Statins Daptomycin

DAPTOMYCIN LIPID-LOWERING DRUGS -FIBRATES, STATINS Risk of myopathy Additive effect Avoid co-administration... 

Daptomycin neither inhibits nor induces CYPs, and there are no important drug-drug interactions. However, caution is recommended when administering daptomycin in conjunction with aminoglycosides or statins because of potential risks of nephrotoxicity and myopathy, respectively. 

The use of statins and probably fibrates should be suspended during daptomycin use because of the possible increased risk of muscle toxicity. Daptomycin does not appear to interact with warfarin, but its use may result in falsely elevated prothrombin times. NSAIDs may reduce daptomycin excretion and concurrent use may increase the risks of renal impairment... 

The manufacturers note that experience of the concurrent use of daptomycin with statins is limited, and therefore the use of a statin should be suspended if daptomycin is given, - unless the benefits of concurrent use... 

A randomised, open-label, controlled trial of daptomycin to treat osteomyelitis associated with prosthetic devices revealed increases in CPK levels in 16% of those treated with 6mg/kg, and 21.7% of those treated with 8mg/kg. Daptomycin was given for between 6 and 8 weeks [148 ]. Similarly, a retrospective analysis of the use of daptomycin (4-6mg/kg) for complicated skin and soft-tissue infections with or without associated bacteraemia revealed a favourable safety profile. The most common adverse event reported was elevation of blood CPK [149 ]. A similar retrospective analysis investigating the safety of prolonged (>14days) daptomycin in 2263 patients reported increased blood CPK, nausea, diarrhoea, vomiting, thrombocytopenia, rash, pyrexia and increased blood creatinine at a rate of between 0.1% and 2.2% [150 ]. In contrast to this, a retrospective study assessed the safety of co-administration of daptomycin with statins. There was no significant increase in rhabdomyolysis with the combination [ISl ]. 

Parra-Ruiz J, Duenas-Gutierrez C, Tomas-Jimenez C, Linares-Palomino JP, Garrido-Gomez J, Hemandez-Quero J. Safety analysis of high dose (>6mg/kg/day) daptomycin in patients with concomitant statin therapy. Eur J Clin Microbiol Infect Dis 2012 31(8) 1771-4. 

---