DAPTOMYCIN
| DAPTOMYCIN (dap-to-my'sin) Cubicin Classifications: antibiotic; lipopeptide; Therapeutic: antibiotic; lipopeptide Pregnancy Category: B |
Availability
500 mg vial
Action
Daptomycin is cyclic lipopeptide antibiotic. It binds to bacterial membranes of gram-positive bacteria causing rapid depolarization of the membrane potential leading to inhibition of protein, DNA, and RNA synthesis and bacterial cell death.
Therapeutic Effect
Daptomycin is effective against a broad spectrum of gram-positive organisms, including both susceptible and resistant strains of S. aureus.
Uses
Complicated skin and skin structure infections, bacteremia.
Unlabeled Uses
Vancomycin-resistant enterococci.
Contraindications
Pseudomembranous colitis. Safe use in infants or children <18 y is not known.
Cautious Use
Severe renal or hepatic impairment, end-stage renal impairment; peripheral neuropathy; GI disease; history of rhabdomyolysis, myopathy; elderly; pregnancy (category B), lactation.
Route & Dosage
| Skin Infections Adult: IV 4 mg/kg q24h x 7–14 d Bacteremia (S. aureus) Adult: IV 6 mg/kg x 2–6 wk Renal Impairment Skin infection: Clcr <30 mL/min: 4 mg/kg q48h; bacteremia: Clcr <30 mL/min: 6 mg/kg q48h Hemodialysis: Dose by Clcr, administer after dialysis |
Administration
| Intravenous PREPARE: IV Infusion: Reconstitute the 250 mg vial or the 500 mg vial with 5 mL or 10 mL, respectively, of NS to yield 50 mg/mL. Further dilute the 50 mg/mL solution in 50–100 mL of NS. ADMINISTER: IV Infusion: Infuse over 30 min; if same IV line is used for infusion of other drugs, flush line before/after with NS. INCOMPATIBILITIES Solution/additive: Dextrose-containing solutions. |
- Store unopened vials in 2°–8° C (36°–46° F). Avoid excessive heat. May store reconstituted, single-use vials or IV solution for 12 h at room temperature or 48 h if refrigerated.
Adverse Effects (≥1%)
Body as a Whole: Injection site reactions, fever, fungal infections. CNS: Headache, insomnia, dizziness. CV: Hypotension, hypertension. GI: Constipation, nausea, vomiting, diarrhea, abnormal liver function tests. Hematologic: Anemia. Metabolic: Elevated CPK. Musculoskeletal: Limb pain, arthralgia. Respiratory: Dyspnea. Skin: Rash, pruritus. Urogenital: UTIs, renal failure.Interactions
Drug: Significant reactions not identified.Pharmacokinetics
Elimination: Primarily renal. Half-Life: 8 h.Nursing Implications
Assessment & Drug Effects
- Monitor for and report: muscle pain or weakness, especially with concurrent therapy with HMG-CoA reductase inhibitors (statin drugs); S&S of peripheral neuropathy, superinfection such as candidiasis.
- Lab tests: Perform C&S before treatment is begun; baseline renal function tests; weekly CPK levels; PT/INR during first few days of daptomycin therapy with concurrent warfarin use; daily blood glucose monitoring in diabetics; serum electrolytes if S&S of hypokalemia or hypomagnesemia (see Appendix F) appear.
- Withhold drug and notify physician if S&S of myopathy develop with CPK elevation >1000 U/L (
5
x ULN), or if CPK level is ≥10 x ULN.
Patient & Family Education
- Report any of the following to the physician: muscle pain, weakness or unusual tiredness; numbness or tingling; difficulty breathing or shortness of breath; severe diarrhea or vomiting; skin rash or itching.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug