Nuzyra
Nuzyra (omadacycline) is a tetracycline antibiotic that's used to treat community-acquired bacterial pneumonia and skin infections in adults. It's available as a tablet taken by mouth and an injection into the veins (IV). On the first day of treatment, Nuzyra (omadacycline) might be given twice during the day. After that, it's taken once per day until treatment is complete. Side effects can include nausea and vomiting. Nuzyra (omadacycline) is currently available as a brand-name medication only.
What is Nuzyra (omadacycline)?
What is Nuzyra (omadacycline) used for?
Skin infections (e.g., cellulitis)
How Nuzyra (omadacycline) works
Nuzyra (omadacycline) is a tetracycline antibiotic. It stops bacteria from making certain proteins that they need for growth and survival.
Drug Facts
What are the side effects of Nuzyra (omadacycline)?
Common Side Effects
- Nausea (22%)
- Vomiting (11%)
- Elevated liver enzyme levels (up to 4%)
Other Side Effects
- Stomach pain
- Diarrhea
- Constipation
- Trouble sleeping
- Headache
- Tiredness
- Faster heart rate
- High blood pressure
- Infusion site reactions (e.g., pain, swelling, redness, irritation)
Serious Side Effects
- Clostridioides difficile (C. diff)-associated diarrhea: stomach cramping and pain, frequent loose bowel movements, nausea, fever
- Allergic reaction (anaphylaxis): closing of the throat, trouble breathing, skin rash, swelling of the face
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Increased pressure around the brain—severe headache, blurry vision, change in vision, nausea, vomiting
- Change in tooth color
- Severe diarrhea, fever
- Skin reactions on sun-exposed areas
- Unusual vaginal discharge, itching, or odor
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Constipation
- Headache
- Nausea
- Trouble sleeping
- Vomiting
Pros and cons of Nuzyra (omadacycline)
Pros
Works against a wide range of bacteria, including some resistant bacteria
Taken once a day (after the first day of treatment)
Safe for people who have kidney or liver problems
Cons
Need take the tablets on an empty stomach (requires specific timing)
Not safe for use in children, during pregnancy, or while breastfeeding
No lower-cost generic available; a brand-name medication only
Pharmacist tips for Nuzyra (omadacycline)
On the first day of your treatment with Nuzyra (omadacycline), you'll take a one-time dose that's higher called a loading dose to help the antibiotic start to work faster. Then, you'll continue to take the medication at a lower dose for the rest of treatment.
Take Nuzyra (omadacycline) exactly as prescribed. Finish all of the Nuzyra (omadacycline) tablets that were prescribed to you, even if you no longer feel sick. Your infection might come back and be even harder to treat if you skip any doses or stop taking the antibiotic early.
Take Nuzyra (omadacycline) on an empty stomach. Don't eat or drink anything, except for water, for 4 hours before and 2 hours after you take your dose of Nuzyra (omadacycline). Take the antibiotic with water only.
Don't eat or drink any dairy products for 4 hours before and 4 hours after you take a dose of Nuzyra (omadacycline). The antibiotic can interact with dairy products; the interaction can make your body absorb less of the antibiotic, so it might not work as well to treat your infection.
Take Nuzyra (omadacycline) 4 hours apart from antacids containing aluminum, calcium, and magnesium; bismuth subsalicylate (Pepto Bismol); iron supplements; or multivitamins. Taking these products and Nuzyra (omadacycline) at the same time can make your body absorb less of the antibiotic, which can possibly make it work less well to treat your infection.
If you're taking a blood thinner, such as Eliquis (apixaban) or warfarin (Coumadin), let the healthcare professional (HCP) managing your blood thinner therapy that you're taking Nuzyra (omadacycline). Taking this antibiotic with blood thinners might make it take longer for any bleeding to stop. The HCP might lower the dose of your blood thinner to prevent the risk of serious bleeding while you're taking this antibiotic.
Tell your prescriber if you're pregnant or thinking of becoming pregnant. You should avoid taking Nuzyra (omadacycline) while pregnant because of the risk of growth problems and permanent tooth discoloration in babies. Your prescriber will probably switch your treatment to a different antibiotic that's safer.
It isn't recommended to breastfeed while you're taking Nuzyra (omadacycline) and for 4 days after your last dose. It's not known whether the antibiotic would affect your breastfed baby, but there's potential for serious complications like bone growth and teeth problems if it does. Let your prescriber know if you're breastfeeding.
Frequently asked questions about Nuzyra (omadacycline)
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What are the risks and warnings for Nuzyra (omadacycline)?
Nuzyra (omadacycline) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
More reported deaths in studies when treating pneumonia
Risk factors: Taking Nuzyra (omadacycline) for pneumonia | Older than 65 years of age | Multiple health conditions
In clinical studies, 8 deaths happened in the group of people who took Nuzyra (omadacycline) to treat pneumonia. In comparison, 4 people who took another antibiotic called moxifloxacin (Avelox) died during the same study. For these reported deaths, people were older than 65 and had multiple health conditions. The causes of the deaths included worsening of the infection and the person's health condition. It's not known why there were more deaths reported with Nuzyra (omadacycline), so talk to your prescriber if you're concerned about taking this medication.
Color changes to the teeth
Risk factors: Age 8 or younger | Taking Nuzyra (omadacycline) during the second and third trimester of pregnancy | Taking Nuzyra (omadacycline) for a long time | Taking many short course of treatment with Nuzyra (omadacycline)
Tetracycline antibiotics like Nuzyra (omadacycline) can affect the teeth when they're still growing in young children. Usually, the teeth will permanently turn a yellow, gray, or brown color. In addition, as the teeth grow, they might not be as strong because the medication also affects their protective outer covering (enamel). Nuzyra (omadacycline) can also affect the future growth of teeth in an unborn baby if the antibiotic is taken during the second or third trimester of pregnancy. Young children and people who are pregnant shouldn't take Nuzyra (omadacycline) unless there aren't any other medications available.
Slower growth in children
Risk factors: Age 8 or younger | Taking Nuzyra (omadacycline) during the second and third trimester of pregnancy
Nuzyra (omadacycline) can slow down bone growth in young children. Bone growth usually goes back to normal once the medication is stopped. Nuzyra (omadacycline) can also affect bone growth in an unborn baby if the antibiotic is taken during the second or third trimester of pregnancy. Young children and people who are pregnant shouldn't take Nuzyra (omadacycline) unless there aren't any other medications available and the benefits are greater than the risks.
Allergic reaction
Risk factors: Allergic reaction to another tetracycline antibiotic
Stop taking Nuzyra (omadacycline) and get medical attention as soon as possible if you have any of these signs of an allergic reaction to the antibiotic. These signs can include a tingling sensation, swelling in the face, shortness of breath, itching, or a skin rash. Call 911 right away if you experience anaphylaxis or closing of the throat because this is a serious life-threatening allergic reaction. Tell your care team before you start treatment if you've ever had an allergic reaction to another tetracycline antibiotic; you might have an allergic reaction to Nuzyra (omadacycline) too.
Severe infectious diarrhea (called C. diff-associated diarrhea or CDAD)
Risk factors: Previous C. diff infection | Recent hospital visit | Age 65 or older | Weakened immune system
Nuzyra (omadacycline) can raise your risk of getting infected with a bacteria called Clostridioides difficile (C. diff). Like many other bacteria, C.diff naturally lives in your gut and doesn't normally cause any problems. But taking antibiotics like Nuzyra (omadacycline) can cause C. diff to grow out of control in the gut. This can lead to an infection that causes severe and sometimes life-threatening diarrhea.
Let your care team know about your medical history before you start Nuzyra (omadacycline). Your risk for CDAD is higher if you're over the age of 65 or if you have a weakened immune system. Also note that CDAD can develop a couple months after you stop taking the antibiotic.
Contact your healthcare team right away if you experience fever, tiredness, bloody or watery stool, or very frequent diarrhea. These might be signs of CDAD and you might need treatment for it.
Side effects related to tetracycline antibiotics
Nuzyra (omadacycline) is a tetracycline antibiotic. This means that it's possible for Nuzyra (omadacycline) to cause side effects that other tetracycline antibiotics do.
For example, taking tetracycline antibiotics can make your skin more more sensitive to the sun or ultraviolet (UV) light. This can make it easier for you to get a sunburn. Make sure to wear protective clothing and use sunscreen when you go outside, even on overcast days and during the winter.
Some people have also reported a few more serious side effects from treatment with other tetracycline antibiotics. This includes higher pressure in the brain, leading to headaches and vision problems. Some tetracycline antibiotics can also cause changes in the levels of certain substances in your blood, which can sometimes suggest liver or kidney damage. You'll probably have to stop taking Nuzyra (omadacycline) if you experience these tetracycline antibiotic-related side effects.
Drug-resistant bacteria
Taking Nuzyra (omadacycline) can raise your risk of developing other infections caused by drug-resistant bacteria or fungi. Since Nuzyra (omadacycline) fights against only certain bacteria, it can cause other bacteria or fungi to grow out of control. This can lead to infections that are very hard to treat.
Take Nuzyra (omadacycline) exactly as prescribed. Talk to your prescriber before changing your dose or stopping the medication. Contact your healthcare team if your infection doesn't seem to be getting better with treatment or if you have new symptoms of infection, such as fever and chills.
Nuzyra (omadacycline) dosage forms
Typical dosing for Nuzyra (omadacycline)
Nuzyra (omadacycline) tablets
Pneumonia: The typical dose is 300 mg by mouth twice a day on day 1, then 300 mg by mouth once a day for the rest of treatment. Take the tablets on an empty stomach with water.
Skin infections: The typical dose is 450 mg by mouth once a day on days 1 and 2, then 300 mg by mouth once a day for the rest of treatment. Take the tablets on an empty stomach with water.
Nuzyra (omadacycline) IV infusion
Pneumonia and skin infections: The typical starting dose is 200 mg IV over 60 minutes or 100 mg IV over 30 minutes twice on day 1. Then for the rest of treatment, the typical dose is 100 mg IV over 30 minutes once a day.
The typical length of treatment is 7 to 14 days.
Nuzyra (omadacycline) contraindications
Allergy to any tetracycline antibiotic
What are alternatives to Nuzyra (omadacycline)?
Skin infections (e.g., cellulitis)
Lung infections (such as pneumonia)
Infections caused by ticks, mites, or fleas (Rocky Mountain spotted fever or typhus fever)
Sexually transmitted infections (STIs such as chlamydia, gonorrhea, or syphilis)
Urinary tract infections (UTIs)
Stomach infections
Severe acne
Anthrax
Plague
Cholera
Rosacea
Lung infections (e.g., community acquired pneumonia, chronic bronchitis flare-ups)
Skin infections
Gut infections
Sinus infections
Nuzyra (omadacycline) images
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References
Best studies we foundCenters for Disease Control and Prevention. (2024). About C. diff.
Centers for Disease Control and Prevention. (2024). Methicillin-resistant Staphylococcus aureus (MRSA) basics.
Durães, F., et al. (2019). Omadacycline: A newly approved antibacterial from the class of tetracyclines. Pharmaceuticals.
Gallagher, J. C. (2019). Omadacycline: A modernized tetracycline. Clinical Infectious Diseases.
Lin, F., et al. (2023). Omadacycline for treatment of acute bacterial infections: A meta-analysis of phase II/III trials. BioMed Central Infectious Diseases.
Paratek Pharmaceuticals, Inc. (2024). Nuzyra- omadacycline injection, powder, lyophilized, for solution; Nuzyra- omadacycline tablet, film coated [package insert]. DailyMed.
Stets, R., et al. (2019). Omadacycline for community-acquired bacterial pneumonia. The New England Journal of Medicine.
Tzanis, E., et al. (2017). Effect of food on the bioavailability of omadacycline in healthy participants. Journal of Clinical Pharmacology.
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