DAPTOMYCIN IN 0.9% SODIUM CHLORIDE
Clinical safety rating: safe
No 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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Breastfeeding | Unknown if daptomycin is excreted in human milk. Caution advised due to potential disruption of infant gut flora. No M/P ratio available. |
| 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. |
■ FDA Black Box Warning
None.
| Common Effects | fluid replacement |
| Serious Effects |
["Known hypersensitivity to daptomycin or 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."] |
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| 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. |