[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Tetracyclines](https://durgical.com/en/pharmacology/classes/tetracyclines/) › Eravacycline

# Eravacycline

## Tetracyclines?

Tetracyclines

IV fluorocycline, a relative of tigecycline, for complicated intra-abdominal infections, even by bacteria resistant to older tetracyclines.

Updated Nov 1, 2026

## Quick facts

**Group**
[Tetracyclines](https://durgical.com/en/pharmacology/classes/tetracyclines/)

**Target**
Bacterial ribosome, 30S subunit (16S rRNA, A site)

**Key effects**
Nausea · Pain · Dizziness

**Monitor**
Headache or visual change · Severe abdominal pain

**ATC**
J01AA13

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◆**Bacterial ribosome, 30S subunit (16S rRNA, A site)**Eravacycline

ⓘ The figure shows eravacycline bound to the 30S ribosomal subunit of Acinetobacter baumannii.

**Target in 3D:** Bacterial ribosome, 30S subunit (16S rRNA, A site). PDB structure 7M4U (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/7M4U) · Drag to rotate · pinch to zoom

Eravacycline binds the 30S subunit and keeps aminoacyl-tRNA out of the A site, like the other tetracyclines. It is a structural analogue of tigecycline (a fluorocycline): its bulky substituent hinders ribosomal protection proteins and it is not a substrate of the common Tet pumps, so it keeps activity against many tetracycline-resistant strains.

- Enters the bacterium and binds the 30S
- Aminoacyl-tRNA cannot enter the A site
- Evades Tet pumps and ribosomal protection
- Protein synthesis stops

## Indications

- Complicated intra-abdominal infections in adults (not used for urinary infections) [Intra-abdominal abscess →](https://durgical.com/en/conditions/intra-abdominal-abscess/)

## Adverse effects

### Common

- Nausea, vomiting and diarrhoea
- Pain, redness or swelling at the infusion site
- Dizziness

### Serious (rare, important)

- Permanent tooth staining and slower bone growth if used in pregnancy or before age 8
- Intracranial hypertension (headache, blurred or double vision)
- Abdominal pain spreading to the back (pancreatitis) and severe skin reactions
- Clostridioides difficile diarrhoea and severe allergic reactions

## Contraindications

- Allergy to eravacycline or other tetracyclines

## Key interactions

**Strong CYP3A4 inducers (rifampicin, carbamazepine, phenytoin)**
Shorten its half-life and lower its levels.

**CYP3A4 inhibitors (itraconazole)**
Raise its levels.

## What is monitored

- Headache or visual change
- Severe abdominal pain, and pancreatic enzymes if it appears
- Diarrhoea during and after treatment
- Course of the surgical wound

## Administration and safety

- IV infusion, each one over about 60 minutes
- Check the medicine list for CYP3A4 inducers

## Pregnancy and breastfeeding

It can harm the fetus: like the other tetracyclines, it stains teeth and affects bone growth if used in the second half of pregnancy.

## Nursing care

- Ask about pregnancy and breastfeeding; breastfeeding is avoided during treatment and for 4 days after
- Watch the infusion site
- Ask the patient to report severe headache, blurred vision or abdominal pain spreading to the back
- Watch for wound-healing problems

## Pharmacokinetics

**Absorption**
Poorly absorbed by mouth; IV only.

**Distribution**
Fast and wide into tissues.

**Metabolism**
CYP3A4 substrate.

**Elimination**
Mostly unchanged, with a small share of metabolites; no adjustment in kidney failure.

## Memory aid

«A new ERA of tetracycline»: eravacycline is tigecycline with fluorine, for the complicated abdomen, never for urine.

## Test yourself

Think of the answer, then tap the question to see it.

## Why does eravacycline keep activity against doxycycline-resistant bacteria?

It is not a substrate of the common Tet pumps, and its bulky substituent hinders ribosomal protection proteins.

## Which infection is eravacycline approved for, and which is it not used for?

Complicated intra-abdominal infections; it is not used for urinary infections because it failed non-inferiority in trials.

## Which drugs lower eravacycline levels?

Strong CYP3A4 inducers such as rifampicin, carbamazepine or phenytoin.

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[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Tigecycline](https://durgical.com/en/pharmacology/tigecycline/)
- [Omadacycline](https://durgical.com/en/pharmacology/omadacycline/)
- [Doxycycline](https://durgical.com/en/pharmacology/doxycycline/)

## Related conditions 1

- [Intra-abdominal abscess](https://durgical.com/en/conditions/intra-abdominal-abscess/)

[← Back to the class: Tetracyclines](https://durgical.com/en/pharmacology/classes/tetracyclines/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Eravacycline Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a618047.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [A. baumannii Ribosome-Eravacycline complex: 30S](https://www.rcsb.org/structure/7M4U) (RCSB Protein Data Bank, 2026).

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Representative model, for educational purposes only.

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