Eravacycline

Patients concomitantly receiving strong CYP3A4 inducers: 1.5 mg/kg 12 hourly for 4-14 days.

Severe (Child-Pugh class C): 1 mg/kg 12 hourly on day 1, then 1 mg/kg 24 hourly thereafter. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).

Reconstitute each vial labelled as containing 50 mg or 100 mg with 5 mL of NaCl 0.9% inj or sterile water for inj to achieve a concentration of 10 mg/mL and 20 mg/mL, respectively. Gently swirl to dissolve; avoid shaking. Further dilute the reconstituted vial using NaCl 0.9% solution by withdrawing the full or partial contents of the vial, then add it to the infusion bag to make a final concentration of 0.3 mg/mL (ranging from 0.2-0.6 mg/mL). Do not shake the infusion bag.

Hypersensitivity to eravacycline or other tetracycline antibiotics.

Patients concomitantly receiving strong CYP3A4 inducers. Not indicated for the treatment of complicated urinary tract infections. Hepatic impairment. Pregnancy and lactation.

Significant: Fungal or bacterial superinfection, including pseudomembranous colitis, Clostridioides difficile-associated diarrhoea; permanent discolouration (yellow-grey-brown) of the teeth (particularly when given during tooth development [last half of pregnancy; infancy and childhood to the age of 8 years]), tooth enamel hypoplasia, reversible inhibition of bone growth; antianabolic effects (e.g. azotaemia, acidosis, hyperphosphataemia, increased BUN), abnormal LFTs, pancreatitis, pseudotumour cerebri, photosensitivity; infusion-site reactions (e.g. erythema, pain/tenderness, phlebitis, thrombophlebitis); may prolong prothrombin time and aPTT.
Blood and lymphatic system disorders: Hypofibrinogenaemia.
Gastrointestinal disorders: Nausea, vomiting.
Injury, poisoning and procedural complications: Wound dehiscence.
Nervous system disorders: Headache.
Skin and subcutaneous tissue disorders: Hyperhidrosis, rash.
Vascular disorders: Hypotension.
Potentially Fatal: Hypersensitivity or anaphylactic reactions.

IV: Z (Should not be used unless clinically required, especially beyond first trimester, as exposure during second and third trimester may affect bone and teeth development of the child.)

Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor liver function periodically. Assess for signs and symptoms of anaphylaxis during administration.

Concomitant administration with strong CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin) may decrease the efficacy of eravacycline.

May decrease efficacy with St. John's Wort.

Description:
Mechanism of Action: Eravacycline is a fluorocycline antibiotic belonging to the tetracycline class. It inhibits protein synthesis in susceptible bacteria by binding to the 30S ribosomal subunit, thereby preventing the incorporation of amino acid residues into the elongating peptide chain.
Pharmacokinetics:
Distribution: Crosses the placenta. Plasma protein binding: 79-90%.
Metabolism: Mainly metabolised by CYP3A4- and FMO-mediated oxidation of the pyrrolidine ring into TP-6208, and by chemical epimerisation at C-4 into TP-498.
Excretion: Via urine (20% as unchanged drug); faeces (47%; 17% as unchanged drug). Elimination half-life: 20 hours.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 54726192, Eravacycline. https://pubchem.ncbi.nlm.nih.gov/compound/Eravacycline. Accessed June 26, 2025.

Intact vials: Store between 2-8°C. Reconstituted IV solution: May be stored at room temperature (≤25°C) for up to 1 hour. Diluted solution for IV infusion: Store at room temperature (≤25°C) for up to 12 hours or between 2-8°C for 72 hours. Do not freeze. Storage recommendations may vary between individual products (refer to specific product guidelines).

Tetracyclines

J01AA13 - eravacycline ; Belongs to the class of tetracyclines. Used in the systemic treatment of infections.

Brayfield A, Cadart C (eds). Eravacycline. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/06/2025.

Eravacycline. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 03/06/2025.

Eravacycline. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 03/06/2025.

Joint Formulary Committee. Eravacycline. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/06/2025.

Xerava 100 mg Powder for Concentrate for Solution for Infusion (PAION Deutschland GmbH). MHRA. https://products.mhra.gov.uk. Accessed 03/06/2025.

Xerava 50 mg Powder for Concentrate for Solution for Infusion (Everest Medicines Limited). MIMS Hong Kong. http://www.mims.com/hongkong. Accessed 03/06/2025.

Xerava Injection, Powder, Lyophilized, for Solution (Tetraphase Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 03/06/2025.