Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.
If you were prescribed this medicine, other products containing Dalbavancin hydrochloride may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.
for The name of your medicine is Dalbavancin 500 mg powder for concentrate for solution for infusion (called Dalbavancin throughout this leaflet) it contains the active substance dalbavancin, which is an antibiotic of the glycopeptide group. Dalbavancin is used to treat adults and children aged 3 months and over with infections of the skin or in the layers of flesh below the skin. Dalbavancin works by killing certain bacteria, which can cause serious infections. It kills these bacteria by interfering with the formation of bacterial cell walls. If you also have other bacteria that cause your infection, your doctor may decide to treat you with other antibiotics in addition to Dalbavancin.
Dalbavancin Do not use Dalbavancin if you are allergic to dalbavancin or any of the other ingredients of this medicine (listed in section 6). Warnings and precautions Talk to your doctor, pharmacist or nurse before being given Dalbavancin:
Dalbavancin contains sodium This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially 'sodium- free'.
Dalbavancin Dalbavancin will be given to you by a doctor or nurse.
: Common (may affect up to 1 in 10 people)
Dalbavancin Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the vial after EXP. The expiry date refers to the last day of that month. Chemical and physical in-use stability of Dalbavancin has been demonstrated for both the reconstituted concentrate and for the diluted solution for 48 hours at or below 25 °C. The total in-use stability from reconstitution to administration should not exceed 48 hours. From a microbiological point of view, the product should be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 24 hours at 2 to 8 °C, unless reconstitution/ dilution has taken place in controlled and validated aseptic conditions. Do not freeze. This medicine does not require any special storage conditions if kept unopened in the original container. The prepared Dalbavancin solution for infusion must not be used if there are any particles or the solution is cloudy. Dalbavancin is for single use only. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
What Dalbavancin contains
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The following information is intended for medical or healthcare professionals only:
Package leaflet: Information for the patient
Important: Please refer to the Summary of Product Characteristics (SmPC) before prescribing. Dalbavancin must be reconstituted with sterile water for injections and subsequently diluted with 50 mg/ml (5 %) glucose solution for infusion. Dalbavancin vials are for single-use only. Instructions for reconstitution and dilution Aseptic technique must be used for reconstitution and dilution of Dalbavancin. 1.The content of each vial must be reconstituted by slowly adding 25 ml of water for injections. 2.Do not shake. To avoid foaming, alternate between gentle swirling and inversion of the vial, until its contents are completely dissolved. The reconstitution time may be up to 5 minutes. 3.The reconstituted concentrate in the vial contains 20 mg /ml dalbavancin. 4.The reconstituted concentrate must be a clear, colourless to yellow solution with no visible particles. 5.The reconstituted concentrate must be further diluted with 50 mg/ml (5 %) glucose solution for infusion. 6.To dilute the reconstituted concentrate, the appropriate volume of the 20 mg/ml concentrate must be transferred from the vial to an intravenous bag or bottle containing 50 mg/ml (5 %) glucose solution for infusion. For example: 25 ml of the concentrate contains 500 mg dalbavancin. 7.After dilution the solution for infusion must have a final concentration of 1 to 5 mg/ml dalbavancin 8.The solution for infusion must be clear, colourless to yellow solution with no visible particles. 9.If particulate matter or discoloration is identified, the solution must be discarded. Dalbavancin must not be mixed with other medicinal products or intravenous solutions. Sodium chloride containing solutions can cause precipitation and should NOT be used for reconstitution or dilution. The compatibility of reconstituted Dalbavancin concentrate has only been established with 50 mg/ml (5 %) glucose solution for infusion. If a common intravenous line is being used to administer other medicinal products in addition to Dalbavancin, the line should be flushed before and after each Dalbavancin infusion with 5 % glucose solution for infusion. Use in the paediatric population For paediatric patients, the dose of Dalbavancin will vary according to the age and weight of the child up to a maximum of 1,500 mg. Transfer the required dose of reconstituted dalbavancin solution, according to the instructions above, based on the child's weight, from the vial to an intravenous bag or bottle containing 50 mg/ml (5 %) glucose solution for infusion. The diluted solution must have a final dalbavancin concentration of 1 to 5 mg/ml. Table 1 below provides information to prepare an infusion solution with a final concentration of 2 mg/ml or 5 mg/ml (sufficient for most scenarios), to be administered by syringe pump, to achieve a dose of 22.5 mg/kg in paediatric patients from 3 to 12 months of age weighing from 3 to 12 kg. Alternative concentrations may be prepared, but must have a final concentration range of 1 to 5 mg/ml of dalbavancin. Refer to Table 1 to confirm the calculations. Values shown are approximate. Note that the table is NOT inclusive of all possible calculated doses for every age group but may be utilised to estimate the approximate volume to verify the calculation.
Table 1. Preparation of Dalbavancin (final infusion concentration 2 mg/ml or 5 mg/ml to be administered by syringe pump) in paediatric patients aged 3 to 12 months (22.5 mg/kg dose) Volume of of reconstituted Volume diluent dalbavancin 50 mg/ml Final Total Patient Dose (mg) solution dalbavancin Volume (5 %) Weight to achieve (20 mg/ infusion Dosed by glucose (kg) 22.5 mg/kg ml) to be solution syringe withdrawn tosolution concentration pump (ml) add for from vial mixing (ml) (ml) 3 67.5 33.8 4
90.0
5
112.5
45.0
6
135.0
7
157.5
78.8
8
180.0
90.0
9
202.5
40.5
10
225.0
11 12
247.5 270.0
10 ml
20 ml
90 ml
60 ml
2 mg/ml
5 mg/ml
56.3 67.5
45.0 49.5 54.0
Disposal Discard any portion of the reconstituted solution that remains unused. Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
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Dalbavancin 500 mg powder for concentrate for solution for infusion comes as infusion containing 500mg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.
The active substance in Dalbavancin 500 mg powder for concentrate for solution for infusion is dalbavancin hydrochloride.
Medicines with the same active substance, strength and form include: Xydalba 500 mg powder for concentrate for solution for infusion, Dalbavancin 500 mg powder for concentrate for solution for infusion, Dalbavancin Baxter 500 mg powder for concentrate for solution for infusion. They are interchangeable only if your prescriber or pharmacist says so.
This leaflet reproduces the patient information leaflet approved for Dalbavancin 500 mg powder for concentrate for solution for infusion, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.
Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.
The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.
Dalbavancin is indicated for the treatment of acute bacterial skin and skin structure infections (ABSSSI) in adults and paediatric patients aged 3 months and older (see sections 4.4 and 5.1).
Consideration should be given to official guidance on the appropriate use of antibacterial agents.
Posology
Adults
The recommended dose of dalbavancin is 1,500 mg administered as either a single infusion of 1,500 mg or as 1,000 mg followed one week later by 500 mg (see sections 5.1 and 5.2).
Children and adolescents aged from 6 years to less than 18 years
The recommended dose of dalbavancin is a single dose of 18 mg/kg (maximum 1,500 mg).
Infants and children aged from 3 months to less than 6 years
The recommended dose of dalbavancin is a single dose of 22.5 mg/kg (maximum 1,500 mg).
Special populations
Elderly
No dose adjustment is necessary (see section 5.2).
Renal impairment
Dose adjustments are not required for adult and paediatric patients with mild or moderate renal impairment (creatinine clearance ≥ 30 to 79 ml/min). Dose adjustments are not required for adult patients receiving regularly scheduled haemodialysis (3 times/week), and dalbavancin may be administered without regard to the timing of haemodialysis.
In adult patients with chronic renal impairment whose creatinine clearance is < 30 ml/min and who are not receiving regularly scheduled haemodialysis, the recommended dose is reduced to either 1,000 mg administered as a single infusion or 750 mg followed one week later by 375 mg (see section 5.2).
There is insufficient information to recommend dosage adjustment for patients younger than 18 years with creatinine clearance less than 30 ml/min/1.73 m2. Currently available information is described in section 5.2, but no recommendation on a posology can be made.
Hepatic impairment
No dose adjustment of dalbavancin is recommended for patients with mild hepatic impairment (Child-Pugh A). Caution should be exercised when prescribing dalbavancin to patients with moderate or severe hepatic impairment (Child-Pugh B & C) as no data are available to determine appropriate dosing (see sections 5.2).
Paediatric population
The safety and efficacy of dalbavancin in children aged < 3 months old has not yet been established. Currently available data are described in section 5.2, but no recommendation on a posology can be made.
Method of administration
Intravenous use
Dalbavancin must be reconstituted and then further diluted prior to administration by intravenous infusion over a 30 - minute period. For instructions on reconstitution and dilution of the medicinal product before administration, see section 6.6.
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
Hypersensitivity reactions
Dalbavancin should be administered with caution in patients known to be hypersensitive to other glycopeptides since cross-hypersensitivity may occur. If an allergic reaction to dalbavancin occurs, administration should be discontinued and appropriate therapy for the allergic reaction should be instituted.
Clostridioides (formerly Clostridium) difficile-associated diarrhoea
Antibacterial-associated colitis and pseudomembranous colitis have been reported with the use of nearly all antibiotics and may range in severity from mild to life threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea during or subsequent to the treatment with dalbavancin (see section 4.8). In such circumstance, the discontinuation of dalbavancin and the use of supportive measures together with the administration of specific treatment for Clostridioides (formerly Clostridium) difficile should be considered. These patients must never be treated with medicinal products that suppress the peristalsis.
Infusion-related reactions
Dalbavancin is to be administered via intravenous infusion, using a total infusion time of 30 minutes to minimise the risk of infusion-related reactions. Rapid intravenous infusions of glycopeptide antibacterial agents can cause reactions including flushing of the upper body, urticaria, pruritus, and/or rash. Stopping or slowing the infusion may result in cessation of these reactions.
Renal impairment
Information on the efficacy and safety of dalbavancin in patients with creatinine clearance < 30 ml/min is limited. Based on simulations, dose adjustment is needed for adult patients with chronic renal impairment whose creatinine clearance is < 30 ml/min and who are not receiving regular haemodialysis (see sections 4.2 and 5.2). There is insufficient information to recommend dosage adjustment for patients younger than 18 years with creatinine clearance less than 30 ml/min/1.73 m2.
Mixed infections
In mixed infections in which Gram-negative bacteria are suspected patients should also be treated with an appropriate antibacterial agent(s) against Gram-negative bacteria (see section 5.1).
Non-susceptible organisms
The use of antibiotics may promote the overgrowth of non-susceptible micro-organisms. If superinfection occurs during therapy, appropriate measures should be taken.
Limitations of the clinical data
There is limited data on safety and efficacy of dalbavancin when administered for more than two doses (one week apart). In the major trials in ABSSSI the types of infections treated were confined to cellulitis/erysipelas, abscesses and wound infections only. There is no experience with dalbavancin in the treatment of severely immunocompromised patients.
Excipients
This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially 'sodium- free'.
Results from an in vitro receptor screening study do not indicate a likely interaction with other therapeutic targets or a potential for clinically relevant pharmacodynamic interactions (see section 5.1).
Clinical drug-drug interaction studies with dalbavancin have not been conducted. Potential for other medicinal products to affect the pharmacokinetics of dalbavancin.
Dalbavancin is not metabolised by CYP enzymes in vitro, therefore co-administered CYP inducers or inhibitors are unlikely to influence the pharmacokinetics of dalbavancin.
It is not known if dalbavancin is a substrate for hepatic uptake and efflux transporters.
Co-administration with inhibitors of these transporters may increase the exposure to dalbavancin. Examples of such transporter inhibitors are boosted protease inhibitors, verapamil, quinidine, itraconazole, clarithromycin and cyclosporine.
Potential for dalbavancin to affect the pharmacokinetics of other medicinal products.
The interaction potential of dalbavancin on medicinal products metabolised by CYP enzymes is expected to be low since it is neither an inhibitor nor an inducer of CYP enzymes in vitro. There are no data on dalbavancin as an inhibitor of CYP2C8.
It is not known if dalbavancin is an inhibitor of transporters. Increased exposure to transporter substrates sensitive for inhibited transporter activity, such as statins and digoxin, cannot be excluded if combined with dalbavancin.
Pregnancy
There are no data from the use of dalbavancin in pregnant women. Studies in animals have shown reproductive toxicity (see section 5.3).
Dalbavancin is not recommended during pregnancy, unless the potential expected benefit clearly justifies the potential risk to the foetus.
Breast-feeding
It is unknown whether dalbavancin is excreted in human milk. However, dalbavancin is excreted in the milk of lactating rats and may be excreted in human breast milk. Dalbavancin is not well absorbed orally; however, an impact on the gastrointestinal flora or mouth flora of a breast-feeding infant cannot be excluded. A decision must be made whether to continue/discontinue breast-feeding or to continue/discontinue therapy with Dalbavancin taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
Fertility
Studies in animals have shown reduced fertility (see section 5.3). The potential risk for humans is unknown.
Dalbavancin may have a minor influence on the ability to drive and use machines, as dizziness has been reported in a small number of patients (see section 4.8).
Summary of the safety profile
In Phase 2/3 clinical studies, 2,473 adult patients received dalbavancin administered as either a single infusion of 1,500 mg or as 1,000 mg followed one week later by 500 mg. The most common adverse reactions occurring in ≥ 1 % of patients treated with dalbavancin were nausea (2.4 %), diarrhoea (1.9 %), and headache (1.3 %) and were generally of mild or moderate severity.
Tabulated list of adverse reactions (Table 1)
The following adverse reactions have been identified in Phase 2/3 clinical trials with dalbavancin. Adverse reactions are classified according to System Organ Class and frequency. Frequency categories are derived according to the following conventions: very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000).
Table 1.
System Organ Class
Common
Uncommon
Rare
Infections and infestations
vulvovaginal mycotic infection, urinary tract infection, fungal infection, Clostridioides (formerly Clostridium) difficile colitis, oral candidiasis
Blood and lymphatic system disorders
anaemia, thrombocytosis, eosinophilia, leucopenia, neutropenia
Immune system disorders
anaphylactoid reaction
Metabolism and nutrition disorders
decreased appetite
Psychiatric disorders
insomnia
Nervous system disorders
headache
dysgeusia, dizziness
Vascular disorders
flushing, phlebitis
Respiratory, thoracic and mediastinal disorders
cough
bronchospasm
Gastrointestinal disorders
nausea, diarrhoea
constipation, abdominal pain, dyspepsia, abdominal discomfort, vomiting
Skin and subcutaneous tissue disorders
pruritus, urticaria, rash
Reproductive system and breast disorders
vulvovaginal pruritus
General disorders and administration site conditions
infusion-related reactions
Investigations
blood lactate dehydrogenase increased, alanine aminotransferase increased, aspartate aminotransferase increased, blood uric acid increased, liver function test abnormal, transaminases increased, blood alkaline phosphatase increased, platelet count increased, body temperature increased, hepatic enzyme increased, gamma-glutamyl transferase increased
Description of selected adverse reactions
Class adverse reactions
Ototoxicity has been associated with glycopeptide use (vancomycin and teicoplanin); patients who are receiving concomitant therapy with an ototoxic medicinal product, such as an aminoglycoside, may be at increased risk.
Paediatric population
The safety of dalbavancin was evaluated in one Phase 3 clinical trial which included 168 paediatric patients from birth to less than 18 years of age with ABSSSI treated with dalbavancin (90 patients treated with a single dose of dalbavancin and 78 patients, all of them aged 3 months and older, treated with a two-dose regimen of dalbavancin). Overall, the safety findings of dalbavancin in these paediatric patients were similar to those observed in adults.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play and Apple App store.
No specific information is available on the treatment of overdose with dalbavancin, as dose-limiting toxicity has not been observed in clinical studies. In Phase 1 studies, healthy volunteers have been administered single doses of up to 1,500 mg, and cumulative doses up to 4,500 mg over a period of up to 8 weeks, with no signs of toxicity or laboratory results of clinical concern. In Phase 3 studies, patients have been administered single doses of up to 1,500 mg.
Treatment of overdose with dalbavancin should consist of observation and general supportive measures. Although no information is available specifically regarding the use of haemodialysis to treat overdose, it should be noted that in a Phase 1 study in patients with renal impairment, less than 6 % of the recommended dalbavancin dose was removed after 3 hours of haemodialysis.
Ask anything about Dalbavancin 500 mg powder for concentrate for solution for infusion. The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.
Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.
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