Acute Porphyria Drug Database

J01XX09 - Daptomycin
Propably not porphyrinogenic
PNP

Rationale
Daptomycin is not metabolised by CYP enzymes. Risk for gastrointestinal adverse events in the form of nausea, vomiting and diarrhoea motivates vigilance against insufficient intake of food, especially of carbohydrate.
Therapeutic characteristics
Daptomycin is indicated for the treatment of complicated skin and soft-tissue infections (cSSTI), right sided infective endocarditis due to Staphylococcus aureus (RIE) and Staphylococcus aureus bacteraemia when associated the RIE or with cSSTI. Common side effects that can be potentially porphyrinogenic through reduction in carbohydrate intake and that also can be confused with an acute porphyria attack are gastrointestinal- and abdominal pain, nausea, vomiting, obstipation and diarrhoea. Other common side effects are fungal infections, urinary tract infection and candida infection.
Metabolism and pharmacokinetics
Daptomycin undergoes little to no CYP450-mediated metabolism. In vitro studies have shown that daptomycin does not inhibit or induce CYP1A2, CYP2A6, CYP2C9, CYP 2C19, CYP2D6, CYP2E1 and CYP3A4 (Oleson 2004 and SPC). Around 50-60% of a dose is excreted unchanged in urine (SPC), 24 hours after administration of daptomycin (Hair 2007). The site of metabolism has not been identified (SPC).

References

  1. Scientific articles
  2. Hair PI, Keam SJ. Daptomycin: a review of its use in the management of complicated skin and soft-tissue infections and Staphylococcus aureus bacteraemia. Drugs. 2007;67(10):1483-512. PMID 17600394. #1663
  3. Oleson FB, Berman CL, Li AP. An evaluation of the P450 inhibition and induction potential of daptomycin in primary human hepatocytes. Chem Biol Interact. 2004 Nov 20;150(2):137-47. PMID 15535984. #1665
  4. Summary of Product Characteristics
  5. Norwegian medicines agency. Summary of Product Characteristics (SPC). Daptomycin. #1664

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