Reserved for highly resistant infections or when significant allergies restrict other options and when there is documented susceptibility
Associated with more treatment failures than alternatives and excess mortality - Black Box Warning
Pregnancy: No reports describing the use of tigecycline in human pregnancy have been published. In one animal species, exposures close to those obtained in humans that did not cause maternal toxicity did result in reduced fetal weight and minor skeletal anomalies. Similar to other tetracyclines, tigecycline can permanently discolor the teeth if used in the second half of pregnancy so use in the second and third trimester should be avoided. Inadvertent or planned use in the first trimester probably does not represent a major risk to the embryo or fetus but there is not enough information available to confirm this.
Breastfeeding: No information on tigecycline use during breastfeeding is available. Tigecycline is known to enter milk in rat species but was not detected systemically in rat pups, likely because of its low oral bioavailability. It would be unlikely that an infant would be exposed to clinical relevant amounts of tigecycline via breastmilk with short courses but repeated exposure and courses greater than 3 weeks should be avoided due to know the known risks of other tetracyclines.
Coagulation parameters (including aPTT, PTT, fibrinogen)
Liver function tests
Avoid or use with caution in patients with tetracycline reactions
GI side effects very prominent with significant nausea and vomiting
Tetracycline related adverse events: photosensitivity, acute pancreatitis
Increased liver enzymes, increased bilirubin, jaundice
Increased INR, prolonged partial thromboplastin time, prolonged prothrombin time
Can increase the concentrations of tacrolimus and warfarin.
Infectious Disease consultation strongly recommended.
Documented safety concerns in bacteremia.
An increase in all-cause mortality has been observed in a meta-analysis of phase 3 and 4 clinical trials in tigecycline treated patients versus comparator
Antimicrobial class: Tetracycline derivative