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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

Pharmacology

Quinupristin inhibits the late phase of protein synthesis; dalfopristin inhibits the early phase of protein synthesis.

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Always get your pet's drug and dose recommendation from the veterinarian.

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 .

Contraindications

Hypersensitivity to any component of product or prior hypersensitivity to other streptogramins.

Dosage and Administration

VREF
Adults 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 Infection
Adults 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.

General Advice

  • 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.

Storage/Stability

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 Interactions

Drugs 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.

Incompatibility

Saline solutions.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Thrombophlebitis; palpitations; phlebitis; vasodilation.

CNS

Headache.

Dermatologic

Pain, edema and inflammation at infusion site; rash; pruritus.

GI

Nausea; diarrhea; vomiting.

Genitourinary

Hematuria.

Miscellaneous

Pain; abdominal pain; leg cramps; allergic reactions; chest pain.

Precautions

Warnings

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.


Pregnancy

Category B .

Lactation

Undetermined.

Children

Safety and efficacy in children younger than 16 yr of age not established.

Superinfection

May result in bacterial or fungal overgrowth of nonsusceptible microorganisms.

Pseudomembranous colitis

Consider in patients who develop diarrhea.

Patient Information

  • 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.

Copyright © 2009 Wolters Kluwer Health.

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