Daptomycin

Daptomycin is a prescription medication used to treat Staphylococcus Aureus Bacteremia, and Complicated Skin and Skin Structure Infections. 

• Daptomycin is available under the following different brand names: Cubicin.

Adult and pediatric dosage

Injection, lyophilized powder for reconstitution

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

Staphylococcus Aureus Bacteremia 

Adult dosage

• 6 mg/kg IV infusion every 24 hours for at least 2-6 weeks

Pediatric dosage

• Children younger than 1 year of age: Safety and efficacy not established
• Children 1 year-6 years of age: 12 mg/kg IV every 24 hours
• Children 7-11 years of age: 9 mg/kg IV every 24 hours
• Children 12-17 years of age: 7 mg/kg IV every 24 hours
• Duration of therapy: up to 42 days

Complicated Skin & Skin Structure Infections 

Adult dosage

• 4 mg/kg IV every 24 hours for 7-14 days

Pediatric dosage

• Children younger than 1 year of age: Safety and efficacy not established
• Children 1 year-2 years of age: 10 mg/kg IV every 24 hours
• Children 2 years-6 years of age: 9 mg/kg IV every 24 hours
• Children 7-11 years of age: 7 mg/kg IV every 24 hours
• Children 12-17 years of age: 5 mg/kg IV every 24 hours
• Duration of therapy: up to 14 days

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Daptomycin include:

• chest pain, 
• trouble breathing, 
• headache, 
• dizziness, 
• stomach pain, 
• vomiting, 
• swelling, 
• abnormal liver function tests, 
• rash, 
• itching, 
• sweating, 
• trouble sleeping, 
• sore throat, and 
• increased blood pressure

Serious side effects of Daptomycin include:

• hives, 
• difficult breathing, 
• swelling of the face, lips, tongue, or throat, 
• severe stomach pain, 
• watery or bloody diarrhea (even if it occurs months after your last dose),
• fever, 
• flu symptoms, 
• mouth and throat ulcers, 
• rapid heart rate, 
• shallow breathing, 
• pain or burning while urinating, 
• numbness, tingling, or burning pain in the hands or feet, 
• easy bruising, 
• unusual bleeding, 
• new or worsening cough, 
• fever, 
• trouble breathing, 
• unexplained muscle pain, 
• tenderness, and 
• weakness

Rare side effects of Daptomycin include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Daptomycin has severe interactions with no other drugs. 
• Daptomycin has serious interactions with the following drug:
  • cholera vaccine
• Daptomycin has moderate interactions with the following drugs: 
  • atorvastatin
  • fluvastatin
  • lovastatin
  • pitavastatin
  • pravastatin
  • rosuvastatin
  • simvastatin
• sodium picosulfate/magnesium oxide/anhydrous citric acid
  • tobramycin
• Daptomycin has minor interactions with no other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Hypersensitivity 

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Daptomycin?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Daptomycin?”

Cautions

• Anaphylaxis/hypersensitivity reactions have been reported and may be life-threatening; discontinue the drug and institute appropriate therapy if an 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 younger than 12 months of age; potential nervous system or muscular system effects
• Decreased efficacy was 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 is 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 the risk of the 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 the 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 symptoms of myopathy and CPK over 1000 U/L (over 5x ULN), or no symptoms and CPK over 2000 U/L (over 10x ULN)
• CPK elevations are more prevalent if dosed more frequently than every 24 hours
• 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

Pregnancy and Lactation

• 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 the breastfed infant from therapy or the underlying maternal condition.