Omadacycline
Tetracyclines
Tetracyclines
Aminomethylcycline derived from minocycline, oral or IV, for community pneumonia and skin infections; taken fasting and away from minerals.
Quick facts
- Group
- Tetracyclines
- Target
- Bacterial ribosome, 30S subunit (16S rRNA, A site)
- Used for
- Acute bacterial skin
- Key effects
- Nausea · Constipation · Insomnia and headache
- Monitor
- Clinical response of the pneumonia
- ATC
- J01AA15
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows omadacycline bound to the head of the Escherichia coli 30S ribosomal subunit; the same crystal has spectinomycin at another site.
Omadacycline binds the 30S subunit and keeps aminoacyl-tRNA out of the A site. It is an aminomethylcycline derived from minocycline: its bulky substituent hinders ribosomal protection proteins and the common Tet pumps do not expel it, so it acts against many tetracycline-resistant strains.
- Binds the 30S at the tetracycline site
- Aminoacyl-tRNA cannot enter the A site
- Evades Tet pumps and ribosomal protection
- Protein synthesis stops
Indications
- Community-acquired bacterial pneumonia in adults Community-acquired pneumonia →
- Acute bacterial skin and skin-structure infections in adults
Adverse effects
Common
- Nausea, vomiting and diarrhoea
- Constipation
- Insomnia and headache
Contraindications
- Allergy to omadacycline or other tetracyclines
Key interactions
- Antacids, calcium, magnesium, iron and multivitamins with minerals
- Chelate omadacycline and lower absorption; separated by 4 hours.
- Food and dairy
- Greatly reduce absorption of the oral form.
What is monitored
- Clinical response of the pneumonia or skin infection
- Headache or visual change
- Diarrhoea during and after treatment
Administration and safety
- Oral on an empty stomach, with water, at least 4 hours after eating; then only water for 2 hours and no dairy for 4 hours
- Separate by 4 hours from antacids, iron and vitamins with iron
Pregnancy and breastfeeding
It can harm the fetus: like the other tetracyclines, it stains teeth and affects bone growth; pregnancy is avoided during treatment.
Nursing care
- Schedule the dose away from meals, dairy and mineral supplements
- Ask about pregnancy; breastfeeding is avoided during treatment and for 4 days after
- Teach to report severe headache or visual change
- Teach to finish the course
Pharmacokinetics
- Absorption
- Oral (bioavailability about one third) or IV; food and cations (calcium, magnesium, aluminium, iron) greatly reduce absorption.
- Distribution
- Wide; unlike other tetracyclines, it binds little to plasma proteins.
- Elimination
- Mostly unchanged, in bile and urine.
- Half-life
- Long, about 16 hours, allowing one dose a day.
Test yourself
Think of the answer, then tap the question to see it.
Which tetracycline is omadacycline derived from, and what sets it apart?
Minocycline; it is oral and IV, binds little to proteins and keeps activity against tetracycline-resistant strains.
How is oral omadacycline taken so that it is absorbed well?
Fasting, with water, at least 4 hours after eating, with no food, dairy or minerals in the hours after.
Which infections is omadacycline approved for?
Community-acquired bacterial pneumonia and acute skin and skin-structure infections in adults.
Connections
← Back to the class: 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: Omadacycline: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Omadacycline and spectinomycin bound to the 30S ribosomal subunit head (RCSB Protein Data Bank, 2026).
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Representative model, for educational purposes only.