Can tigecycline (generic) cause fever?

Tigecycline and Fever: Adverse Effect Profile

Yes, tigecycline can cause fever as an adverse effect, as documented in clinical guidelines and case reports. 1

Evidence for Tigecycline-Induced Fever

Fever is not listed among the most common adverse effects of tigecycline, but it is documented in the British Thoracic Society (BTS) guidelines as a potential side effect. According to these guidelines, fever occurs in approximately 6.3% of patients receiving tigecycline therapy 1.

This is further supported by case reports, including a documented case of tigecycline-induced drug fever accompanied by leukemoid reaction after approximately 3 weeks of therapy 2. In this case, the patient developed high fever that completely resolved within 3 days of discontinuing tigecycline, confirming the causal relationship.

Common Adverse Effects of Tigecycline

The most frequently reported adverse effects of tigecycline include:

• Gastrointestinal effects: nausea (most common), vomiting, diarrhea, abdominal pain, dyspepsia, anorexia 1, 3
• Dermatological: pruritus, rash 1
• Hematological: prolonged activated partial thromboplastin time (aPTT), prolonged prothrombin time (PT) 1
• Hepatic: elevated liver function tests 1
• Metabolic: hypoglycemia, hypoproteinemia 1
• Neurological: dizziness, headache 1
• Vascular: phlebitis 1
• Fever: reported in approximately 6.3% of patients 1, 2

Clinical Considerations

Recognition and Management

• Fever typically develops after several days to weeks of therapy
• Diagnosis is often one of exclusion after ruling out progression of primary infection
• T-cell subset monitoring may facilitate early diagnosis of drug-induced fever 2
• Resolution typically occurs within days of discontinuing the medication

Risk Factors

• Prolonged therapy (approximately 3 weeks in the documented case) 2
• Previous hypersensitivity to tetracyclines 1

Differential Diagnosis

When fever develops during tigecycline therapy, consider:

1. Progression of the primary infection
2. New secondary infection
3. Drug-induced fever from tigecycline or other medications
4. Non-infectious causes of fever

Recommendations for Clinical Practice

• Monitor patients on tigecycline for development of fever, especially after prolonged therapy
• If fever develops, perform a thorough evaluation to rule out worsening infection or new infection
• If tigecycline-induced fever is suspected, consider discontinuation if clinically appropriate
• Document the adverse reaction to prevent re-exposure
• Consider alternative antimicrobial therapy based on culture results and clinical situation

Special Populations

Tigecycline should be used with caution in:

• Patients with hepatic impairment (Child-Pugh class C) - dose reduction required 1
• Pregnant women and children under 8 years (contraindicated) 1
• Patients with previous hypersensitivity to tetracyclines 1

While fever is not among the most common adverse effects of tigecycline, clinicians should be aware of this potential side effect, particularly when evaluating persistent or new-onset fever in patients receiving this antibiotic.