Abametapir and Eravacycline: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jun 30, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Abametapir
No brand names on recordEravacycline
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Abametapir is a lotion used on the scalp to treat head lice. Even though you rub it on your skin, a little gets into your body and can briefly slow down a liver enzyme called CYP3A4. This enzyme helps break down many medicines, including eravacycline (Xerava), an antibiotic given by IV.
When that enzyme is slowed, more eravacycline can build up in your body than expected, which could raise the chance of side effects. The good news is this is easy to plan around. Your care team can space the two out or pick another option, so let your pharmacist or doctor know if you have used the lice lotion recently.
Mechanism: Abametapir inhibits CYP3A4. Eravacycline is partly metabolized by CYP3A4, so concurrent use is expected to increase eravacycline exposure (higher AUC/Cmax) and potential toxicity. Direction: increased substrate effect. Neither agent is a prodrug requiring activation.
- Onset: rapid
- Severity: major
- Evidence: theoretical (based on abametapir's known CYP3A4 inhibition, not direct study of this pair)
Management: Avoid CYP3A4 substrates, including eravacycline, within 2 weeks after topical abametapir application. If avoidance is not feasible, do not use abametapir. Consider an alternative antibiotic or defer lice treatment, and monitor for enhanced eravacycline effects if co-administration is unavoidable.
What happens
Increased exposure of CYP3A4 substrate
Interaction Deep Dive
Within a 2-week window following abametapir application, the use of CYP3A4 substrates should be avoided. When avoiding such substrates is not possible, then abametapir itself should not be used1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism by abametapir
How to manage this interaction
This interaction is manageable with timing and planning by your care team.
- Keep taking your prescribed antibiotic unless your doctor tells you otherwise.
- The main strategy is separation in time: abametapir can affect the CYP3A4 enzyme for up to 2 weeks after you apply it, so your team may avoid the antibiotic during that window or choose a different treatment.
- Tell your pharmacist or prescriber if you have recently used the lice lotion, or if lice treatment is planned.
- If both must be used, your team may monitor you more closely for side effects.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Abametapir and Eravacycline together?
Abametapir can raise eravacycline levels by slowing its breakdown, so avoid the antibiotic within 2 weeks of using the lice lotion; if that is not possible, skip the lice lotion. Check with your pharmacist or doctor before combining them. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abametapir and Eravacycline interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How is the Abametapir and Eravacycline interaction managed?
This interaction is manageable with timing and planning by your care team. Keep taking your prescribed antibiotic unless your doctor tells you otherwise. The main strategy is separation in time: abametapir can affect the CYP3A4 enzyme for up to 2 weeks after you apply it, so your team may avoid the antibiotic during that window or choose a different treatment. Tell your pharmacist or prescriber if… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Abametapir or Eravacycline need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: XEGLYZE(TM) topical lotion, abametapir topical lotion. Dr Reddy’s Laboratories Inc (per FDA), Princeton, NJ, 2020. DailyMed
Keep reading about Abametapir
Keep reading about Eravacycline
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