daptomycin


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Related to daptomycin: vancomycin

DAPTOmycin

(dap-to-mye-sin) ,

Cubicin

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: cyclic lipopeptide antibacterial agents
Pregnancy Category: B

Indications

Complicated skin and skin structure infections caused by aerobic Gram-positive bacteria.

Action

Causes rapid depolarization of membrane potential following binding to bacterial membrane; this results in inhibition of protein, DNA, and RNA synthesis.

Therapeutic effects

Death of bacteria with resolution of infection.
Active against Staphylococcus aureus (including methicillin-resistant strains), Streptococcus pyogenes, S. pyogenes agalactiae, some S. dysgalactiae, and Enterococcus faecalis (vancomycin-susceptible strains).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Unknown.
Protein Binding: 92%.
Metabolism and Excretion: Metabolism not known; mostly excreted by kidneys.
Half-life: 8.1 hr.

Time/action profile

ROUTEONSETPEAKDURATION
IVrapidend of infusion24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: CCr <30 mL/min (dose ↓ required);Moderate-to-severe renal impairment (may have ↓ clinical response); Geriatric: May have ↓ clinical response with ↑ risk of adverse reactions; Obstetric: Use only if clearly needed; Lactation: Lactation; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness

Respiratory

  • eosinophilic pneumonia (life-threatening)
  • dyspnea

Cardiovascular

  • hypertension
  • hypotension

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • constipation
  • diarrhea
  • nausea
  • vomiting
  • ↑ liver enzymes

Genitourinary

  • renal failure

Dermatologic

  • pruritus
  • rash

Hematologic

  • anemia

Local

  • injection site reactions

Musculoskeletal

  • ↑ CPK

Miscellaneous

  • fever

Interactions

Drug-Drug interaction

Tobramycin ↑ blood levels.Concurrent HMG-CoA reductase inhibitors may ↑ the risk of myopathy.

Route/Dosage

Intravenous (Adults) 4 mg/kg every 24 hr.

Renal Impairment

Intravenous (Adults) CCr <30 mL/min—4 mg/kg every 48 hr.

Availability

Powder for injection: 500 mg/vial

Nursing implications

Nursing assessment

  • Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Monitor for signs and symptoms of eosinophilic pneumonia (new onset or worsening fever, dyspnea, difficulty breathing, new infiltrates on chest imaging studies). Discontinue daptomycin if symptoms occur.
  • Monitor for development of muscle pain or weakness, particularly of distal extremities. Discontinue daptomycin in patients with unexplained signs and symptoms of myopathy in conjunction with CPK elevation >1000 U/L, or in patients without reported symptoms who have marked elevations in CPK >2000 U/L. Consider temporarily suspending agents associated with rhabdomyolysis (HMG-CoA reductase inhibitors) in patients receiving daptomycin.
  • Lab Test Considerations: Monitor CPK weekly, more frequently in patients with unexplained ↑. Discontinue daptomycin if CPK >1000 units/L and signs and symptoms of myopathy occur. In patients with renal insufficiency, monitor both renal function and CPK more frequently.
    • May cause false prolongation of PT and ↑ INR.

Potential Nursing Diagnoses

Risk for infection (Indications,  Side Effects)

Implementation

  • Do not confuse daptomycin with dactinomycin.
  • Intravenous Administration
  • pH: 4.5.
  • Reconstitute 500-mg vial with 10 mL of 0.9% NaCl inserted toward wall of vial. Rotate vial gently to wet powder. Allow to stand for 10 min undisturbed. Swirl vial gently to completely reconstitute solution. Reconstituted vials are stable for 12 hr at room temperature or 48 hr if refrigerated. Concentration: 50 mg/mL.
  • Rate: Administer over 2 min.
  • Intermittent Infusion: Diluent: Dilute further in 50 mL of 0.9% NaCl. Solution is stable for 12 hr at room temperature or 48 hr if refrigerated. Do not administer solutions that are cloudy or contain a precipitate.
  • Rate: Infuse over 30 min. Do not infuse daptomycin with ReadyMED® elastomeric infusion pumps due to incompatibility.
  • Y-Site Compatibility: alfentanil, amifostine, amikacin, aminophylline, aminocaproic acid, amiodarone, amphotericin B liposome, ampicillin, ampicillin/sulbactam, argatroban, arsenic trioxide, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, ciprofloxacin, cisatracurium, cisplatin, clindamycin, cyclophosphamide, cyclosporine, dacarbazine, dactinomycin, daunorubicin hydrochloride, dexamethasone sodium phosphate, dexmedetomidine, dexrazoxane, diazepam, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doripenem, doxacurium, doxorubicin hydrochloride, doxorubicin liposome, doxycycline, droperidol, enalaprilat, epinephrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydralazine, hydrocortisone sodium succinate, hydromorphone, idarubicin, ifosfamide, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methyldopate, methylprednisolone sodium succinate, metoclopramide, metoprolol, midazolam, milrinone, mitoxantrone, morphine, moxifloxacin, mycophenolate mofetil, nafcillin, nalbuphine, naloxone, nicardipine, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pemetrexed, pentamidine, phenobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, rocuronium, sodium acetate, sodium bicarbonate, sodium phosphates, succinylcholine, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, topotecan, trimethoprim/sulfamethoxazole, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
  • Y-Site Incompatibility: acyclovir, alemtuzumab, allopurinol, amphotericin B colloidal, amphotericin B lipid complex, cytarabine, dantrolene, gemcitabine, imipenem/cilastatin, methotrexate, metronidazole, mitomycin, nesiritide, nitroglycerin, pantoprazole, pentazocine, pentobarbital, phenytoin, remifentanil, streptozocin, sufentanil, thiopental, vancomycin
  • Solution Incompatibility: D5W

Patient/Family Teaching

  • Inform patient of purpose of medication.
  • Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
  • May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient to notify health care professional immediately if signs and symptoms of eosinophilic pneumonia occur.

Evaluation/Desired Outcomes

  • Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

daptomycin

a miscellaneous antiinfective.
indications This drug is used to treat complicated skin and skin structure infections caused by Staphylococcus aureus (including methicillin-resistant strains), S. agalactiae, S. dysgalactiae, and Enterococcus faecalis (vancomycin-susceptible strains only).
contraindication Known hypersensitivity to this drug prohibits its use.
adverse effects Adverse effects of this drug include hypotension, hypertension, increased creatinine phosphokinase, nausea, constipation, diarrhea, vomiting, dyspepsia, headache, insomnia, dizziness, muscle pain or weakness, arthralgia, fungal infection, urinary tract infection, anemia, nephrotoxicity, rash, and pruritus. A life-threatening side effect is pseudomembranous colitis.
References in periodicals archive ?
Daptomycin also has been shown to be effective against organisms resistant to vancomycin and oxacillin, the investigators said.
The Citizen Petition urges FDA to refrain from approving any ANDA for generic daptomycin until the following conditions are satisfied:
Daptomycin is the first in a new class of lipopeptide antibiotics.
The maker of daptomycin, Cubist Pharmaceuticals, Lexington, Mass.
Through previously published studies, it is understood that daptomycin initially attacks bacteria by inserting its "tail" into the cell membrane of Gram-positive bacteria in a calcium-dependent manner.
We are looking forward to completing the registration of the facility and providing Cubist commercial-grade daptomycin.
Daptomycin (DAP) for the Treatment of Documented Gram-positive (GP) Catheter-Related Bacteremia (CRB).
Nasdaq: GILD) today jointly announced the signing of a licensing agreement for the exclusive rights to commercialize Cubist's investigational antibacterial drug Cidecin(TM) (daptomycin for injection) and an oral formulation of daptomycin in 16 European countries following regulatory approval.
Cubist Pharmaceuticals (NASDAQ: CBST) said today that it believes that no generic manufacturer acted last September to secure a potential "first to file" advantage, by filing an abbreviated new drug application (ANDA) for daptomycin.
Consistent with our mission, drug development has been a key focus for Cubist since acquiring daptomycin and commencing our clinical program.
This agreement follows successful completion of proof-of-principle feasibility studies using Emisphere carrier molecules and daptomycin.
Snydman, MD, Professor of Medicine at Tufts University School of Medicine and Chief of Geographic Medicine and Infectious Disease at the New England Medical Center, discussed the characteristics of daptomycin and presented new clinical data as part of Monday afternoon's session on Emerging Therapies.