DAPTOMYCIN IN 0.9% SODIUM CHLORIDE
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Daptomycin is a cyclic lipopeptide antibiotic that binds to bacterial cell membranes, causing rapid depolarization and potassium ion efflux, leading to inhibition of protein, DNA, and RNA synthesis, and bacterial cell death.
| Metabolism | Metabolism is not well characterized; minor hepatic metabolism suspected. Primarily excreted renally as unchanged drug. |
| Excretion | Primarily renal (78% unchanged in urine); biliary/fecal excretion is negligible (<6%). |
| Half-life | Terminal elimination half-life: approximately 8-9 hours in patients with normal renal function; prolonged in renal impairment (up to 28 hours in severe impairment). |
| Protein binding | 92-93% bound to human plasma proteins, primarily albumin. |
| Volume of Distribution | 0.1 L/kg; low Vd indicating limited tissue distribution, primarily confined to extracellular fluid. |
| Bioavailability | Not applicable (intravenous only; bioavailability is 100% by IV route). |
| Onset of Action | Intravenous: bactericidal activity begins within hours; clinical effect seen within 24-48 hours. |
| Duration of Action | Dosing interval is every 24 hours; antibacterial effect persists for the dosing interval due to concentration-dependent killing and prolonged post-antibiotic effect. |
| Molecular Weight | 1620.69 |
4-6 mg/kg intravenously every 24 hours. For Staphylococcus aureus bloodstream infections (bacteremia), including right-sided infective endocarditis, 6 mg/kg intravenously every 24 hours.
| Dosage form | SOLUTION |
| Renal impairment | CrCl ≥30 mL/min: no adjustment. CrCl <30 mL/min: 4-6 mg/kg intravenously every 48 hours. For patients on hemodialysis or continuous ambulatory peritoneal dialysis, administer after dialysis on dialysis days. |
| Liver impairment | No dosage adjustment required for mild to moderate hepatic impairment (Child-Pugh Class A or B). Not studied in severe hepatic impairment (Child-Pugh Class C). |
| Pediatric use | Children 1-6 years: 10 mg/kg intravenously every 24 hours. Children 7-17 years: 7 mg/kg intravenously every 24 hours. Maximum dose: 500 mg per dose. |
| Geriatric use | No specific dose adjustment based solely on age. Use caution due to increased risk of renal impairment; adjust dose based on creatinine clearance as for adults. |
| 1st trimester | Limited human data; animal studies suggest no fetal harm at clinically relevant doses. Use only if clearly needed. |
| 2nd trimester | Limited human data; no evidence of teratogenicity. Use only if clearly needed. |
| 3rd trimester | Limited human data; no evidence of fetal risk. Use only if clearly needed, especially near term due to risk of neonatal eosinophilic pneumonia. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | Crosses the placenta in humans; maternal serum levels similar to cord blood levels (approximately 2-4% of maternal dose). |
| Breastfeeding | Daptomycin is excreted into human milk in low amounts; likely not absorbed orally by infant. Use with caution in lactating women, weighing benefit vs risk. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | No adequate and well-controlled studies in pregnant women. Animal studies show no evidence of fetal harm at systemic exposures up to 4 times the human dose. Risk cannot be ruled out; use only if clearly needed. |
| Fetal Monitoring | Monitor renal function, creatine phosphokinase (CPK) levels, and signs of hypersensitivity. No additional fetal-specific monitoring required unless other indications. |
| Fertility Effects | No known adverse effects on fertility in animal studies at therapeutic doses. |
■ FDA Black Box Warning
None.
| Common Effects | fluid replacement |
| Serious Effects |
Hypersensitivity to daptomycinHypersensitivity to any component of the formulation
| Precautions | Eosinophilic pneumonia: Monitor for new onset fever, dyspnea, cough, and pulmonary infiltrates., Peripheral neuropathy: Monitor for sensory or motor deficits., Clostridioides difficile-associated diarrhea: Consider if diarrhea occurs., Skeletal muscle effects: Monitor creatine phosphokinase (CPK) levels weekly; discontinue if marked elevation or myopathy symptoms., Renal impairment: Dose adjustment required for CrCl <30 mL/min., Anaphylaxis/hypersensitivity reactions: Discontinue if severe reactions occur. |
| Food/Dietary | No clinically significant food interactions. Take without regard to meals. |
| Clinical Pearls | Monitor creatine phosphokinase (CPK) weekly due to risk of myopathy; daptomycin is inactivated by pulmonary surfactant, so avoid use in pneumonia. Administer over 30 min IV. Dose adjustment required for CrCl <30 mL/min (including hemodialysis). |
| Patient Advice | Report unexplained muscle pain, tenderness, or weakness immediately. · Complete the full course of therapy even if you feel better. · Inform your doctor if you have kidney disease or are on dialysis. · This medication is given intravenously; you may experience injection site reactions. |
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