Names and pronunciation
(er′a-va-sye′kleen) Xerava
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Drug reference
(er′a-va-sye′kleen) Xerava
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Func. class.: Antibiotic—tetracycline
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Chem. class.: Synthetic fluorocycline E
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ACTION: Disrupts bacterial protein synthesis by binding to the 30S ribosomal subunit and preventing the incorporation of amino acid residues into elongating peptide chains
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USES: Complicated intraabdominal infections caused by Bacteroides cac- cae, Bacteroides fragilis, Bacteroides ovatus, Bacteroides thetaiotaomi- cron, Bacteroides uniformis, Bacte- roides vulgatus, Citrobacter freundii, Citrobacter koseri, Clostridium per- fringens, Enterobacter aerogenes, Enterobacter cloacae, Enterococcus faecalis, Enterococcus faecium, Esch- erichia coli, Klebsiella oxytoca, Kleb- siella pneumoniae, Parabacteroides distasonis, Staphylococcus aureus (MRSA), Staphylococcus aureus (MSSA), Streptococcus anginosus, Streptococcus salivarius
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CONTRAINDICATIONS: Hyper- sensitivity to this product or tetracyclines Precautions: Breastfeeding, children, colitis, diarrhea, geriatric patients, GI/ hepatic disease, increased intracranial pressure, inflammatory bowel disease/ ulcerative colitis, papilledema, preg- nancy, CDAD, UV exposure
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SIDE EFFECTS CV: Hypotension EENT: Tooth discoloration GI: Nausea, vomiting, diarrhea, pancre- atitis, Clostridium difficile HEMA: Thrombosis INTEG: Rash RESP: Pleural effusion SYST: Anaphylaxis, wound dehiscence
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INTERACTIONS Increase: anticoagulation—anticoagulants; anticoagulant may need dosage reduction Increase: eravacycline effect—strong CYP3A inducers (clarithromycin, telithromycin, nefazodone, itraconazole, ketoconazole, atazanavir, darunavir, indin avir, lopinavir, nelfinavir, ritonavir, saqui- navir, tipranavir) Decrease: eravacycline effect—strong CYP3A inducers (carBAMazepine, rifAMPin)
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DOSAGE AND ROUTES • Adult: IV 1 mg/kg q12hr × 4-14 days
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Available forms: Powder for injection 50 mg
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Administer: Intermittent IV INFUSION route • Visually inspect for particulate matter and discoloration prior to use; reconstituted solution is clear, pale yellow to orange • Reconstitution: Reconstitute each vial with 5 mL of sterile water for injec- tion to a concentration of 10 mg/mL; swirl until powder has dissolved; avoid shaking or rapid movement. Do not give reconstituted solution by direct injection • Dilution: Withdraw the full or partial reconstituted content from each vial and add it into a 0.9% sodium chloride for injection infusion bag to a concentration of 0.3 mg/mL (within a range of 0.2-0.6 mg/mL). Do not shake • Storage: Diluted solution must be in- fused within 6 hr if stored at room tem- perature 77°F (max 25°C) or within 24 hr if stored refrigerated at 36°F-46°F (2°C-8°C). Do not freeze Intermittent IV infusion • Infuse through a dedicated IV line or by Y-site. If the same IV line is used for sequential infusion of several drugs, flush the line prior to and after infusion with 0.9% sodium chloride for injection. Give over 60 min; assess IV site frequently
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Assess: • Infection: fever, condition of wound, pain, vital signs, urine, stools; monitor WBC for increased levels indicating con- tinued infection; obtain C&S prior to starting treatment, may start product prior to receiving results • Bowel function: diarrhea with mu- cus, blood; may indicate CDAD (Clos- tridium difficile–associated disease); report to health care provider immedi- ately; may occur several weeks after last dose • Wound dehiscence: fever, inflamma- tion, bleeding, pain, wound opening; re- port any of these signs immediately • Anaphylaxis: rash, dyspnea, swelling of lips/tongue; discontinue product; if severe, EPINEPHrine is usually given; if allergic reaction is mild, discontinuing product and giving diphenhydramine may be sufficient • Tooth discoloration: may occur if used in second or third trimester of pregnancy or in children <8 yr
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To inform health care provider of all OTC, Rx, herbal and supplemental prod- ucts taken; not to change medication without prescriber’s approval • Pregnancy/breastfeeding: to inform health care provider if pregnancy is planned or suspected, or if breastfeeding; that this product may cause permanent tooth discoloration and reversible inhibi- tion of bone growth when used in the second and third trimesters of pregnancy; not to breastfeed during and for 4 days after last dose • Allergic reactions: to identify aller- gies; that allergic reactions, including serious ones, could occur and that seri- ous reactions require immediate treat- ment. Ask patient about any previous allergies • Diarrhea: to report watery and bloody stools (with or without stomach cramps and fever), which may be a serious intestinal infection, even 2 or more mo after last dose • That this product is used only to treat bacterial infections; to take all of the medication even if feeling better; not to skip doses or fail to complete the full course of therapy
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PHARMACOKINETICS Metabolized primarily by CYP3A4- and FMO-mediated oxidation, excretion 47% feces, 34% urine, half-life 20 hr
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• Adult: IV 1 mg/kg q12hr × 4-14 days
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