Summary

The concurrent use of daptomycin and rosuvastatin may increase the risk of muscle-related adverse effects, including myopathy and rhabdomyolysis. Both medications can independently cause muscle toxicity, and their combination may have additive effects requiring careful monitoring.

Introduction

Daptomycin is a cyclic lipopeptide antibiotic used to treat serious gram-positive bacterial infections, including complicated skin and soft tissue infections and bacteremia. Rosuvastatin is an HMG-CoA reductase inhibitor (statin) prescribed to lower cholesterol levels and reduce cardiovascular risk. Both medications are commonly used in clinical practice and may be prescribed concurrently in patients with infections who also require cholesterol management.

Mechanism of Interaction

Both daptomycin and rosuvastatin can cause muscle toxicity through different mechanisms. Daptomycin may cause muscle damage through membrane disruption and calcium-dependent effects on muscle cells. Rosuvastatin, like other statins, can cause myopathy through depletion of coenzyme Q10 and interference with cholesterol synthesis in muscle cells. When used together, these mechanisms may have additive effects, potentially increasing the risk of muscle-related adverse events including elevated creatine kinase levels, myalgia, myopathy, and in rare cases, rhabdomyolysis.

Risks and Symptoms

The primary clinical risk of concurrent daptomycin and rosuvastatin use is increased muscle toxicity. Patients may experience muscle pain, weakness, tenderness, or cramping. Laboratory findings may include elevated creatine kinase (CK) levels, which can progress to clinically significant myopathy or rhabdomyolysis in severe cases. Rhabdomyolysis can lead to acute kidney injury and other serious complications. The risk may be higher in elderly patients, those with kidney disease, hypothyroidism, or other predisposing factors for muscle toxicity.

Management and Precautions

When daptomycin and rosuvastatin must be used concurrently, close monitoring is essential. Baseline creatine kinase levels should be obtained before starting therapy. Patients should be counseled to report any muscle pain, weakness, or dark urine immediately. Regular monitoring of CK levels is recommended, particularly during the first few weeks of concurrent therapy. If CK levels rise significantly (typically >10 times upper limit of normal) or if clinical signs of myopathy develop, consideration should be given to discontinuing one or both medications. Healthcare providers should weigh the benefits and risks of concurrent use and consider alternative antibiotics or temporary statin discontinuation when clinically appropriate.

Daptomycin interactions with food and lifestyle

Rosuvastatin interactions with food and lifestyle

Grapefruit and grapefruit juice should be avoided or consumed with caution while taking rosuvastatin, as they can increase blood levels of the medication and potentially increase the risk of side effects. Excessive alcohol consumption should be limited as it may increase the risk of liver problems when combined with rosuvastatin. Patients should maintain consistent dietary habits and inform their healthcare provider about any significant changes in diet or lifestyle.