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daptomycin (Rx)Brand and Other Names:Cubicin

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

lyophilized powder for reconstitution

  • 500mg/vial
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Skin Infections

4 mg/kg IV infusion q24hr for 7-14 days 

Staphylococcus Aureus Bacteremia (Including Endocarditis)

6 mg/kg IV infusion q24hr for at least 2-6 weeks 

Complicated Skin & Skin Structure Gram-Positive Bacterial Infections

6 mg/kg IV q24hr for 2-4 weeks

Spectrum of action

  • Staphylococcus aureus (including MRSA)
  • Streptococcus pyogenes
  • Streptococcus agalactiae
  • Streptococcus dysgalactiae ssp equisimilis
  • Enterococcus faecalis (vancomycin-susceptible)

Dosage Modifications

Renal impairment

  • CrCl <30 mL/min: Give same dose q48hr
  • On hemodialysis days, administer after hemodialysis

Dosing Considerations

Monitor creatine phosphokinase (CPK)

<18 years: Safety and efficacy not established

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Interactions

Interaction Checker

daptomycin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Insomnia (9.0%)

            Pharyngolaryngeal pain (8.0%)

            Chest pain (7.0%)

            Elevated blood creatine phosphokinase (7.0%)

            Edema (7.0%)

            Abdominal pain (6.0%)

            Hypertension (6.0%)

            Pruritus (6.0%)

            Headache (5.4%)

            Diarrhea (5.2%)

            Sweating (5.0%)

            Bacteremia (5.0%)

            Sepsis (5.0%)

            Rash (4.3%)

            Abnormal LFTs (3.0%)

            UTI (2.4%)

            Hypotension (2.4%)

            Dizziness (2.2%)

            Dyspnea (2.1%)

            Postmarketing Reports

            Immune system disorders: Anaphylaxis; hypersensitivity reactions, including angioedema, drug rash with eosinophilia and systemic symptoms (DRESS), pruritus, hives, shortness of breath, difficulty swallowing, truncal erythema, and pulmonary eosinophilia; consider treatment with systemic steroids

            Infections and infestations: Clostridium difficile–associated diarrhea

            Musculoskeletal disorders: myoglobin increased; rhabdomyolysis;

            Respiratory, thoracic, and mediastinal disorders: Cough, eosinophilic pneumonia

            Nervous system disorders: Peripheral neuropathy

            Skin and subcutaneous tissue disorders: Serious skin reactions, including Stevens-Johnson syndrome and vesiculobullous rash

            Gastrointestinal disorders: Nausea, vomiting

            Special senses: Visual disturbances

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Pseudomembranous colitis has been reported; may range from mild to life-threatening

            Use cautiously in patients with peripheral neuropathies and myopathy; consider discontinuation

            Discontinue with symptoms of myopathy and CPK >1000 U/L (>5x ULN), or no symptoms and CPK >2000 U/L (>10x ULN)

            CPK elevations more prevalent if dosed more frequently than q24hr

            Consider suspending statins during daptomycin therapy; theoretical risk of additive myopathy

            Monitor INR closely for several days if on warfarin

            May cause eosinophilic pneumonia characterized by fever, cough, shortness of breath, and difficulty breathing; may result in progressive respiratory failure and is potentially fatal

            Prolonged use may result in fungal or bacterial superinfection

            Perform susceptibility testing and rule out sequestered foci of infection if persisting or relapsing S. aureus bacteremia/endocarditis occurs

            Evaluate patients for Clostridium difficile if diarrhea occurs

            Avoid use in pediatric patients <12 months; potential nervous system or muscular system effects

            Decreased efficacy reported in patients with moderate baseline renal impairment

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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Present in human milk but is poorly bioavailable orally; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Cyclic lipopeptide: Binds to bacterial membranes and causes rapid depolarization of membrane potential; causes inhibition of protein, DNA, RNA synthesis, and bacterial cell death

            Absorption

            Peak plasma time

            • 0.5-0.8 hr

            Peak plasma concentration

            • 4 mg/kg dose: 58 mcg/mL
            • 6 mg/kg dose: 94 mcg/mL

            AUC

            • 4 mg/kg dose: 494 mcg•hr/mL
            • 6 mg/kg dose: 632 mcg•hr/mL

            Distribution

            Protein bound: 92%

            Vd: 0.1 L/kg

            Elimination

            Half-life: 8 hr

            Dialyzable: 11-15% of dose removed by continuous ambulatory peritoneal dialysis/hemodialysis

            Renal clearance: 3.7-4.8 mL/hr/kg

            Total body clearance: 8-9 mL/hr/kg

            Excretion: Urine (78%)

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            Administration

            IV Incompatibilities

            Solution: Dextrose-containing diluents

            Do not admix with other drugs

            IV Compatibilities

            Solution: NS, LR

            IV Preparation

            Reconstitute 500 mg vial with 10 mL NS; dilute further with NS for infusion using aseptic technique (no preservatives or bacteriostatic agents)

            Reconstituted solution and diluted infusion solution stable for 12 hr at room temperature and 48 hr at 2-8°C, but do not exceed combined storage time of 12 hr at room temperature and 48 hr refrigerated

            IV Administration

            Administer intravenously in 0.9% sodium chloride either by injection over 2 min or infusion over 30 min

            Do not use in conjunction with ReadyMED elastometric infusion pumps

            On hemodialysis days, administer after hemodialysis

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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