AHFS Class:

8:12.28.32 Streptogramins

Quinupristin-dalfopristin is available as a lyophilized powder in single-dose vials containing a total of 500 mg of the two pristinamycin derivatives (quinupristin 150 mg and dalfopristin 350 mg).³²²⁹ The 500-mg vial should be reconstituted with 5 mL of dextrose 5% or sterile water for injection and gently swirled (without shaking) to facilitate dissolution while limiting foam formation.³²²⁹ The reconstituted solution should be allowed to sit for a few minutes until all of the foam has dissipated and a clear 100-mg/mL solution has formed; this solution must be diluted for administration.³²²⁹

The appropriate dose of quinupristin-dalfopristin should be added to an infusion bag containing 250 mL of dextrose 5%.³²²⁹ For central line administration, 100 mL of dextrose 5% may be used for dilution.³²²⁹

Diluted solutions of quinupristin-dalfopristin for infusion should be visually inspected for particulate matter prior to administration.³²²⁹

Trade Name(s)

Synercid

Quinupristin-dalfopristin is administered by intravenous infusion over 60 minutes following dilution of the reconstituted solution in dextrose 5%; other infusion rates are not recommended.³²²⁹ An infusion pump or device may be used to control the rate of infusion.³²²⁹

If moderate-to-severe venous irritation occurs during peripheral administration of the reconstituted solution diluted in 250 mL of dextrose 5%, consideration should be given to increasing the infusion volume to 500 or 750 mL, changing the infusion site, or infusing through a peripherally inserted central catheter (PICC) or central venous catheter.³²²⁹

If a common infusion line is used for the intermittent infusion of quinupristin-dalfopristin and other drugs, the manufacturer recommends flushing the line with dextrose 5% prior to and following administration of quinupristin-dalfopristin.³²²⁹ The vein also should be flushed with dextrose 5% following completion of peripheral administration of the drug in order to minimize venous irritation; the vein should not be flushed with sodium chloride or heparin after drug administration.³²²⁹

Intact vials of quinupristin-dalfopristin should be stored under refrigeration.³²²⁹ Although refrigerated storage is required, one manufacturer has stated that the drug may be stored at room temperature for 7 days.²⁷⁴⁵ Because no antimicrobial preservative is present, the manufacturer recommends dilution of the reconstituted solution within 30 minutes.³²²⁹ Quinupristin-dalfopristin diluted for infusion in dextrose 5% is stated to be stable for 5 hours at room temperature and 54 hours at 2 to 8°C.³²²⁹

Use of sodium chloride-containing solutions for dilution or flushing is not recommended because of incompatibility.³²²⁹

Freezing Solutions

Diluted solutions of quinupristin-dalfopristin for infusion should not be frozen.³²²⁹

Solution Compatibility

Y-Site Injection Compatibility (1:1 Mixture)

For a list of references cited in the text of this monograph, search the monograph titled References.

ASHP^® Injectable Drug Information^TM. Selected Revisions December 12, 2018. © Copyright, 2024. American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.