section name header

Pronunciation ⬇

dap-to-MYE-sin

Classifications ⬆ ⬇

Therapeutic Classification: anti-infectives

Pharmacologic Classification: cyclic lipopeptide antibacterial agents

Indications ⬆ ⬇

REMS

Action ⬆ ⬇

  • Causes rapid depolarization of membrane potential following binding to bacterial membrane; this results in inhibition of protein, DNA, and RNA synthesis.
Therapeutic effects:
  • Death of bacteria with resolution of infection.

Spectrum:

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Protein Binding: 92%.

Metabolism/Excretion: Metabolism not known; mostly excreted by kidneys.

Half-Life: 8.1 hr.

Time/Action Profile ⬆ ⬇

ROUTEONSETPEAKDURATION
IVrapidend of infusion24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

  • Hypersensitivity.

Use Cautiously in:

  • Severe renal impairment (↓ dose);
  • Moderate to severe renal impairment (may have ↓ clinical response);
  • OB: Safety not established in pregnancy;
  • Lactation: Safety not established in breastfeeding;
  • Pedi: Children <1 yr (↑ risk of muscular, neuromuscular, and CNS effects; avoid use);
  • Geri: Older adults may have ↓ clinical response with ↑ risk of adverse reactions.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, hypotension

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: ↑CK

Neuro: dizziness

Resp: dyspnea, EOSINOPHILIC PNEUMONIA

Misc: ANGIOEDEMA, fever

Interactions ⬆ ⬇

Drug-drug:

  • Tobramycin may ↑ levels and risk of toxicity.
  • HMG-CoA reductase inhibitors may ↑ risk of myopathy; consider discontinuing statin before starting daptomycin; if used with statin, closely monitor CK levels.

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
  • Premixed infusion: 350 mg/50 mL 0.9% NaCl; 500 mg/50 mL 0.9% NaCl; 700 mg/100 mL 0.9% NaCl; 1000 mg/100 mL 0.9% NaCl

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, 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 >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.
  • Monitor for signs and symptoms of peripheral neuropathy during use.

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 impairment, monitor both renal function and CK more frequently.
    • May cause false ↑ PT and INR.
    • Monitor renal function before 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 and children ≥7 yr:Diluent: Dilute contents of reconstituted vial in 50 mL of 0.9% NaCl. 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 yr:Diluent: Dilute contents of reconstituted vial in 25 mL of 0.9% NaCl.
  • Rate: Infuse over 60 min.
  • Y-Site Compatibility:
    • amikacin
    • aminocaproic acid
    • aminophylline
    • amiodarone
    • amphotericin B liposomal
    • ampicillin
    • ampicillin/sulbactam
    • argatroban
    • arsenic trioxide
    • atracurium
    • 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
    • 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
    • letermovir
    • 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
    • rifampin
    • rocuronium
    • sodium acetate
    • sodium bicarbonate
    • sodium phosphate
    • succinylcholine
    • sufentanil
    • 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
    • blinatumomab
    • cytarabine
    • D5W
    • dantrolene
    • gemcitabine
    • gemtuzumab ozogamicin
    • imipenem/cilastatin
    • meropenem/vaborbactam
    • methotrexate
    • metronidazole
    • minocycline
    • mitomycin
    • nitroglycerin
    • pantoprazole
    • pentobarbital
    • phenytoin
    • plazomicin
    • remifentanil
    • sufentanil
    • sulbactam/durlobactam
    • vancomycin

Patient/Family Teaching ⬆ ⬇

  • Explain the purpose and side effects of daptomycin. Advise patient to read Medication Guide before starting and periodically during therapy in case of changes.
  • 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. Instruct patient to avoid using HMG-CoA reductase inhibitors (cholesterol-lowering agents such as atorvastatin, fluvastatin, lovastatin, pitavastatin, simvastatin) unless approved by health care professional, as concurrent use with daptomycin may ↑ risk of myopathy.
  • Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Monitor breastfed infants exposed to daptomycin for GI disturbances.

Evaluation/Desired Outcomes ⬆ ⬇

  • Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

US Brand Names ⬆ ⬇

Cubicin, Cubicin RF

Code ⬆

NDC Code