quinupristin/dalfopristin (Rx)

Brand and Other Names:Synercid
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

quinupristin/dalfopristin

lyophilized powder for solution

  • 500mg (150mg/350mg) per vial
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Skin & Skin Structure Infection

Indicated for complicated skin and skin structure infections caused by Staphylococcus aureus (methicillin susceptible) or Streptococcus pyogenes

7.5 mg/kg IV q12hr for at least 7 days 

Also see Administration for IV preparation and infusion rate

Bacteremia (Off-label)

IDSA guidelines recommend for methicillin-resistant S aureus

7.5 mg/kg IV q8hr 

Intravascular Catheter-associated Bacteremia (Off-label)

IDSA guidelines recommend for methicillin-resistant coagulase negative staphylococci or ampicilin0 and vancomycin-resistant E Faecium)

7.5 mg/kg IV q8hr 

Dosage Forms & Strengths

quinupristin/dalfopristin

lyophilized powder for solution

  • 500mg (150mg/350mg) per vial
more...

Skin & Skin Structure Infection

Indicated for complicated skin and skin structure infections caused by Staphylococcus aureus (methicillin susceptible) or Streptococcus pyogenes

<16 years: Safety and efficacy not established

≥16 years: 7.5 mg/kg IV q12hr for at least 7 days 

Also see Administration for IV preparation and infusion rate

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Interactions

Interaction Checker

and quinupristin/dalfopristin

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Local pain (40-44%)

            Inflammation at infusion site (38-42%)

            Hyperbilirubinemia (3-35%)

            Local edema (17-18%)

            Infusion site reaction (12-13%)

            1-10%

            Arthralgia (<1-8%)

            Nausea (3-5%)

            Myalgia (<1-5%)

            Vomiting (3% to 4%)

            Anemia (3%)

            Diarrhea (3%)

            incr LDH (3%)

            Rash (3%)

            Pain (2-3%)

            Headache (2%)

            Increased CPK (2%)

            Increased GGT (2%)

            Pruritus (2%)

            Thrombophlebitis (2%)

            Hyperglycemia (1%)

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            Warnings

            Contraindications

            Hypersensitivity to drug, or other streptogramins (eg, pristinamycin, virginiamycin)

            Cautions

            Not active against E. faecalis

            Caution in hepatic impairment

            May cause arthralgias/myalgias, hyperbilirubinemia and phlebitis

            Prolonged use may result in fungal or bacterial superinfection

            Inhibits metabolism of drugs metabolized by CYP3A4

            May prolong QTc when administered concurrently with cisapride

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

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: unknown

            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

            Inhibits early and late phase protein synthesis at bacterial ribosome by binding at different sites on the 50S bacterial ribosomal unit

            Quinupristin and dalfopristin act synergistically

            Absorption

            Peak plasma concentration: 3.2 mcg/mL (quinupristin and metabolites); 7.96 mcg/mL (dalfopristin and metabolite)

            AUC: 7.2 mcg·h/mL (quinupristin and metabolites); 10.57 mcg·h/mL (dalfopristin and metabolite)

            Distribution

            Vd: 0.45 L/kg (quinupristin); 0.24 L/kg (dalfopristin)

            Protein bound: Moderate

            Metabolism

            Quinupristin and dalfopristin are the main active components circulating in plasma

            Quinupristin and dalfopristin are converted to several active major metabolites: 2 conjugated metabolites for quinupristin (1 with glutathione and 1 with cysteine) and 1 nonconjugated metabolite for dalfopristin (formed by drug hydrolysis)

            Shown to be a major inhibitor; in vitro inhibits 70% cyclosporine biotransformation at 10 mcg/mL

            Elimination

            Half-life: 0.85 hr (quinupristin); 0.7 hr (dalfopristin); mean elimination half-lives, including metabolites: 3 and 1 hr, respectively

            Clearance: 0.72 L/hr/kg (similar for both drugs)

            Excretion: Feces (75-77% as unchanged drug and metabolites); urine (15-19%)

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            Administration

            IV Incompatibilities

            Solution: NaCl-containing diluents

            IV Compatibilities

            Y-site: aztreonam, ciprofloxacin, fenoldopam, fluconazole, haloperidol, metoclopramide, KCl

            IV Preparation

            Reconstitute 500 mg-containing vial with 5 mL of D5W or SWI to obtain 100 mg/mL solution

            Do not shake; swirl gently to dissolve while limiting foam formation

            Dilute reconstituted solution within 30 min

            Reconstituted solution should be added to at least 250 mL of D5W for peripheral administration (increase to 500 mL or 750 mL if necessary to limit venous irritation). Final conc NMT 2 mg/mL

            An infusion volume of 100 mL may be used for central line infusions

            Do not freeze solution

            IV Administration

            Flush with D5W before and after administration; incompatible with saline

            Complete infusion over 1 hr (toxicity may be increased with shorter infusion)

            If severe venous irritation occurs following peripheral administration of quinupristin/dalfopristin diluted in 250 mL D5W, consider increasing the infusion volume to 500 mL or 750 mL, changing the infusion site, or infusing by a peripherally inserted central catheter (PICC) or a central venous catheter

            Storage

            Refrigerate unopened vials

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            Formulary

            FormularyPatient Discounts

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

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

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • 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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