synercid

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

7.5 mg/kg every 8 hours

PHARMACOKINETICS

Molecular weight :1118.3 (quinupristin); 787 (dalfopristin) – as mesilate

%Protein binding :55–78 (quinupristin); 11–26 (dalfopristin)

%Excreted unchanged in urine : 15 (quinupristin); 19 (dalfopristin)

Volume of distribution (L/kg) :0.45 (quinupristin); 0.24 (dalfopristin)

half-life – normal/ESRD (hrs) :0.9 (quinupristin); 0.7 (dalfopristin)

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : 5–7.5 mg/kg 8–12 hourly

10 to 20 : 5–7.5 mg/kg 8–12 hourly

<10 : 5 mg/kg 8–12 hourly

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed.

10 to 20 : mg/kg/day in 2 divided doses1

HD :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Unlikely to be dialysed. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anti-arrhythmics: increased risk of ventricular arrhythmias with disopyramide and lidocaine – avoid concomitant useAnxiolytics and hypnotics: increased concentration of midazolam (risk of profound sedation); metabolism of zopiclone inhibited

Calcium-channel blockers: increased concentration of nifedipine

Ciclosporin: increased levels of ciclosporin

Ergot alkaloids: avoid concomitant use with ergotamine and methysergide

Tacrolimus: tacrolimus levels increased by 15%

ADMINISTRATION

Reconstition

With 5 mL glucose 5% or water for injection

Route

IV infusion

through a central line

Rate of Administration

Over 60 minutes

Comments

Central access is recommended: Dilute reconstituted solution further in —100 mL glucose 5% for central access Or 250 mL for peripheral access (for —emergency administration of 1st dose only). Stable for 5 hours at room temperature and 24 hours if refrigeratedIncompatible with saline solutions

OTHER INFORMATION

After the infusion, flush the line with glucose 5% to minimise venous irritationHas been administered intraperitoneally at a dose of 25 mg/L in alternate bags, in combination with intravenous treatmentSynercid is an inhibitor of CYP 3A4: caution is recommended when co-administering any drug also metabolised by this route

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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