daptomycin

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	24 hr

Derm: DRUG RASH WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), pruritus, rash

GI: ↑liver enzymes, CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), constipation, diarrhea, nausea, vomiting

GU: renal impairment

Hemat: anemia

Local: injection site reactions

MS: ↑creatine kinase

Neuro: dizziness

Resp: dyspnea, EOSINOPHILIC PNEUMONIA

Misc: ANGIOEDEMA, fever

Interactions ⬆ ⬇

Drug-drug:

Tobramycin↑ blood levels.
Concurrent HMG-CoA reductase inhibitors may ↑ the risk of myopathy.

Route/Dosage ⬆ ⬇

Complicated Skin/Skin Structure Infections

IV (Adults ): 4 mg/kg every 24 hr for 7–14 days.
IV (Children 12–17 yr): 5 mg/kg every 24 hr for up to 14 days.
IV (Children 7–11 yr): 7 mg/kg every 24 hr for up to 14 days.
IV (Children 2–6 yr): 9 mg/kg every 24 hr for up to 14 days.
IV (Children 1–<2 yr): 10 mg/kg every 24 hr for up to 14 days.

Renal Impairment

IV (Adults ): CCr <30 mL/min: 4 mg/kg every 48 hr for 7–14 days; Hemodialysis and CAPD: 4 mg/kg every 48 hr for 7–14 days with dose administered after hemodialysis on hemodialysis days.

Staphylococcus aureus Bacteremia/Right-Sided Infective Endocarditis

IV (Adults ): 6 mg/kg every 24 hr for 2–6 wk.

Renal Impairment

IV (Adults ): CCr <30 mL/min: 6 mg/kg every 48 hr for 2–6 wk; Hemodialysis and CAPD: 6 mg/kg every 48 hr for 2–6 wk with dose administered after hemodialysis on hemodialysis days.

Staphylococcus aureus Bacteremia

IV (Children 12–17 yr): 7 mg/kg every 24 hr for up to 42 days.
IV (Children 7–11 yr): 9 mg/kg every 24 hr for up to 42 days.
IV (Children 1–6 yr): 12 mg/kg every 24 hr for up to 42 days.

Availability ⬆ ⬇

(Generic available)

Lyophilized powder for injection: 350 mg/vial; 500 mg/vial

Assessment ⬆ ⬇

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of CDAD. May begin up to several wk following cessation of therapy.
Monitor for signs and symptoms of eosinophilic pneumonia (new onset or worsening fever, dyspnea, difficulty breathing, new infiltrates on chest imaging studies). Discontinue daptomycin if symptoms occur.
Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, and/or facial swelling), associated with involvement of other organ systems (hepatitis, nephritis, hematologic abnormalities, myocarditis, myositis) during therapy. May resemble an acute viral infection. Eosinophilia is often present. Discontinue therapy if signs occur.
Monitor for development of muscle pain or weakness, particularly of distal extremities. Discontinue daptomycin in patients with unexplained signs and symptoms of myopathy in conjunction with CK elevation >1000 units/L, or in patients without reported symptoms who have marked elevations in CK >2000 units/L. Consider temporarily suspending agents associated with rhabdomyolysis (HMG-CoA reductase inhibitors) in patients receiving daptomycin.

Lab Test Considerations:

Monitor CK weekly, more frequently in patients with unexplained ↑. Discontinue daptomycin if CK >1000 units/L and signs and symptoms of myopathy occur. In patients with renal insufficiency, monitor both renal function and CK more frequently.
- May cause false prolongation of PT and ↑ INR.
- Monitor renal function prior to and periodically during therapy. If new or worsening renal impairment occurs, evaluate renal function. If tubulointerstitial nephritis is suspected, discontinue daptomycin and begin treatment.

Implementation ⬆ ⬇

Do not confuse daptomycin with dactinomycin.

IV Administration:

IV Push: Reconstitution: Reconstitute 500-mg vial with 10 mL of 0.9% NaCl inserted toward wall of vial. Rotate vial gently to wet powder. Allow to stand for 10 min undisturbed. Swirl vial gently to completely reconstitute solution. Reconstituted vials are stable for 12 hr at room temperature or 48 hr if refrigerated. Concentration: 50 mg/mL.
Rate: Administer over 2 min (for adults only).
Intermittent Infusion: Adults:Diluent: Dilute further in 50 mL of 0.9% NaCl for adults, adolescents and children 7 yrs. Solution is stable for 12 hr at room temperature or 48 hr if refrigerated. Do not administer solutions that are cloudy or contain a precipitate.
Rate: Infuse over 30 min.
Intermittent Infusion: Children 1–6 yrs:Diluent: Dilute further into a 25 mL IV infusion bag of 0.9% NaCl.
Rate: Infuse over 60 min at a rate of 0.42 mL/min.
Intermittent Infusion: Children 7–17 yrs:Diluent: Dilute further into a 50 mL IV infusion bag of 0.9% NaCl.
Rate: Infuse over 30 min at a rate of 1.67 mL/min.
Y-Site Compatibility:
- amifostine
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- amphotericin B liposomal
- ampicillin
- ampicillin/sulbactam
- argatroban
- azithromycin
- aztreonam
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- busulfan
- butorphanol
- calcium chloride
- calcium gluconate
- cangrelor
- carboplatin
- carmustine
- caspofungin
- cefazolin
- cefepime
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftazidime/avibactam
- ceftolozane/tazobactam
- ceftriaxone
- cefuroxime
- chloramphenicol
- chlorpromazine
- ciprofloxacin
- cisatracurium
- cisplatin
- clindamycin
- cyclophosphamide
- cyclosporine
- dacarbazine
- dactinomycin
- daunorubicin hydrochloride
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- eptifibatide
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gentamicin
- glycopyrrolate
- granisetron
- haloperidol
- heparin
- hydralazine
- hydrocortisone
- hydromorphone
- idarubicin
- ifosfamide
- insulin, regular
- irinotecan
- isavuconazonium
- isoproterenol
- ketorolac
- labetalol
- leucovorin calcium
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methadone
- methylprednisolone
- metoclopramide
- metoprolol
- midazolam
- milrinone
- mitoxantrone
- morphine
- moxifloxacin
- mycophenolate
- nafcillin
- nalbuphine
- naloxone
- nicardipine
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- pemetrexed
- pentamidine
- phenobarbital
- phentolamine
- phenylephrine
- piperacillin/tazobactam
- posaconazole
- potassium acetate
- potassium chloride
- potassium phosphate
- procainamide
- prochlorperazine
- promethazine
- propranolol
- rocuronium
- sodium acetate
- sodium bicarbonate
- sodium phosphate
- succinylcholine
- tacrolimus
- tedizolid
- theophylline
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trimethoprim/sulfamethoxazole
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- acyclovir
- alemtuzumab
- allopurinol
- amphotericin B lipid complex
- blinatumomab
- cytarabine
- D5W
- dantrolene
- gemcitabine
- gemtuzumab ozogamicin
- imipenem/cilastatin
- meropenem/vaborbactam
- methotrexate
- metronidazole
- minocycline
- mitomycin
- nitroglycerin
- pantoprazole
- pentobarbital
- phenytoin
- plazomicin
- remifentanil
- sufentanil
- thiopental
- vancomycin

Patient/Family Teaching ⬆ ⬇

Inform patient of purpose of daptomycin.
Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient to notify health care professional immediately if weakness, numbness, or tingling in forearms and lower legs, or signs and symptoms of eosinophilic pneumonia or DRESS occur.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding. Monitor infants exposed to daptomycin through breast milk for GI disturbances.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇