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Tygacil

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Tygacil

Side Effects
Interactions

SIDE EFFECTS

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

In clinical trials, 2514 patients were treated with TYGACIL. TYGACIL was discontinued due to adverse reactions in 7% of patients compared to 6% for all comparators. Table 1 shows the incidence of treatment-emergent adverse reactions through test of cure reported in ≥ 2% of patients in these trials.

Table 1: Incidence (%) of Adverse Reactions Through Test of Cure Reported in ≥ 2% of Patients Treated in Clinical Studies

Body System
Adverse Reactions
TYGACIL
(N=2514)
Comparatorsa
(N=2307)
Body as a Whole
  Abdominal pain 6 4
  Abscess 2 2
  Asthenia 3 2
  Headache 6 7
  Infection 7 5
Cardiovascular System
  Phlebitis 3 4
Digestive System
  Diarrhea 12 11
  Dyspepsia 2 2
  Nausea 26 13
  Vomiting 18 9
Hemic and Lymphatic System
  Anemia 5 6
Metabolic and Nutritional
  Alkaline Phosphatase 3 3
Increased
  Amylase Increased 3 2
  Bilirubinemia 2 1
  BUN Increased 3 1
  Healing Abnormal 3 2
  Hyponatremia 2 1
  Hypoproteinemia 5 3
  SGOT Increasedb 4 5
  SGPT Increasedb 5 5
Respiratory System
  Pneumonia 2 2
Nervous System
  Dizziness   3 3
Skin and Appendages
  Rash 3 4
aVancomycin/Aztreonam, Imipenem/Cilastatin, Levofloxacin, Linezolid.
bLFT abnormalities in TYGACIL-treated patients were reported more frequently in the post therapy period than those in comparator-treated patients, which occurred more often on therapy.

In all 13 Phase 3 and 4 trials that included a comparator, death occurred in 4.0% (150/3788) of patients receiving TYGACIL and 3.0% (110/3646) of patients receiving comparator drugs. In a pooled analysis of these trials, based on a random effects model by trial weight, an adjusted risk difference of all-cause mortality was 0.6% (95% CI 0.1, 1.2) between TYGACIL and comparator-treated patients (see Table 2). The cause of the imbalance has not been established. Generally, deaths were the result of worsening infection, complications of infection or underlying co-morbidities.

Table 2: Patients with Outcome of Death by Infection Type

Infection Type TYGACIL n/N % Comparator n/N % Risk Difference* % (95% CI)
cSSSI 12/834 1.4 6/813 0.7 0.7 (-0.3, 1.7)
cIAI 42/1382 3.0 31/1393 2.2 0.8 (-0.4, 2.0)
CAP 12/424 2.8 11/422 2.6 0.2 (-2.0, 2.4)
HAP 66/467 14.1 57/467 12.2 1.9 (-2.4, 6.3)
  Non-VAPa 41/336 12.2 42/345 12.2 0.0 (-4.9, 4.9)
  VAPa 25/131 19.1 15/122 12.3 6.8 (-2.1, 15.7)
RP 11/128 8.6 2/43 4.7 3.9 (-4.0, 11.9)
DFI 7/553 1.3 3/508 0.6 0.7 (-0.5, 1.8)
Overall Adjusted 150/3788 4.0 110/3646 3.0 0.6 (0.1, 1.2)**
CAP = Community-acquired pneumonia; cIAI = Complicated intra-abdominal infections; cSSSI = Complicated skin and skin structure infections; HAP = Hospital-acquired pneumonia; VAP = Ventilator-associated pneumonia; RP = Resistant pathogens; DFI = Diabetic foot infections.
* The difference between the percentage of patients who died in TYGACIL and comparator treatment groups. The 95% CI for each infection type was calculated using the normal approximation method without continuity correction.
** Overall adjusted (random effects model by trial weight) risk difference estimate and 95% CI.
aThese are subgroups of the HAP population. Note: The studies include 300, 305, 900 (cSSSI), 301, 306, 315, 316, 400 (cIAI), 308 and 313 (CAP), 311 (HAP), 307 [Resistant gram-positive pathogen study in patients with MRSA or Vancomycin-Resistant Enterococcus (VRE)], and 319 (DFI with and without osteomyelitis).

In comparative clinical studies, infection-related serious adverse events were more frequently reported for subjects treated with TYGACIL (7%) versus comparators (6%). Serious adverse events of sepsis/septic shock were more frequently reported for subjects treated with TYGACIL (2%) versus comparators (1%). Due to baseline differences between treatment groups in this subset of patients, the relationship of this outcome to treatment cannot be established [see WARNINGS AND PRECAUTIONS].

The most common treatment-emergent adverse reactions were nausea and vomiting which generally occurred during the first 1 – 2 days of therapy. The majority of cases of nausea and vomiting associated with TYGACIL and comparators were either mild or moderate in severity. In patients treated with TYGACIL, nausea incidence was 26% (17% mild, 8% moderate, 1% severe) and vomiting incidence was 18% (11% mild, 6% moderate, 1% severe).

In patients treated for complicated skin and skin structure infections (cSSSI), nausea incidence was 35% for TYGACIL and 9% for vancomycin/aztreonam; vomiting incidence was 20% for TYGACIL and 4% for vancomycin/aztreonam. In patients treated for complicated intraabdominal infections (cIAI), nausea incidence was 25% for TYGACIL and 21% for imipenem/cilastatin; vomiting incidence was 20% for TYGACIL and 15% for imipenem/cilastatin. In patients treated for community-acquired bacterial pneumonia (CABP), nausea incidence was 24% for TYGACIL and 8% for levofloxacin; vomiting incidence was 16% for TYGACIL and 6% for levofloxacin. Discontinuation from tigecycline was most frequently associated with nausea (1%) and vomiting (1%). For comparators, discontinuation was most frequently associated with nausea ( < 1%).

The following adverse reactions were reported infrequently ( < 2%) in patients receiving TYGACIL in clinical studies:

Body as a Whole: injection site inflammation, injection site pain, injection site reaction, septic shock, allergic reaction, chills, injection site edema, injection site phlebitis

Cardiovascular System: thrombophlebitis

Digestive System: anorexia, jaundice, abnormal stools

Metabolic/Nutritional System: increased creatinine, hypocalcemia, hypoglycemia

Special Senses: taste perversion

Hemic and Lymphatic System: partial thromboplastin time (aPTT), prolonged prothrombin time (PT), eosinophilia, increased international normalized ratio (INR), thrombocytopenia

Skin and Appendages: pruritus

Urogenital System: vaginal moniliasis, vaginitis, leukorrhea

Post-Marketing Experience

The following adverse reactions have been identified during postapproval use of TYGACIL. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish causal relationship to drug exposure.

Read the Tygacil (tigecycline) Side Effects Center for a complete guide to possible side effects

DRUG INTERACTIONS

Warfarin

Prothrombin time or other suitable anticoagulation test should be monitored if tigecycline is administered with warfarin [see CLINICAL PHARMACOLOGY].

Oral Contraceptives

Concurrent use of antibacterial drugs with oral contraceptives may render oral contraceptives less effective.

Read the Tygacil Drug Interactions Center for a complete guide to possible interactions

Last reviewed on RxList: 10/10/2013
This monograph has been modified to include the generic and brand name in many instances.

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Tygacil - User Reviews

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