Generic Name: Quinupristin + Dalfopristin Brand Name(s): Generics only. No brands available.

Uses

What is Quinupristin + Dalfopristin used for?

Quinupristin + Dalfopristin is a combination of 2 antibiotics. It is used to treat certain serious bacterial infections that have not responded to treatment with other antibiotics (resistant infections). This medication belongs to the class of antibiotics called streptogramins. Quinupristin/dalfopristin works by stopping the growth of bacteria.

How should I take Quinupristin + Dalfopristin?

This medication is given by injection into a vein as directed by your doctor, usually 2 to 3 times daily (every 8 to 12 hours). It should be injected slowly over 1 hour. The dosage is based on your medical condition, body weight, and response to treatment.

If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.

For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.

Continue to use this medication for the full time prescribed, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.

How do I store Quinupristin + Dalfopristin?

Store intact vials at 2°C to 8°C (36°F to 46°F). Stability of the solution diluted in D5W prior to the infusion is 5 hours at room temperature or 54 hours at 2°C to 8°C (36°F to 46°F); do not freeze. Extended storage information may be available; contact product manufacturer to obtain current recommendations.

If you need to store quinupristin and dalfopristin at home, talk with your doctor, nurse, or pharmacist about how to store it.

There may be different brands of Quinupristin + Dalfopristin that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Quinupristin + Dalfopristin down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Quinupristin + Dalfopristin?

Before using quinupristin/dalfopristin, tell your doctor or pharmacist if you are allergic to it; or to other streptogramin antibiotics (e.g., pristinamycin, virginiamycin); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver problems, high levels of bilirubin in the blood (hyperbilirubinemia).

This medication may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Quinupristin + Dalfopristin during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Quinupristin + Dalfopristin. Quinupristin + Dalfopristin is pregnancy risk category B according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Quinupristin + Dalfopristin?

Nausea, vomiting, diarrhea, and headache may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you develop redness/swelling/pain/warming of the skin at the injection site. Flushing the IV line after each dose of this medication with dextrose 5 percent in water solution as directed will reduce the risk of vein irritation.

Tell your doctor right away if you have any serious side effects, including: joint/muscle pain, yellowing eyes/skin, blood in the urine.

Get medical help right away if you experience this rare but very serious side effect: chest pain.

This medication may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a type of resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Do not use anti-diarrhea products or narcotic pain medications if you have any of the following symptoms because these products may make them worse. Tell your doctor right away if you develop: persistent diarrhea, abdominal or stomach pain/cramping, blood/mucus in your stool.

Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Quinupristin + Dalfopristin?

This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include certain antiarrhythmic drugs (e.g., amiodarone, disopyramide, quinidine), cisapride, cyclosporine, certain macrolide antibiotics (e.g., erythromycin, clarithromycin), certain antipsychotics (e.g., haloperidol, pimozide), among others.

Although most antibiotics are unlikely to affect hormonal birth control such as pills, patch, or ring, a few antibiotics (such as rifampin, rifabutin) can decrease their effectiveness. This could result in pregnancy. If you use hormonal birth control, ask your doctor or pharmacist for more details.

Quinupristin + Dalfopristin may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Quinupristin + Dalfopristin?

Quinupristin + Dalfopristin may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Quinupristin + Dalfopristin?

Quinupristin + Dalfopristin may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Quinupristin + Dalfopristin.

What is the dose of Quinupristin + Dalfopristin for an adult?

Usual Adult Dose for Skin or Soft Tissue Infection

Complicated: 7.5 mg/kg IV every 12 hours, infused over 1 hour

Usual Adult Dose for Bacteremia

Vancomycin-resistant Enterococcus faecium infection: 7.5 mg/kg IV every 8 hours, infused over 1 hour

This indication is no longer approved by the FDA. The submitted data failed to confirm clinical benefit for this condition.

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Data from clinical trials suggest that the incidence of adverse effects in patients with chronic liver insufficiency or cirrhosis was comparable to that in patients with normal hepatic function. Pharmacokinetic data in patients with hepatic cirrhosis (Child Pugh A or B) suggest that dosage reduction may be necessary but exact recommendations cannot be made at this time.

Precautions

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following dalfopristin-quinupristin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Dalfopristin-quinupristin is a major inhibitor of CYP450 3A4. If concurrently administered drugs are substrates of this isoenzyme and have narrow therapeutic windows, their levels should be monitored, and substrates that prolong the QTc interval should be avoided.

Dalfopristin-quinupristin should not be administered as a bolus due to the potential for increased toxicity. It should be infused over 60 minutes. There are no data on the safety of other infusion durations. Animal toxicity was higher with bolus administration compared to slow infusion.

To minimize venous irritation, a peripheral infusion should be followed by a flush with 5% dextrose in water. Saline and heparin are incompatible and should not be used for dilution or flushing. If moderate to severe venous irritation occurs with peripheral infusions of 250 mL, increasing the infusion volume to 500 mL or 750 mL, changing the infusion site, or infusing via a PICC line or central venous catheter should be considered.

Cases of arthralgia and myalgia, some severe, have been reported in with dalfopristin-quinupristin. Some patients showed improvement after reducing the dose frequency to every 12 hours. Symptoms resolved after treatment was discontinued in those patients available for follow-up.

Use of antibiotics may result in superinfections of nonsusceptible organisms. Appropriate measures should be taken if superinfection occurs during therapy.

To reduce the risk of development of drug-resistant organisms, antibiotics should only be used to treat or prevent proven or suspected infections caused by bacteria.

Dialysis

No adjustment recommended.

Other Comments

The dosage is expressed in terms of combined “mg” of dalfopristin plus quinupristin.

The minimum recommended treatment duration for complicated skin and skin structure infections is 7 days.

What is the dose of Quinupristin + Dalfopristin for a child?

Usual Pediatric Dose for Skin or Soft Tissue Infection

12 to less than 18 years: 7.5 mg/kg IV every 12 hours, infused over 1 hour

Precautions

Safety and efficacy have not been established in pediatric patients less than 16 years of age.

How is Quinupristin + Dalfopristin available?

Quinupristin + Dalfopristin is available in the following dosage forms and strengths:

  • Intravenous powder for injection.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Quinupristin + Dalfopristin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

 

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: April 21, 2018 | Last Modified: April 21, 2018

Want to live your best life?
Get the Hello Doktor Daily newsletter for health tips, wellness updates and more.