Daptomycin
Dosing in kidney impairment
Dosage in Patients with Renal Impairment Adult Patients No dosage adjustment is required in adult patients with creatinine clearance (CL CR ) greater than or equal to 30 mL/min. The recommended dosage regimen for Daptomycin for Injection in adult patients with CL CR less than 30 mL/min, including adult patients on hemodialysis or continuous ambulatory peritoneal dialysis (CAPD), is 4 mg/kg (cSSSI) or 6 mg/kg ( S. aureus bloodstream infections) once every 48 hours ( Table 3 ).
When possible, Daptomycin for Injection should be administered following the completion of hemodialysis on hemodialysis days [see Warnings and Precautions ( 5.2 , 5.10 ), Use in Specific Populations, and Clinical Pharmacology] . [See table below.] Pediatric Patients The dosage regimen for Daptomycin for Injection in pediatric patients with renal impairment has not been established.
| Creatinine Clearance (CLCR) | Dosage Regimen | |
| cSSSI For 7 to 14 days | S. aureus Bacteremia For 2 to 6 weeks | |
| ≥30 mL/min | 4 mg/kg once every 24 hours | 6 mg/kg once every 24 hours |
| <30 mL/min, including hemodialysis and CAPD | 4 mg/kg once every 48 hours* | 6 mg/kg once every 48 hours* |
| *Administered following hemodialysis on hemodialysis days. | ||
| Age group | Dosage* | Duration of therapy |
| 12 to 17 years | 5 mg/kg once every 24 hours infused over 30 minutes | Up to 14 days |
| 7 to 11 years | 7 mg/kg once every 24 hours infused over 30 minutes | |
| 2 to 6 years | 9 mg/kg once every 24 hours infused over 60 minutes | |
| 1 to less than 2 years | 10 mg/kg once every 24 hours infused over 60 minutes | |
| *Recommended dosage is for pediatric patients (1 to 17 years of age) with normal renal function. Dosage adjustment for pediatric patients with renal impairment has not been established. | ||
| Age group | Dosage* | Duration of therapy |
| 12 to 17 years | 7 mg/kg once every 24 hours infused over 30 minutes | Up to 42 days |
| 7 to 11 years | 9 mg/kg once every 24 hours infused over 30 minutes | |
| 1 to 6 years | 12 mg/kg once every 24 hours infused over 60 minutes | |
| *Recommended dosage is for pediatric patients (1 to 17 years of age) with normal renal function. Dosage adjustment for pediatric patients with renal impairment has not been established. | ||
| *Recommended dosage regimen is for pediatric patients (1 to 17 years of age) with normal renal function. Dosage adjustment for pediatric patients with renal impairment has not been established. | ||
| Age Range | Dosage Regimen* | Duration of therapy |
| 12 to 17 years | 5 mg/kg once every 24 hours infused over 30 minutes | Up to 14 days |
| 7 to 11 years | 7 mg/kg once every 24 hours infused over 30 minutes | |
| 2 to 6 years | 9 mg/kg once every 24 hours infused over 60 minutes | |
| 1 to less than 2 years | 10 mg/kg once every 24 hours infused over 60 minutes | |
Preparation and administration
Important Administration Duration Instructions Adults Administer the appropriate volume of the reconstituted Daptomycin for Injection (concentration of 50 mg per mL) to adult patients intravenously either by injection over a two minute period or by intravenous infusion over a thirty minute period [see Dosage and Administration ( 2.2 , 2.4 , 2.7 )] .
Pediatric Patients (1 to 17 Years of Age) Unlike in adults, do NOT administer Daptomycin for Injection by injection over a two minute period to pediatric patients . Pediatric Patients 7 to 17 years of Age : Administer Daptomycin for Injection intravenously by infusion over a 30-minute period [see Dosage and Administration ( 2.3 , 2.5 , 2.7 )] .
Pediatric Patients 1 to 6 years of Age : Administer Daptomycin for Injection intravenously by infusion over a 60-minute period [see Dosage and Administration ( 2.3 , 2.5 , 2.7 )] .
Preparation and Administration of Daptomycin for Injection There are other formulations of daptomycin that have differences concerning reconstitution and storage. Carefully follow the reconstitution and storage procedures described in this labeling. Reconstitution of Daptomycin for Injection Vial Daptomycin for Injection is supplied in single-dose vials, each containing 350 mg daptomycin as a sterile, lyophilized powder.
The contents of a Daptomycin for Injection vial should be reconstituted, using aseptic technique, to 50 mg per mL as follows: To minimize foaming, AVOID vigorous agitation or shaking of the vial during or after reconstitution. Remove the polypropylene flip-off cap from the Daptomycin for Injection vial to expose the central portion of the rubber stopper.
Wipe the top of the rubber stopper with an alcohol swab or other antiseptic solution and allow to dry. After cleaning, do not touch the rubber stopper or allow it to touch any other surface. Slowly transfer 7 mL of 0.9% sodium chloride injection through the center of the rubber stopper into the Daptomycin for Injection vial, pointing the transfer needle toward the wall of the vial.
It is recommended that a beveled sterile transfer needle that is 21 gauge or smaller in diameter, or a needleless device is used, pointing the transfer needle toward the wall of the vial. Ensure that all of the Daptomycin for Injection powder is wetted by gently rotating the vial. Allow the wetted product to stand undisturbed for 10 minutes.
Gently rotate or swirl the vial contents for a few minutes, as needed, to obtain a completely reconstituted solution. Administration Instructions Parenteral drug products should be inspected visually for particulate matter prior to administration. Slowly remove reconstituted liquid (50 mg daptomycin per mL) from the vial using a beveled sterile needle that is 21 gauge or smaller in diameter.
Administer as an intravenous injection or infusion as described below: Adults Intravenous Injection over a period of 2 minutes For intravenous (IV) injection over a period of 2 minutes in adult patients only : Administer the appropriate volume of the reconstituted Daptomycin for Injection (concentration of 50 mg per mL).
Intravenous Infusion over a period of 30 minutes For intravenous (IV) infusion over a period of 30 minutes in adult patients: The appropriate volume of the reconstituted Daptomycin for Injection (concentration of 50 mg per mL) should be further diluted, using aseptic technique, into a 50 mL IV infusion bag containing 0.9% sodium chloride injection.
Pediatric Patients (1 to 17 Years of Age) Intravenous Infusion over a period of 30 or 60 minutes Unlike in Adults, do NOT administer Daptomycin for Injection by injection over a two minute period to pediatric patients [see Dosage and Administration]. For Intravenous infusion over a period of 60 minutes in pediatric patients 1 to 6 years of age: The appropriate volume of the reconstituted Daptomycin for Injection (concentration of 50 mg per mL) should be further diluted, using aseptic technique, into an intravenous infusion bag containing 25 mL of 0.9% sodium chloride injection.
The infusion rate should be maintained at 0.42 mL/minute over the 60-minute period. For Intravenous infusion over a period of 30 minutes in pediatric patients 7 to 17 years of age: The appropriate volume of the reconstituted Daptomycin for Injection (concentration of 50 mg per mL) should be further diluted, using aseptic technique, into a 50 mL IV infusion bag containing 0.9% sodium chloride injection.
The infusion rate should be maintained at 1.67 mL/minute over the 30-minute period. No preservative or bacteriostatic agent is present in this product. Aseptic technique must be used in the preparation of final IV solution. Do not exceed the In-Use storage conditions of the reconstituted and diluted solutions of Daptomycin for Injection described below.
Discard unused portions of daptomycin for injection. In-Use Storage Conditions for Daptomycin for Injection Once Reconstituted in Acceptable Intravenous Diluents Stability studies have shown that the reconstituted solution is stable in the vial for 12 hours at room temperature and up to 48 hours if stored under refrigeration between 2° and 8°C (36° and 46°F).
The diluted solution is stable in the infusion bag for 12 hours at room temperature and 48 hours if stored under refrigeration. The combined storage time (reconstituted solution in vial and diluted solution in infusion bag) should not exceed 12 hours at room temperature or 48 hours under refrigeration.
Compatible Intravenous Solutions Daptomycin for Injection is compatible with 0.9% sodium chloride injection and Lactated Ringer's injection.
Incompatibilities Daptomycin for Injection is not compatible with dextrose-containing diluents. Daptomycin for Injection should not be used in conjunction with ReadyMED ® elastomeric infusion pumps. Stability studies of daptomycin for injection solutions stored in ReadyMED ® elastomeric infusion pumps identified an impurity (2-mercaptobenzothiazole) leaching from this pump system into the Daptomycin for Injection solution.
Because only limited data are available on the compatibility of daptomycin for injection with other IV substances, additives and other medications should not be added to Daptomycin for Injection single-dose vials or infusion bags, or infused simultaneously with Daptomycin for Injection through the same IV line. If the same IV line is used for sequential infusion of different drugs, the line should be flushed with a compatible intravenous solution before and after infusion with Daptomycin for Injection.