daptomycin (Rx)

Brand and Other Names:Cubicin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injection, lyophilized powder for reconstitution

  • 500mg/vial (Cubicin and Cubicin RF)
  • 350mg/vial

Staphylococcus Aureus Bacteremia

Indication includes those with right-sided infective endocarditis, caused by methicillin-susceptible and methicillin-resistant isolates

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

Complicated Skin & Skin Structure Infections

Susceptible isolates

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

4 mg/kg IV q24hr for 7-14 days  

Dosage Modifications

Renal impairment

  • Complicated skin & skin structure infections (cSSSI)
    • CrCl ≥30 mL/min: 4 mg/kg IV q24hr
    • CrCl <30 mL/min: 4 mg/kg IV q48hr
    • Hemodialysis and CAPD: 4 mg/kg IV q48hr administer following hemodialysis on hemodialysis days
  • Staphylococcus aureus bacteremia
    • CrCl ≥30 mL/min: 6 mg/kg IV q24hr
    • CrCl <30 mL/min: 6 mg/kg IV q48hr
    • Hemodialysis and CAPD: 6 mg/kg IV q48hr administer following hemodialysis on hemodialysis days

Dosing Considerations

Monitor creatine phosphokinase (CPK)

Limitations of use

  • Not indicated for the treatment of pneumonia
  • Not indicated for the treatment of left-sided infective endocarditis due to S aureus; the clinical trial in adults with S aureus bacteremia included limited data from patients with left-sided infective endocarditis; outcomes in these patients were poor
  • Has not been studied in patients with prosthetic valve endocarditis
  • Daptomycin for Injection is not recommended in pediatric patients <1 year due to the risk of potential effects on muscular, neuromuscular, and/or nervous systems (either peripheral and/or central) observed in neonatal dog

Dosage Forms & Strengths

injection, lyophilized powder for reconstitution

  • 500mg/vial (Cubicin)

Staphylococcus Aureus Bacteremia

Cubicin only

<1 year

  • Safety and efficacy not established (see Dosing Considerations)

≥1 year

  • 12-17 years: 7 mg/kg IV q24hr
  • 7-11 years: 9 mg/kg IV q24hr
  • 1-6 years: 12 mg/kg IV q24hr
  • Duration of therapy: Up to 42 days
  • Also see Administration for IV dilution and infusion rate instructions

Complicated Skin & Skin Structure Infections

Cubicin only

Infections caused by susceptible isolates of Gram-positive bacteria

Susceptible isolates

  • Staphylococcus aureus (including MRSA)

  • Streptococcus pyogenes

  • Streptococcus agalactiae

  • Streptococcus dysgalactiae ssp equisimilis

  • Enterococcus faecalis (vancomycin-susceptible only)

<1 year

  • Safety and efficacy not established (see Dosing Considerations)

≥1 year

  • 12-17 years: 5 mg/kg IV q24hr
  • 7-11 years: 7 mg/kg IV q24hr
  • 2-6 years: 9 mg/kg IV q24hr
  • 1 to <2 years: 10 mg/kg IV q24hr
  • Duration of therapy: Up to 14 days
  • Also see Administration for IV dilution and infusion rate instructions

Dosage Modifications

Renal impairment: Dosage regimen in children with renal impairment has not been established

Dosing Considerations

Limitations of use

  • Not indicated for pneumonia
  • <1 year: Not recommended in children aged <1 yr owing to the risk of potential effects on muscular, neuromuscular, and/or nervous systems (either peripheral and/or central) observed in neonatal dogs
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Interactions

Interaction Checker

and daptomycin

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (0)

              Serious - Use Alternative (1)

              • cholera vaccine

                daptomycin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              Monitor Closely (9)

              • atorvastatin

                atorvastatin, daptomycin. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Coadministration of daptomycin with HMG-CoA reductase inhibitors may increase CPK levels and risk for myopathy; consider temporary suspension of HMG-CoA reductase inhibitors during daptomycin therapy.

              • fluvastatin

                fluvastatin, daptomycin. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Coadministration of daptomycin with HMG-CoA reductase inhibitors may increase CPK levels and risk for myopathy; consider temporary suspension of HMG-CoA reductase inhibitors during daptomycin therapy.

              • lovastatin

                lovastatin, daptomycin. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Coadministration of daptomycin with HMG-CoA reductase inhibitors may increase CPK levels and risk for myopathy; consider temporary suspension of HMG-CoA reductase inhibitors during daptomycin therapy.

              • pitavastatin

                pitavastatin, daptomycin. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Coadministration of daptomycin with HMG-CoA reductase inhibitors may increase CPK levels and risk for myopathy; consider temporary suspension of HMG-CoA reductase inhibitors during daptomycin therapy.

              • pravastatin

                pravastatin, daptomycin. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Coadministration of daptomycin with HMG-CoA reductase inhibitors may increase CPK levels and risk for myopathy; consider temporary suspension of HMG-CoA reductase inhibitors during daptomycin therapy.

              • rosuvastatin

                rosuvastatin, daptomycin. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Coadministration of daptomycin with HMG-CoA reductase inhibitors may increase CPK levels and risk for myopathy; consider temporary suspension of HMG-CoA reductase inhibitors during daptomycin therapy.

              • simvastatin

                simvastatin, daptomycin. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Coadministration of daptomycin with HMG-CoA reductase inhibitors may increase CPK levels and risk for myopathy; consider temporary suspension of HMG-CoA reductase inhibitors during daptomycin therapy.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                daptomycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              • tobramycin

                tobramycin, daptomycin. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Tobramycin levels decrease and daptomycin levels increase when coadministered after single a dose.

              Minor (0)

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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, organizing 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

                Blood and lymphatic system disorders: Anemia, thrombocytopenia

                General and administration site conditions: Pyrexia

                Renal and urinary disorders: Acute kidney injury, renal insufficiency, and renal failure

                Skin and Subcutaneous Tissue Disorders: Acute generalized exanthematous pustulosis

                Tubulointerstitial nephritis

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                Warnings

                Contraindications

                Hypersensitivity

                Cautions

                Anaphylaxis/hypersensitivity reactions have been reported and may be life-threatening; discontinue the drug and institute appropriate therapy if allergic reaction occurs

                May cause eosinophilic pneumonia characterized by fever, cough, shortness of breath, and difficulty breathing; may result in progressive respiratory failure and is potentially fatal; prompt medical evaluation, and treatment should be discontinued immediately if signs/symptoms develop; treatment with systemic steroids is recommended

                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

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

                Decreased efficacy reported in patients with moderate baseline renal impairment

                Fever, dyspnea with hypoxic respiratory insufficiency, and diffuse pulmonary infiltrates or organizing pneumonia

                Drug reaction with eosinophilia and systemic symptoms (DRESS) reported postmarketing; patients who develop skin rash, fever, peripheral eosinophilia, and systemic organ (for example, hepatic, renal, pulmonary) impairment while receiving therapy should undergo medical evaluation; if DRESS suspected, discontinue therapy promptly and institute appropriate treatment

                Tubulointerstitial nephritis (TIN) reported post-marketing experience; patients who develop new or worsening renal impairment while receiving therapy should undergo medical evaluation; if TIN suspected, discontinue therapy promptly and institute appropriate treatment

                Cases of peripheral neuropathy have been reported during the daptomycin postmarketing experience; monitor and consider discontinuation

                Prescribing in absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit and increases risk of development of drug-resistant bacteria

                Clostridium difficile-associated diarrhea (CDAD)

                • CDAD has been reported and may range in severity from mild diarrhea to fatal; CDAD must be considered in all patients who present with diarrhea following antibacterial use
                • Careful medical history is necessary because CDAD has been reported to occur more than 2 months after the administration of antibacterial agents
                • Hypertoxin-producing strains of C. difficile cause increased morbidity and mortality, since these infections can be refractory to antimicrobial therapy and may require colectomy; CDAD must be considered in all patients who present with diarrhea following antibacterial use; careful medical history is necessary because CDAD has been reported to occur more than 2 months after administration of antibacterial agents
                • If CDAD is suspected/confirmed, ongoing antibacterial use not directed against C. difficile may need to be discontinued
                • Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated

                Myopathy and rhabdomyolysis

                • Use cautiously in patients with peripheral neuropathies and myopathy; monitor for neuropathy and 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
                • Renal function and CPK should be monitored more frequently than once weekly in adult patients with renal impairment
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                Pregnancy & Lactation

                Pregnancy

                Limited published data on use in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage; no evidence of adverse developmental outcomes observed in animal reproduction studies

                Lactation

                Limited published data report that daptomycin is present in human milk at infant doses of 0.1% of maternal dose; there is no information on effects of daptomycin on breastfed infant or effects of daptomycin on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from therapy or from the underlying maternal condition

                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: 0.9% NaCl, LR

                IV Preparation

                There are 3 formulations of daptomycin that have differences concerning storage and reconstitution; carefully follow the reconstitution and storage procedures in labeling

                Reconstitution

                • Cubicin
                  • To minimize foaming, avoid vigorous agitation or shaking of the vial during or after reconstitution
                  • Slowly transfer 10 mL of 0.9% NaCl through the center of the rubber stopper into vial, pointing the transfer needle toward the wall of the vial
                  • A beveled sterile transfer needle that is 21-gauge or smaller in diameter is recommended, or a needleless device is used, pointing the transfer needle toward the wall of the vial
                  • Ensure that all of the lyophilized powder is wetted by gently rotating the vial
                  • Allow wetted product to stand undisturbed for 10 minutes
                  • Gently rotate or swirl the vial contents for a few minutes, as needed, to obtain a completely reconstituted solution
                • Cubicin RF
                  • Must be reconstituted within the vial with either sterile water for injection or bacteriostatic water for injection
                  • Do not use 0.9% NaCl (saline) based diluents for the reconstitution in the vial because this will result in a hyperosmotic solution that may result in infusion site reactions if the reconstituted product is administered as an IV injection over a period of 2 minutes (adults)
                  • Transfer 10 mL of sterile water for injection or bacteriostatic water for injection through the center of the rubber stopper into the vial
                  • Use a beveled sterile transfer needle that is 21-gauge or smaller in diameter, pointing the transfer needle toward the wall of the vial
                  • Rotate or swirl the vial contents for a few minutes, as needed, to obtain a completely reconstituted solution
                • Daptomycin 350 mg vial
                  • Carefully follow the reconstitution and storage procedures in labeling
                  • Do not use in conjunction with ReadyMED elastomeric infusion pumps in adult patients
                  • Avoid vigorous agitation or shaking of the vial during or after reconstitution
                  • Slowly transfer 7 mL of 0.9% NaCl through the center of the rubber stopper (concentration of 50 mg/mL)
                  • Use a beveled sterile transfer needle that is 21-gauge or smaller in diameter, pointing the transfer needle toward the wall of the vial
                  • Allow the wetted product to stand undisturbed for 10 minutes
                  • Rotate or swirl the vial contents for a few minutes, as needed, to obtain a completely reconstituted solution

                Further dilute for IV infusion

                • Adults and children aged 7-17 years: Add calculated dose from reconstituted vial to IV bag containing 50 mL 0.9% NaCl
                • Children aged 1-6 years: Add calculated dose from reconstituted vial to IV bag containing 25 mL 0.9% NaCl

                IV Administration

                Adults

                • On hemodialysis days, administer after hemodialysis
                • IV push: Administer reconstituted solution IV over 2 min (in adults only)
                • IV infusion: Infuse diluted solution IV over 30 min

                Pediatrics

                • See section on IV preparation for appropriate concentrations of dilution for each age group
                • 1-6 years: Infuse diluted IV solution at rate of 0.42 mL/min over a 60-min period
                • 7-17 years: Infuse diluted IV solution at rate of 1.67 mL/min over a 30-min period
                • Unlike adults, do not administer Cubicin by injection over 2 minutes to children aged 1-17 yr

                Storage

                Unopened vials

                • Cubicin: Refrigerate in original packages at 2-8°C (36-46°F)
                • Cubicin RF: Store in original packages at controlled room temperature of 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F)
                • Daptomycin 350 mg vials: Store in original packages at refrigerated temperatures at 2-8°C (36-46°F); avoid excessive heat

                Reconstituted or diluted solution (Cubicin)

                • Store in room temperature at 20-25°C (68-77°F) for up to 12 hr
                • Store in refrigerator at 2-8°C (36-46°F) for up to 48 hr

                Reconstituted solution (Cubicin RF)

                • Sterile water diluent
                  • Vial or polypropylene syringe: 1 day (controlled room temperature) or 3 days (refrigerated at 2-8°C [36-46°F])
                • Bacteriostatic water for injection diluent
                  • Vial: 2 days (controlled room temperature) or 3 days (refrigerated at 2-8°C [36-46°F])
                  • Polypropylene syringe: 2 days (controlled room temperature) or 5 days (refrigerated at 2-8°C [36-46°F])

                Diluted solution in IV bag (Cubicin RF)

                • Reconstituted and immediately diluted further with 0.9% NaCl
                • Reconstituted with sterile water for injection: 19 hr (room temperature) or 3 days (refrigerated)
                • Reconstituted with bacteriostatic water for injection: 2 days (room temperature) or 5 days (refrigerated)
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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                Cubicin RF intravenous
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                500 mg vial
                daptomycin intravenous
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                500 mg vial
                daptomycin intravenous
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                daptomycin intravenous
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                daptomycin intravenous
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                daptomycin intravenous
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                500 mg vial
                daptomycin intravenous
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                350 mg vial
                daptomycin intravenous
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                500 mg vial
                daptomycin intravenous
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                350 mg vial
                daptomycin intravenous
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                350 mg vial
                daptomycin intravenous
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                350 mg vial
                daptomycin intravenous
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                500 mg vial
                daptomycin intravenous
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                daptomycin intravenous
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                daptomycin intravenous
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                500 mg vial
                daptomycin intravenous
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                350 mg vial
                daptomycin intravenous
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                500 mg vial
                Cubicin intravenous
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                500 mg vial

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Patient Education
                daptomycin intravenous

                DAPTOMYCIN - INJECTION

                (DAP-toe-MYE-sin)

                COMMON BRAND NAME(S): Cubicin, Cubicin RF

                USES: This medication is an antibiotic used to treat serious bacterial infections. It works by stopping the growth of bacteria.This medication is not recommended for use in children younger than 12 months due to possible risk of serious side effects.

                HOW TO USE: This medication is given by injection into a vein as directed by your doctor, usually once daily. The dosage is based on your weight, medical condition, and response to treatment. In children, the dosage is also based on age and weight.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.

                SIDE EFFECTS: Nausea, vomiting, constipation, diarrhea, headache, dizziness, trouble sleeping, increased sweating, or pain/redness/swelling at the injection site may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: muscle pain/tenderness/weakness, unusual tiredness, signs of kidney problems (such as change in the amount of urine), signs of a lung infection (such as cough, shortness of breath, chest pain, new/unexplained fever), numbness/tingling of arms/legs, swelling hands/ankles/feet, mental/mood changes (such as anxiety).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever that doesn't go away, new or worsening lymph node swelling, rash, itching/severe swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Before using daptomycin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, muscle problems (such as myopathy).This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Daptomycin may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk in very small amounts. Consult your doctor before breast-feeding.

                DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: "statin" cholesterol drugs (such as lovastatin, simvastatin).This medication may interfere with certain lab tests (such as PT/INR test), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.Lab and/or medical tests (such as kidney function, CPK levels) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

                MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

                STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

                Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Formulary

                FormularyPatient Discounts

                Adding plans allows you to compare formulary status to other drugs in the same class.

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                Adding plans allows you to:

                • 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.
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                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.
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                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.