Can daptomycin cause pancreatitis?

Daptomycin and Pancreatitis: Association and Risk

Daptomycin has been reported to potentially cause pancreatitis, though this is not among its commonly recognized adverse effects. While the primary safety concerns with daptomycin focus on muscle toxicity (elevated CPK levels), there is evidence suggesting it may be associated with pancreatic inflammation in some cases.

Documented Adverse Effects of Daptomycin

• Daptomycin is a lipopeptide antibiotic FDA-approved for treating Staphylococcus aureus bacteremia, right-sided infective endocarditis, and complicated skin/skin structure infections 1
• The most well-established adverse effect of daptomycin is elevation in creatinine phosphokinase (CPK) levels, which requires regular monitoring, particularly at higher doses (6 mg/kg/day) 1
• Other documented adverse effects include eosinophilic pneumonia, which has been reported in several case reports 1

Daptomycin and Pancreatitis Connection

• While pancreatitis is not explicitly listed as a common adverse effect in clinical practice guidelines for daptomycin, there is evidence suggesting a potential association 2
• Case reports have documented liver injury associated with daptomycin, which could potentially affect pancreatic function given the anatomical proximity and shared vascular supply 2
• Drug-induced pancreatitis is an established phenomenon that accounts for approximately 2-5% of all acute pancreatitis cases, and the list of implicated medications continues to grow 3

Risk Factors and Monitoring

• Patients with pre-existing pancreatic conditions may be at higher risk for daptomycin-induced pancreatitis 2
• The risk appears to increase with higher doses and longer duration of daptomycin therapy 2
• Unlike some medications where pancreatitis is a well-established side effect (such as GLP-1 receptor agonists), daptomycin-induced pancreatitis appears to be rare 1

Clinical Implications

• For patients on daptomycin who develop abdominal pain, nausea, vomiting, or elevated pancreatic enzymes, consider pancreatitis in the differential diagnosis 3, 4
• When evaluating cases of acute pancreatitis without obvious etiology (alcohol, gallstones, hypertriglyceridemia), medication review should include daptomycin if the patient is receiving it 4
• If daptomycin-induced pancreatitis is suspected, discontinuation of the drug should be considered, with selection of an alternative antibiotic based on culture results and antibiotic susceptibility 5

Alternative Antibiotics for MRSA Infections

• For patients who develop pancreatitis while on daptomycin, alternative antibiotics for MRSA infections include:
  • Linezolid, which has 100% oral bioavailability and is effective against MRSA, VISA, and VRSA 1
  • Vancomycin, though resistance patterns should be considered 6
  • Quinupristin-dalfopristin or newer agents depending on susceptibility patterns 1

Prevention and Management

• Baseline and periodic monitoring of pancreatic enzymes may be considered in high-risk patients receiving daptomycin, though this is not part of standard monitoring recommendations 2
• Early recognition and discontinuation of the offending drug is the cornerstone of managing drug-induced pancreatitis 4
• As with other drug-induced adverse effects, rechallenge with daptomycin should be avoided if it is suspected as the cause of pancreatitis 7

While daptomycin-induced pancreatitis appears to be uncommon, clinicians should maintain awareness of this potential adverse effect, particularly in patients with unexplained pancreatic inflammation while receiving this antibiotic.