From the FDA Drug Label
Musculoskeletal Disorders: myoglobin increased; rhabdomyolysis (some reports involved patients treated concurrently with daptomycin for injection and HMG-CoA reductase inhibitors)
The use of daptomycin in patients with a history of tendinitis should be approached with caution, as the drug label reports musculoskeletal disorders such as rhabdomyolysis, but does not directly address tendinitis. However, given the potential for muscle-related adverse effects, patients with a history of tendinitis should be closely monitored for signs of muscle pain or weakness associated with elevated levels of creatine phosphokinase (CPK) 1.
From the Research
Daptomycin should be used with caution in patients with a history of tendinitis due to its potential to cause musculoskeletal toxicity. When considering the use of daptomycin in patients with a history of tendinitis, it is essential to weigh the benefits against the potential risks. The mechanism of action of daptomycin, which involves disrupting cell membrane function, may contribute to its potential for causing musculoskeletal toxicity 2. Key considerations for using daptomycin in these patients include:
- Monitoring patients weekly with creatine phosphokinase (CPK) levels to detect early signs of muscle toxicity 3
- Instructing patients to immediately report any muscle pain, tenderness, or weakness, particularly in the lower extremities
- Discontinuing daptomycin if the patient develops significant muscle symptoms or if CPK levels rise to greater than 5 times the upper limit of normal
- Avoiding concurrent use of other medications associated with muscle toxicity, such as statins, and considering temporarily suspending statin therapy during daptomycin treatment 4
- Ensuring adequate hydration to reduce the risk of muscle toxicity It is also crucial to consider alternative antibiotics when possible, especially in patients with a history of tendinitis, to minimize the risk of exacerbating the condition. If daptomycin is necessary, close monitoring and prompt intervention can help mitigate potential adverse effects. The standard dosing of daptomycin is 4-6 mg/kg IV once daily for most infections, with higher doses sometimes needed for complicated infections 5.