daptomycin: clinical use

Prescribing considerations

• Confirm a licensed infection context, microbiological susceptibility and need for Gram-negative or anaerobic cover.
• Daptomycin is ineffective for pneumonia, and efficacy has not been demonstrated for left-sided or prosthetic-valve endocarditis.
• Arrange prompt source control for deep-seated infection where indicated.
• Use cautiously in renal impairment, severe hepatic impairment and very high body mass index.
• Do not use in infants younger than 1 year.

Contraindications and cautions

• Hypersensitivity to daptomycin or a listed excipient.
• Do not restart after a daptomycin-associated severe cutaneous adverse reaction; re-exposure after eosinophilic pneumonia is also inappropriate.

Monitoring

• Measure creatine phosphokinase before and regularly during treatment, with closer monitoring for renal impairment, muscle symptoms or concurrent myotoxic medicines.
• Review for muscle symptoms, neuropathy, respiratory symptoms and severe skin reactions.
• Monitor renal function, particularly with pre-existing impairment or potentially nephrotoxic medicines.
• Investigate unexplained PT or INR elevation as possible reagent interference.

Clinical pharmacology

Daptomycin is a concentration-dependent bactericidal cyclic lipopeptide active only against Gram-positive organisms. It has high plasma-protein binding, little cytochrome P450 metabolism and predominantly renal elimination; oral absorption is negligible.

Formulation and product differences

• The selected Tillomed document covers a powder vial for intravenous injection or infusion; the selected Cubicin document covers two vial strengths for the same routes.
• Both are reconstituted with sodium chloride solution and produce the same concentration after preparation.
• Daptomycin is incompatible with glucose-containing solutions. Vials are single-use, and product-specific preparation and stability instructions must be followed.

Injection

Route: Parenteral

Strengths: 350 mg, 500 mg