Quinupristin / Dalfopristin
Pronunciation: (kwih-NEW-priss-tin/dal-FOE-priss-tin)Class: Streptogramin
Trade Names:Synercid- Injection, lyophilized 500 mg (150 mg quinupristin; 350 mg dalfopristin)/10 mL
Quinupristin inhibits the late phase of protein synthesis; dalfopristin inhibits the early phase of protein synthesis.
Indications and Usage
Treatment of serious or life-threatening infections associated with VREF; treatment of complicated skin and skin structure infections caused by Staphylococcus aureus (methicillin-susceptible) or Streptococcus pyogenes .
Hypersensitivity to any component of product or prior hypersensitivity to other streptogramins.
Dosage and AdministrationVREFAdults and children (16 yr of age and older)
IV 7.5 mg/kg, infused over a 60-min period, every 8 h. Duration of therapy based on site and severity of infection.Complicated Skin and Skin Structure InfectionAdults and children (16 yr of age and older)
IV 7.5 mg/kg, infused over a 60-min period, every 12 h for at least 7 days.
- For IV administration only. Not for intradermal, subcutaneous, or IM administration.
- Follow manufacturer's instructions for reconstituting the Powder for Injection and subsequent further dilution.
- Dilute reconstituted solution within 30 min of reconstitution.
- Do not administer if particulate matter, cloudiness, or discoloration noted.
- After completing IV infusion, flush vein with 5% dextrose in water to minimize vein irritation.
- If other drugs are being administered through same IV line, flush IV line before and after infusion of quinupristin/dalfopristin with 5% dextrose in water solution.
Store vials in refrigerator (36° to 46°F). Store diluted solution for up to 5 h at room temperature or 54 h under refrigeration (36° to 46°F).
Drug InteractionsDrugs metabolized by CYP-450 3A4 (CYP3A4) enzyme system (eg, carbamazepine, cisapride, cyclosporine, delavirdine, diazepam, diltiazem, disopyramide, HMG-CoA reductase inhibitors [eg, simvastatin], docetaxel, indinavir, lidocaine, methylprednisolone, midazolam, nevirapine, nifedipine, paclitaxel, quinidine, ritonavir, tacrolimus, verapamil, vinca alkaloids [eg, vinblastine])
Plasma concentrations of these agents may be elevated, increasing or prolonging their therapeutic or adverse reactions.
Avoid drugs metabolized by CYP3A4 and that prolong the QTc interval.
Laboratory Test Interactions
None well documented.
Thrombophlebitis; palpitations; phlebitis; vasodilation.
Pain, edema and inflammation at infusion site; rash; pruritus.
Nausea; diarrhea; vomiting.
Pain; abdominal pain; leg cramps; allergic reactions; chest pain.
One of quinupristin/dalfopristin's approved indications is for the treatment of patients with serious of life-threatening infections associated with VREF bacteremia. Quinupristin/dalfopristin has been approved for this indication under the FDA's accelerated approval regulations.
Category B .
Safety and efficacy in children younger than 16 yr of age not established.
May result in bacterial or fungal overgrowth of nonsusceptible microorganisms.
Consider in patients who develop diarrhea.
- Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
- Review dosing schedule and prescribed length of therapy with patient, family, or caregiver. Advise patient that dose and duration of therapy are dependent on site and cause of infection.
- Advise patient that infusion-site reaction, muscle pain, and joint pain are the most common adverse reactions, and to inform health care provider if they occur and are intolerable.
- Advise patient to report the following signs of superinfection to health care provider: black “furry” tongue, white patches in mouth, foul-smelling stools, vaginal itching, or discharge.
- Warn patient, family, or caregiver that diarrhea containing blood or pus may be a sign of a serious disorder and to inform health care provider if noted.
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