daptomycin and myopathy

Q: When should daptomycin be considered discontinued in regards to myopathy?

Answer: The three major side effects which need to be watched during daptomycin therapy are

• myopathy
• peripheral neuropathy, and 
• eosinophilic pneumonia 

Regarding myopathy, treatment should be guided by the creatine phosphokinase (CPK) level.

- In symptomatic patients, daptomycin should be discontinued if CPK ≥5 times the upper limit of normal.

- In asymptomatic patients, daptomycin should be discontinued if CPK ≥10 times the upper limit of normal.

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References:

1. Skiest DJ. Treatment failure resulting from resistance of Staphylococcus aureus to daptomycin. J Clin Microbiol 2006; 44:655.

2. Veligandla SR, Louie KR, Malesker MA, Smith PW. Muscle pain associated with daptomycin. Ann Pharmacother. 2004 Nov;38(11):1860-2. doi: 10.1345/aph.1D639. Epub 2004 Sep 14. PMID: 15367725.