daptomycin

DAPTOmycin

Cubicin

Indications

Action

Pharmacokinetics

Time/action profile

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• dizziness

Respiratory

• eosinophilic pneumonia (life-threatening)
• dyspnea

Cardiovascular

• hypertension
• hypotension

Gastrointestinal

• pseudomembranous colitis (life-threatening)
• constipation
• diarrhea
• nausea
• vomiting
• ↑ liver enzymes

Genitourinary

• renal failure

Dermatologic

• pruritus
• rash

Hematologic

• anemia

Local

• injection site reactions

Musculoskeletal

• ↑ CPK

Miscellaneous

• fever

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
• Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
• Monitor for signs and symptoms of eosinophilic pneumonia (new onset or worsening fever, dyspnea, difficulty breathing, new infiltrates on chest imaging studies). Discontinue daptomycin if symptoms occur.
• Monitor for development of muscle pain or weakness, particularly of distal extremities. Discontinue daptomycin in patients with unexplained signs and symptoms of myopathy in conjunction with CPK elevation >1000 U/L, or in patients without reported symptoms who have marked elevations in CPK >2000 U/L. Consider temporarily suspending agents associated with rhabdomyolysis (HMG-CoA reductase inhibitors) in patients receiving daptomycin.
• Lab Test Considerations: Monitor CPK weekly, more frequently in patients with unexplained ↑. Discontinue daptomycin if CPK >1000 units/L and signs and symptoms of myopathy occur. In patients with renal insufficiency, monitor both renal function and CPK more frequently.
  • May cause false prolongation of PT and ↑ INR.

Potential Nursing Diagnoses

Implementation

• Do not confuse daptomycin with dactinomycin.

• Intravenous Administration

• pH: 4.5.
• Reconstitute 500-mg vial with 10 mL of 0.9% NaCl inserted toward wall of vial. Rotate vial gently to wet powder. Allow to stand for 10 min undisturbed. Swirl vial gently to completely reconstitute solution. Reconstituted vials are stable for 12 hr at room temperature or 48 hr if refrigerated. Concentration: 50 mg/mL.
• Rate: Administer over 2 min.
• Intermittent Infusion: Diluent: Dilute further in 50 mL of 0.9% NaCl. Solution is stable for 12 hr at room temperature or 48 hr if refrigerated. Do not administer solutions that are cloudy or contain a precipitate.
• Rate: Infuse over 30 min. Do not infuse daptomycin with ReadyMED® elastomeric infusion pumps due to incompatibility.
• Y-Site Compatibility: alfentanil, amifostine, amikacin, aminophylline, aminocaproic acid, amiodarone, amphotericin B liposome, ampicillin, ampicillin/sulbactam, argatroban, arsenic trioxide, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, ciprofloxacin, cisatracurium, cisplatin, clindamycin, cyclophosphamide, cyclosporine, dacarbazine, dactinomycin, daunorubicin hydrochloride, dexamethasone sodium phosphate, dexmedetomidine, dexrazoxane, diazepam, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doripenem, doxacurium, doxorubicin hydrochloride, doxorubicin liposome, doxycycline, droperidol, enalaprilat, epinephrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydralazine, hydrocortisone sodium succinate, hydromorphone, idarubicin, ifosfamide, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methyldopate, methylprednisolone sodium succinate, metoclopramide, metoprolol, midazolam, milrinone, mitoxantrone, morphine, moxifloxacin, mycophenolate mofetil, nafcillin, nalbuphine, naloxone, nicardipine, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pemetrexed, pentamidine, phenobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, rocuronium, sodium acetate, sodium bicarbonate, sodium phosphates, succinylcholine, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, topotecan, trimethoprim/sulfamethoxazole, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
• Y-Site Incompatibility: acyclovir, alemtuzumab, allopurinol, amphotericin B colloidal, amphotericin B lipid complex, cytarabine, dantrolene, gemcitabine, imipenem/cilastatin, methotrexate, metronidazole, mitomycin, nesiritide, nitroglycerin, pantoprazole, pentazocine, pentobarbital, phenytoin, remifentanil, streptozocin, sufentanil, thiopental, vancomycin
• Solution Incompatibility: D5W

Patient/Family Teaching

• Inform patient of purpose of medication.
• Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
• May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Advise patient to notify health care professional immediately if signs and symptoms of eosinophilic pneumonia occur.

Evaluation/Desired Outcomes

• Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.