Daptomycin

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

4–6 mg/kg once daily for 7 to 14 days depending on indication

PHARMACOKINETICS

Molecular weight                           :1620.7

%Protein binding                           :90–92

%Excreted unchanged in urine     : Approximately 50%

Volume of distribution (L/kg)       :0.092–0.104

half-life – normal/ESRD (hrs)      :8.1–9/29.41

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

30–50 Dose as in normal renal function<30 4 mg/kg every 48 hours

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD                :Not dialysed. Dose as in GFR<30 mL/min

HD                     :Not dialysed. Dose as in GFR<30 mL/min

HDF/high flux   :Dialysed. Dose as in GFR<30 mL/min

CAV/VVHD

/VVhdFSlightly dialysed. 4–6 mg/kg every 48 hours2

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsWarfarin: Monitor INR when on daptomycinCiclosporin: increased risk of myopathy – try to avoid concomitant useLipid-regulating drugs: increased risk of myopathy with fibrates and statins – try to avoid concomitant use

ADMINISTRATION

Reconstition

7 mL sodium chloride 0.9% or water for injection to give a solution of 50 mg/mL

Route

IV infusion

Rate of Administration

Over 30 minutes

Comments

Once reconstituted, stable for 12 hours at room temperature and 48 hours refrigeratedAdd to 50 mL sodium chloride 0.9% before administration. Stable for 12 hours at room temperature or 24 hours refrigeratedIncompatible with dextrose solutions Compatible with solutions containing aztreonam, ceftazidime, ceftriaxone, gentamicin, fluconazole, levofloxacin, dopamine, heparin and lidocaine

OTHER INFORMATION

May cause renal impairment Vials do not contain any bacteriostatic or fungiostatic agentsCompany advises to administer post dialysisMonitor creatinine phosphokinase levels, muscle pain or weaknessIncreased risk of myopathy in severe renal failure due to increased daptomycin levels15% of dose is removed by 4 hours of haemodialysis and 11% over 48 hours by peritoneal dialysisTherapeutic concentrations of daptomycin are unlikely due to low PD clearance of drug therefore systemic use for peritonitis is unlikely to work

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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