAH, TRI-LO-ESTARYLLA, TRI-LO-MARZIA, TRI-LO-MILI, TRI-LO-SPRINTEC, TRI-MILI, TRI-SPRINTEC, TRI-VYLIBRA, TRI-VYLIBRA LO, TRIVORA-28, TULANA, TURQOZ, TYBLUME, VALTYA, VELIVET, VESTURA, VIENVA, VIORELE, VOLNEA, VYFEMLA, VYLIBRA, WERA, WYMZYA FE, XARAH FE, XELRIA FE, YASMIN 28, YAZ, ZARAH, ZOVIA 1-35, ZUMANDIMINE |
| Digoxin, Oral/Tetracyclines SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: In approximately 10% of patients receiving digoxin, a considerable amount of an administered dose of the drug is metabolized by GI bacteria to inactive digoxin reduction products (DRPs). Concomitant administration of tetracycline may alter the GI flora, enabling an increased amount of digoxin to be absorbed. CLINICAL EFFECTS: Increased serum digoxin levels with possible toxicity may occur. This effect may persist for several months after tetracycline is discontinued. Symptoms of digoxin toxicity can include anorexia, nausea, vomiting, headache, fatigue, malaise, drowsiness, generalized muscle weakness, disorientation, hallucinations, visual disturbances, and arrhythmias. PREDISPOSING FACTORS: Low body weight, advanced age, impaired renal function, hypokalemia, hypercalcemia, and/or hypomagnesemia may increase the risk of digoxin toxicity. PATIENT MANAGEMENT: Monitor serum digoxin levels and observe the patient for toxicity. The dosage of digoxin may need to be decreased by 30-50% or the frequency of administration may be reduced.(3) DISCUSSION: Approximately 10% of the patients receiving digoxin metabolize 30% or more of an ingested dose of digoxin to inactive DRPs. Concurrent current administration of tetracycline may alter the GI flora, decreasing the conversion of digoxin to DRPs. In these patients this could produce an increase in plasma digoxin concentration. The effect of tetracycline on the metabolism of digoxin to DRPs may persist for several months after the antibiotic is discontinued. Concomitant administration of tetracycline and digoxin increased the digoxin serum concentration 100%. (3) |
DIGITEK, DIGOXIN, DIGOXIN MICRONIZED, LANOXIN |
| Coumarin Anticoagulants/Tetracyclines SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The exact mechanism is unknown. Tetracyclines may interfere with vitamin-K producing gut flora. CLINICAL EFFECTS: The addition of a tetracycline to a patient maintained on a coumarin anticoagulant may result in increased anticoagulant effects, including bleeding. PREDISPOSING FACTORS: he risk for bleeding episodes may be greater in patients with disease-associated factors (e.g. thrombocytopenia). Drug associated risk factors include concurrent use of multiple drugs which inhibit anticoagulant/antiplatelet metabolism and/or have an inherent risk for bleeding (e.g. NSAIDs). PATIENT MANAGEMENT: Patients maintained on coumarin anticoagulants should be closely monitored when tetracyclines are initiated and discontinued. The dosage of the anticoagulant may need to be adjusted. When applicable, perform agent-specific laboratory test (e.g. INR, aPTT) to monitor efficacy and safety of anticoagulation. Discontinue anticoagulation in patients with active pathologic bleeding. Instruct patients to report any signs and symptoms of bleeding, such as unusual bleeding from the gums or nose; unusual bruising; red or black, tarry stools; red, pink or dark brown urine; acute abdominal or joint pain and/or swelling. The time of highest risk for a coumarin-type drug interaction is when the precipitant drug is initiated or discontinued. Contact the prescriber before initiating, altering the dose or discontinuing either drug. DISCUSSION: In a retrospective review of patients receiving either acenocoumarol or phenprocoumon, use of doxycycline and tetracycline was associated with relative risk of major bleeding of 3 and 9, respectively.(1) There are several case reports of bleeding following the addition of doxycycline(2-4) and tetracycline(5,6) to warfarin therapy. |
DICUMAROL, JANTOVEN, WARFARIN SODIUM |
The following contraindication information is available for XERAVA (eravacycline di-hydrochloride):
Drug contraindication overview.
Eravacycline dihydrochloride is contraindicated in patients with known hypersensitivity to eravacycline, other tetracyclines, or any excipients in the preparation.
Eravacycline dihydrochloride is contraindicated in patients with known hypersensitivity to eravacycline, other tetracyclines, or any excipients in the preparation.
There are 0 contraindications.
There are 2 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Clostridioides difficile infection |
| Pregnancy |
There are 0 moderate contraindications.
The following adverse reaction information is available for XERAVA (eravacycline di-hydrochloride):
Adverse reaction overview.
Adverse effects reported in 1% or more of patients receiving eravacycline include infusion site reactions, nausea, vomiting, diarrhea, hypotension, wound dehiscence, and anemia.
Adverse effects reported in 1% or more of patients receiving eravacycline include infusion site reactions, nausea, vomiting, diarrhea, hypotension, wound dehiscence, and anemia.
There are 15 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Hypotension Surgical wound dehiscence |
| Rare/Very Rare |
|---|
|
Acute eruptions of skin Acute pancreatitis Clostridioides difficile infection Elevated serum amylase Elevated serum lipase Fungal infection Hypersensitivity drug reaction Hypocalcemia Leukopenia Necrotizing pancreatitis Neutropenic disorder Pleural effusions Tooth enamel hypoplasia |
There are 14 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Injection site sequelae Nausea Vomiting |
Diarrhea |
| Rare/Very Rare |
|---|
|
Chest pain Dental discoloration Depression Dizziness Dysgeusia Dyspnea Hyperhidrosis Insomnia Skin rash Symptoms of anxiety |
The following precautions are available for XERAVA (eravacycline di-hydrochloride):
Safety and efficacy of eravacycline have not been established in patients younger than 18 years of age. Use of eravacycline in pediatric patients younger than 8 years of age is not recommended because of the adverse effects of tetracyclines on tooth development and bone growth. (see Tooth Discoloration and Enamel Hypoplasia and see Inhibition of Bone Growth under Cautions: Warnings/Precautions)
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Eravacycline, like other tetracyclines, may cause permanent discoloration of deciduous teeth and reversible inhibition of bone growth if administered during the second or third trimester of pregnancy. (See Tooth Discoloration and Enamel Hypoplasia and see Inhibition of Bone Growth under Cautions: Warnings/Precautions.) There are insufficient data regarding use of eravacycline in pregnant women to inform a drug-associated risk of major birth defects and miscarriages. Results of animal studies indicate that tetracyclines, including eravacycline, cross the placenta, are found in fetal plasma, and can have toxic effects on the developing fetus.
Evidence of embryotoxicity has been noted in animals that received tetracyclines early in pregnancy. In rats, eravacycline crosses the placenta and is found in fetal plasma following IV administration to the dams. In rats and rabbits, eravacycline administered during the period of organogenesis at doses approximately 8.6
and 6.3 times higher, respectively, than clinical exposures based on area under the plasma concentration-time curve (AUC) was associated with decreased ossification, decreased fetal body weight, and/or increased post-implantation loss. Patients should be advised of the potential risks to the fetus if eravacycline is used during the second or third trimester of pregnancy. (See Advice to Patients.)
Evidence of embryotoxicity has been noted in animals that received tetracyclines early in pregnancy. In rats, eravacycline crosses the placenta and is found in fetal plasma following IV administration to the dams. In rats and rabbits, eravacycline administered during the period of organogenesis at doses approximately 8.6
and 6.3 times higher, respectively, than clinical exposures based on area under the plasma concentration-time curve (AUC) was associated with decreased ossification, decreased fetal body weight, and/or increased post-implantation loss. Patients should be advised of the potential risks to the fetus if eravacycline is used during the second or third trimester of pregnancy. (See Advice to Patients.)
Eravacycline and its metabolites are distributed into milk in lactating rats. It is not known if the drug is distributed into milk in humans, affects the breast-fed infant, or affects milk production. Because other antibacterial options are available to treat complicated intra-abdominal infections in lactating women and because of the potential for serious adverse effects in the breast-fed infant (see Tooth Discoloration and Enamel Hypoplasia and see Inhibition of Bone Growth under Cautions: Warnings/Precautions), breast-feeding is not recommended during eravacycline treatment and for 4 days after the last dose of the drug.
In phase 3 clinical studies evaluating eravacycline for the treatment of complicated intra-abdominal infections, 30% of patients were 65 years of age or older and 11% were 75 years of age or older. No overall differences in safety or efficacy were observed between geriatric and younger adults. Based on population pharmacokinetic analysis, no clinically relevant age-related differences in eravacycline pharmacokinetics were observed in adults 18-86 years of age.
The following prioritized warning is available for XERAVA (eravacycline di-hydrochloride):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for XERAVA (eravacycline di-hydrochloride)'s list of indications:
| Infectious disease of abdomen | |
| A51.1 | Primary anal syphilis |
| K35 | Acute appendicitis |
| K35.2 | Acute appendicitis with generalized peritonitis |
| K35.20 | Acute appendicitis with generalized peritonitis, without abscess |
| K35.200 | Acute appendicitis with generalized peritonitis, without perforation or abscess |
| K35.201 | Acute appendicitis with generalized peritonitis, with perforation, without abscess |
| K35.209 | Acute appendicitis with generalized peritonitis, without abscess, unspecified as to perforation |
| K35.21 | Acute appendicitis with generalized peritonitis, with abscess |
| K35.210 | Acute appendicitis with generalized peritonitis, without perforation, with abscess |
| K35.211 | Acute appendicitis with generalized peritonitis, with perforation and abscess |
| K35.219 | Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation |
| K35.3 | Acute appendicitis with localized peritonitis |
| K35.30 | Acute appendicitis with localized peritonitis, without perforation or gangrene |
| K35.31 | Acute appendicitis with localized peritonitis and gangrene, without perforation |
| K35.32 | Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess |
| K35.33 | Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess |
| K35.8 | Other and unspecified acute appendicitis |
| K35.80 | Unspecified acute appendicitis |
| K35.89 | Other acute appendicitis |
| K35.890 | Other acute appendicitis without perforation or gangrene |
| K35.891 | Other acute appendicitis without perforation, with gangrene |
| K65.0 | Generalized (acute) peritonitis |
| K65.2 | Spontaneous bacterial peritonitis |
Formulary Reference Tool