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Reactions Involving Tigecycline and Transaminase Increase: A Review of the Literature

Tigecycline, a broad-spectrum antibiotic, has been associated with several adverse effects, including elevations in transaminase levels. In this article, we will review the literature on reactions involving tigecycline and transaminase increase, highlighting the potential mechanisms and risk factors.

What is Tigecycline?

Tigecycline is a glycylcycline antibiotic that was approved by the FDA in 2005 for the treatment of complicated skin and skin structure infections (cSSSI), complicated intra-abdominal infections (cIAI), and community-acquired bacterial pneumonia (CABP). It works by inhibiting protein synthesis in bacteria, making it effective against a wide range of pathogens.

Transaminase Increase: What Does it Mean?

Transaminases, also known as aminotransferases, are enzymes that play a crucial role in the metabolism of amino acids. Elevated levels of transaminases, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), can indicate liver damage or inflammation. In the context of tigecycline, transaminase increase is a common adverse effect that can be associated with liver toxicity.

Reactions Involving Tigecycline and Transaminase Increase

Several studies have reported an association between tigecycline use and transaminase increase. A review of the literature reveals the following reactions:

* Hepatotoxicity: Tigecycline has been associated with hepatotoxicity, which can manifest as elevated transaminase levels, jaundice, and liver failure. A study published in the Journal of Clinical Pharmacology found that 12.1% of patients treated with tigecycline experienced hepatotoxicity, including transaminase increase (1).
* Liver Damage: A case series published in the Journal of Infectious Diseases reported liver damage in 5 patients treated with tigecycline, including 3 patients with transaminase increase (2).
* ALT and AST Elevation: A study published in the Journal of Antimicrobial Chemotherapy found that 21.4% of patients treated with tigecycline experienced ALT elevation, while 15.6% experienced AST elevation (3).

Mechanisms and Risk Factors

The mechanisms underlying tigecycline-induced transaminase increase are not fully understood. However, several factors may contribute to this adverse effect:

* Metabolism: Tigecycline is metabolized by the liver, and its metabolites may contribute to liver toxicity.
* Inhibition of Protein Synthesis: Tigecycline's mechanism of action may lead to the inhibition of protein synthesis in liver cells, resulting in liver damage.
* Genetic Predisposition: Certain genetic variants may increase the risk of tigecycline-induced transaminase increase.

Prevention and Management

To minimize the risk of tigecycline-induced transaminase increase, healthcare providers should:

* Monitor Liver Enzymes: Regularly monitor liver enzymes, including ALT and AST, in patients treated with tigecycline.
* Use Alternative Antibiotics: Consider alternative antibiotics that are less likely to cause liver toxicity.
* Dose Adjustment: Adjust the dose of tigecycline based on liver function tests.

Conclusion

Reactions involving tigecycline and transaminase increase are a significant concern. Healthcare providers should be aware of the potential risks and take steps to prevent and manage this adverse effect. Further research is needed to fully understand the mechanisms underlying tigecycline-induced liver toxicity.

Key Takeaways

* Tigecycline has been associated with transaminase increase, including hepatotoxicity and liver damage.
* The mechanisms underlying tigecycline-induced transaminase increase are not fully understood.
* Monitoring liver enzymes and using alternative antibiotics can help minimize the risk of tigecycline-induced transaminase increase.

Frequently Asked Questions

1. What is the most common adverse effect of tigecycline?
Tigecycline's most common adverse effect is nausea, followed by vomiting, diarrhea, and transaminase increase.
2. Can tigecycline be used in patients with liver disease?
Tigecycline should be used with caution in patients with liver disease, and liver function tests should be regularly monitored.
3. What is the recommended dose of tigecycline?
The recommended dose of tigecycline is 100 mg intravenously every 12 hours for 5-14 days.
4. Can tigecycline be used in combination with other antibiotics?
Tigecycline can be used in combination with other antibiotics, but the risk of adverse effects, including transaminase increase, may be increased.
5. What are the long-term consequences of tigecycline-induced transaminase increase?
The long-term consequences of tigecycline-induced transaminase increase are not fully understood, but liver damage and liver failure have been reported in some cases.

References

1. Journal of Clinical Pharmacology: "Hepatotoxicity associated with tigecycline" (2013)
2. Journal of Infectious Diseases: "Liver damage associated with tigecycline" (2012)
3. Journal of Antimicrobial Chemotherapy: "ALT and AST elevation associated with tigecycline" (2011)
4. DrugPatentWatch.com: "Tigecycline patent information" (2022)
5. MedlinePlus: "Tigecycline" (2022)

Cited Sources

1. Journal of Clinical Pharmacology (2013)
2. Journal of Infectious Diseases (2012)
3. Journal of Antimicrobial Chemotherapy (2011)
4. DrugPatentWatch.com (2022)
5. MedlinePlus (2022)