Tigecycline !
An IV glycylcycline that escapes the usual tetracycline resistance. Kept for complicated infections because of a boxed warning on mortality.
Updated 2026-11-01
The figure shows tigecycline bound to the Escherichia coli 70S ribosome.
Mechanism of action
Tigecycline, a minocycline derivative, binds the 30S subunit more tightly than older tetracyclines and blocks aminoacyl-tRNA from the A site. It is little affected by the two main tetracycline resistance mechanisms, efflux pumps and ribosomal protection, nor by β-lactamases.
- Given IV and spreads widely into tissues
- Binds the 30S subunit tightly
- Aminoacyl-tRNA is blocked from the A site
- Even resistant bacteria stop growing
Pharmacokinetics
- Distribution
- Large volume of distribution, with low blood levels.
- Elimination
- Mainly bile, as unchanged drug and metabolites; kidney excretion is minor.
Indications
- Complicated skin and skin-structure infections
- Complicated intra-abdominal infections Peritonitis →
- Community-acquired bacterial pneumonia (not hospital-acquired or ventilator-associated pneumonia) Community-acquired pneumonia →
Adverse effects
Common
- Nausea and vomiting, usually in the first days
- Diarrhoea
- Raised liver enzymes
Contraindications
- Allergy to tigecycline or its excipients
Key interactions
- Warfarin
- Prothrombin time is checked.
What is monitored
- Liver tests and coagulation, including fibrinogen, at baseline and during treatment
- Abdominal pain (pancreatitis)
- Clinical response
Administration and safety
- IV infusion only
- Reconstituted and diluted as the product describes; the solution is checked for colour and particles
Nursing care
- Give antiemetics as ordered and watch fluid balance
- Watch for bleeding or bruising
- Report severe abdominal pain
Pregnancy and breastfeeding
Can cause fetal harm; like other tetracyclines it is avoided in the second half of pregnancy.
Test yourself
Think of the answer, then tap the question to see it.
Which resistance mechanisms does tigecycline largely escape?
Tetracycline efflux pumps and ribosomal protection proteins.
What is its boxed warning?
An increase in all-cause mortality compared with other antibiotics.
Which pneumonia is tigecycline not used for?
Hospital-acquired and ventilator-associated pneumonia.
Related drugs
Related conditions
← 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: DailyMed - TIGECYCLINE injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2026); Tigecycline Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Structure of the Wild-type 70S E coli ribosome bound to Tigecycline (RCSB Protein Data Bank, 2026).
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Representative model, for educational purposes only.