Names and pronunciation
(dap′toe-mye-sin) Cubicin Cubicin RF
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Drug reference
(dap′toe-mye-sin) Cubicin Cubicin RF
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Func. class.: Antiinfective—miscel- laneous
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Chem. class.: Lipopeptide
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ACTION: Binds to the bacterial mem- brane and results in a rapid depolarization of the membrane potential, leading to inhi- bition of DNA, RNA, and protein synthesis
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USES: Bacteremia, endocarditis, UTI, complicated skin, skin structure infections caused by Staphylococcus aureus (MRSA, MSSA) including methicillin-resistant strains, Streptococcus agalactiae, Strepto- coccus dysgalactiae, Enterococcus faeca- lis (vancomycin-susceptible strains), Streptococcus pyogenes (group A beta- hemolytic), Staphylococcus aureus, Staphylococcus epidermidis, Corynebac- terium jeikeium, Staphylococcus haemo- lyticus
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, children, geriatric patients, GI/renal dis- ease, myopathy, ulcerative/CDAD, rhab- domyolysis, eosinophilic pneumonia
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SIDE EFFECTS CNS: Headache, insomnia, dizziness CV: Hypo/hypertension GI: Nausea, constipation, diarrhea, vom- iting, dyspepsia, CDAD, abdominal pain GU: Nephrotoxicity HEMA: Anemia INTEG: Rash, pruritus, injection site reactions MS: Rhabdomyolysis RESP: Cough, eosinophilic pneumonia, dyspnea SYST: Anaphylaxis, DRESS, Stevens- Johnson syndrome, angioedema
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INTERACTIONS • May alter anticoagulant levels—war- farin; monitor PT, INR Increase: myopathy—HMG-CoA reduc- tase inhibitors Drug/Lab Test Increase: CK, AST, ALT, BUN, creatinine, albumin, LDH Increase/Decrease: glucose Decrease: alkaline phosphatase, magne- sium, phosphate, bicarbonate, Hb/Hct
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DOSAGE AND ROUTES Complicated skin and skin structure infections • Adult: IV INFUSION 4 mg/kg over ½ hr diluted in 0.9% NaCl, give q24hr × 7-14 days; some indications may use up to 6 mg/kg • Child/Adolescent 12 to 17 yrs: IV 5 mg/kg/dose q 24 hr for up to 14 days • Child 7-11 yr: IV 7 mg/kg/dose q 24 hr for up to 14 days • Child 2-6 yr: IV 9 mg/kg/dose q 24 hr for up to 14 days • Child 1 year: IV 10 mg/kg/dose q 24 hr for up to 14 days Staphylococcus aureus bacteremia, right-sided infective endocarditis • Adult: IV INFUSION 6 mg/kg daily × 2-6 wk, up to 8-10 mg/kg daily; treat- ment failures should use another agent Renal dose • Adult: IV INFUSION CCr <30 mL/min, hemodialysis, CAPD 4 mg/kg q48hr, 6 mg/ kg q48hr (bacteremia) Bacteremia caused by S. aureus in children with normal renal function • Child 12-17 yr: IV INFUSION 7 mg/kg q24hr for up to 42 days • Child 7-11 yr: IV INFUSION 9 mg/kg q24hr up to 42 days • Child 1-6 yr: IV INFUSION 12 mg/kg q24hr up to 42 days
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Available forms: Lyophilized powder for injection 500 mg/vial; powder for IV infusion 350 mg/vial
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Administer: IV route • Cubicin RF and Cubicin have different reconstitution and storage methods • For IV use only; use a 21-gauge or smaller needle for all transfers • Do not admix • Cubicin RF is compatible with 0.9% NaCl injection, sterile water for injection, and bacteriostatic water for injection; Cubicin is compatible with 0.9% NaCl injection and LR injection • Do not use with ReadyMED elasto- meric infusion pumps • Visually inspect for particulate matter and discoloration prior to use Cubicin RF preparation Reconstitution • Reconstitute a 500-mg vial/10 mL of sterile water for injection or bacterio- static water for injection (50 mg/mL) • Do NOT reconstitute with saline prod- ucts • Transfer the 10 mL of sterile water for injection or bacteriostatic water for in- jection through the center of the rubber stopper. Point the transfer needle against the inside wall of the vial • Prior to use, rotate or swirl the vial for a few minutes • Vials are not preserved and are for single-use only • Storage (Vials): Vials reconstituted with sterile water for injection can be stored for 1 day at room temperature, and vials reconstituted with bacteriostatic water for injection can be stored for 2 days at room temperature. Vials reconstituted with either solution can be stored for 3 days under re- frigeration at 36°F to 46°F (2°C to 8°C) • Storage (Syringes): Solutions reconsti- tuted with sterile water for injection are stable in polypropylene syringes with an elastomeric plunger stopper for 1 day at room temperature, and solutions reconsti- tuted with bacteriostatic water for injection are stable in this type of syringe for 2 days at room temperature. Solutions reconsti- tuted with sterile water for injection and bacteriostatic water for injection are stable in this syringe for 3 days and 5 days, respec- tively, under refrigeration Dilution: • Adults/child 7-17 yr: Further dilute in 50 mL of 0.9% sodium chloride in- jection • Child 1 to 6 yr: Further dilute in 25 mL of 0.9% sodium chloride injection Cubicin preparation Reconstitution • To minimize foaming, avoid vigorous agitation or shaking of the vial during or after reconstitution • Reconstitute the vial with 0.9% NaCl for injection according to the manufac- turer’s instructions (50 mg/mL) • Transfer the appropriate volume of 0.9% sodium chloride for injection through the center of the rubber stopper. Point the transfer needle against the in- side wall of the vial • Ensure that all the powder is wetted by gently rotating the vial. Allow the wetted product to stand undisturbed for 10 min. Gently rotate or swirl the vial contents for a few minutes, as needed, to obtain a completely reconstituted solution • Vials are not preserved and are for single-use only • Storage: The reconstituted solution is stable in the vial for 12 hr at room tem- perature and up to 48 hr if stored under refrigeration at 35°F to 46°F (2°C to 8°C) Dilution: • Adults/child 7-17 yr: Further dilute in 50 mL of 0.9% NaCl • Child 1-6 yr: Further dilute in 25 mL of 0.9% NaCl • Storage: Diluted solutions are stable for 12 hr at room temperature or 48 hr under refrigeration Cubicin RF and Cubicin adminis- tration: • Do not use IV push in children IV push: • Give via slow IV push over 2 min Intermittent IV Infusion: • Adult/child 7-17 yr: Give over 30 min • Child 1-6 yr: Give over 60 min • If the same IV line is used for sequen- tial infusion of different drugs, flush the line with a compatible IV solution prior to and after daptomycin administration Y-site compatibilities: Alfentanil, amifos- tine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B liposome, ampicillin, ampicillin-sulbac- tam, argatroban, arsenic trioxide, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, cal- cium chloride/gluconate, CARBOplatin, car- D mustine, caspofungin, ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZi- dime, ceftizoxime, cefTRIAXone, cefurox- ime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, dacarbazine, DACTINomy- cin, DAUNOrubicin, dexamethasone, dex- medetomidine, dexrazoxane, diazepam, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, dro- peridol, enalaprilat, ePHEDrine, EPINEPH- rine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famoti- dine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphe- nytoin, furosemide, ganciclovir, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubi- cin, ifosfamide, inamrinone, insulin (regu- lar), irinotecan, isoproterenol, ketorolac, labetalol, lepirudin, leucovorin, levofloxa- cin, lidocaine, linezolid, LORazepam, mag- nesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methyldopate, methyl- PREDNISolone, metoclopramide, metopro- lol, midazolam, milrinone, mitoXANtrone, mivacurium, morphine, moxifloxacin, mycophenolate mofetil, nafcillin, nalbu- phine, naloxone, niCARdipine, nitroprus- side, norepinephrine, octreotide, ondanse- tron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, PEMEtrexed, pentamidine, PHENobarbital, phenylephrine, piperacillin- tazobactam, polymyxin B, potassium ace- tate/chloride/phosphates, procainamide, prochlorperazine, promethazine, proprano- lol, quinupristin-dalfopristin, ranitidine, rocuronium, sodium acetate/bicarbonate/ citrate/phosphates, succinylcholine, sulfamethoxazole-trimethoprim, tacroli- mus, teniposide, theophylline, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecy- cline, tirofiban, tobramycin, topotecan, trimethobenzamide, vasopressin, vecuronium, verapamil, vinBLAStine, vin- CRIStine, vinorelbine, voriconazole, zid- ovudine, zoledronic acid
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Assess: • Eosinophilic pneumonia: assess for dyspnea, fever, cough, shortness of breath; if left untreated, can lead to respiratory failure and death • DRESS: Assess for swelling, rash, fe- ver, may lead to organ involvement, dis- continue product • Nephrotoxicity: any patient with com- promised renal system; toxicity may oc- cur; BUN, creatinine • Rhabdomyolysis: check for myopa- thy, CPK >1000 U/L (>5 × ULN), discon- tinue product, muscle pain, weakness; caution if concomitant HMG-CoA reduc- tase inhibitor therapy, consider discon- tinuation of therapy • Bowel function: assess for diarrhea, fever, abdominal pain; report to prescriber; CDAD may occur • Monitor I&O ratio: report hematuria, oliguria; nephrotoxicity may occur • B/P during administration; hypoten- sion/hypertension may occur • Signs of infection • Pregnancy/breastfeeding: Identify whether pregnancy is planned or sus- pected; avoid use in pregnancy or breast- feeding, lack of controlled studies
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Evaluate: • Therapeutic response: negative cul- ture, resolution of infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About allergies prior to treatment, re- action to each medication • To report sore throat, fever, fatigue; could indicate superinfection; diarrhea; muscle weakness, pain, shortness of breath • To avoid driving, hazardous activities until response is known; may cause diz- ziness • To avoid breastfeeding, use in preg- nancy
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PHARMACOKINETICS Site of metabolism unknown, protein binding 92%, half-life 8.1 hr, 78% excreted unchanged (urine), excreted in breast milk, peak infusion’s end, duration 24 hr
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• Child/Adolescent 12 to 17 yrs: IV 5 mg/kg/dose q 24 hr for up to 14 days
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• Child 7-11 yr: IV 7 mg/kg/dose q 24 hr for up to 14 days
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• Child 2-6 yr: IV 9 mg/kg/dose q 24 hr for up to 14 days
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• Child 1 year: IV 10 mg/kg/dose q 24 hr for up to 14 days Staphylococcus aureus bacteremia, right-sided infective endocarditis
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• Child 12-17 yr: IV INFUSION 7 mg/kg q24hr for up to 42 days
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• Child 7-11 yr: IV INFUSION 9 mg/kg q24hr up to 42 days
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• Child 1-6 yr: IV INFUSION 12 mg/kg q24hr up to 42 days
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