Daptomycin can cause muscle toxicity, from a silent rise in creatine kinase to myopathy and, rarely, rhabdomyolysis. The risk is higher at higher doses, in kidney impairment and with statins. Standard practice is a baseline creatine kinase and weekly checks thereafter, more often when the dose is high or a statin cannot be stopped.
Daptomycin is inactivated by lung surfactant, so it should not be used to treat pneumonia, even when the organism is susceptible.
- Measure creatine kinase before starting daptomycin and weekly during treatment.
- Consider holding a statin for the course of daptomycin where it is safe to do so.
- Ask about muscle pain or weakness at each review.
- Do not use daptomycin for pneumonia: surfactant inactivates it.
- Adjust dosing interval in significant kidney impairment.
Why it matters
The higher doses now advised for enterococcal infection make muscle monitoring more important, not less.
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