Dosing & Uses
Dosage Forms & Strengths
capsule (Vancocin)
- 125mg
- 250mg
injection, lyophilized powder for reconstitution (generic)
- 500mg
- 750mg
- 1g
- 5g
- 10g
kit, powder for oral solution (Firvanq)
- 3.75g
- 7.5g
- 10.5g
- 15g
injection, single-dose flexible bag (generic)
- 500mg/100mL
- 750mg/150mL
- 1g/200mL
- 1.25g/250mL
- 1.5g/300mL
- 1.75g/350mL
- 2g/400mL
Staphylococcal Enterocolitis
Vancocin and Firvanq
Indicated for enterocolitis caused by Staphylococcus aureus (including methicillin-resistant strains)
Firvanq: Indicated for treatment of enterocolitis in adults and pediatric patients <18 years
0.5-2 g/day PO divided q6-8hr for 7-10 days
Clostridium difficile-associated Diarrhea
Vancocin and Firvanq
Indicated for treatment of Clostridium difficile (C. difficile)-associated diarrhea
Firvanq: Indicated for treatment of C. difficile-associated diarrhea in adults and pediatric patients <18 years
125 mg PO q6hr for 10 days
Infective Endocarditis
Indicated for treatment of infective endocarditis due to: susceptible isolates of MRSA, viridans group streptococci Streptococcus gallolyticus, Enterococcus species, and Corynebacterium species
For enterococcal endocarditis, use in combination with an aminoglycoside
Methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or who have failed to respond to other therapies
Indicated for treatment of early-onset prosthetic valve endocarditis caused by Staphylococcus epidermidis in combination with rifampin and an aminoglycoside
Usual dosage: 2 g divided either as 500 mg q6hr or 1 gram q12hr
Initial daily dose should be no less than 15 mg/kg
Septicemia
Indicated for treatment of septicemia due to: susceptible isolates of methicillin-resistant Staphylococcus aureus (MRSA) and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or patients who cannot receive or who have failed to respond to other drugs, including penicillins or cephalosporins
Usual dosage: 2 g divided either as 500 mg q6hr or 1 gram q12hr
Initial daily dose should be no less than 15 mg/kg
Skin and Skin Structure Infections
Indicated for treatment of skin and skin structure infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies
Usual dosage: 2 g divided either as 500 mg q6hr or 1 g q12hr
Initial daily dose should be no less than 15 mg/kg
Bone Infections
Indicated for treatment of bone infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies
Usual dosage: 2 g divided either as 500 mg q6hr or 1 gram q12hr
Initial daily dose should be no less than 15 mg/kg
Lower Respiratory Tract Infections
Indicated for treatment of lower respiratory tract infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies
Usual dosage: 2 g divided either as 500 mg q6hr or 1 gram q12hr
Initial daily dose should be no less than 15 mg/kg
Preoperative Antimicrobial Prophylaxis (Off-label)
Gastrointestinal [GI] and genitourinary [GU] procedures: 1 g IV by slow infusion over 1 hour, beginning 1-2 hours before procedure (with or without gentamicin 1.5 mg/kg; not to exceed 120 mg IV or IM <30 minutes before procedure)
Surgical Prophylaxis (Off-label)
Prophylaxis of infection in cardiac, thoracic, and arterial procedures; craniotomy; joint replacement; amputation
15 mg/kg IV over 1-2 hr; begin administration within 2 hr before incision; duration of prophylaxis for most procedures should be <24 hr
Dosing Modifications
Renal impairment
- Mild-to-severe: Initial dose should be no less than 15 mg/kg
- Functionally anephric patients: Initial dose of 15 mg/kg of body weight to achieve prompt therapeutic serum concentration; start at 1.9 mg/kg/24 hr after the initial dose of 15 mg/kg
Dosing Considerations
Peak values 18-26 mg/L; trough values 5-10 mg/L; however, Infectious Diseases Society of America and other guidelines urge troughs 15-20 mg/L
Only treat or prevent infections proven or strongly suspected to be caused by susceptible bacteria to reduce development of drug-resistant bacteria
Limitations of use
- Oral vancomycin: Not effective for other types of infections
- IV vancomycin: Not effective for treatment of staphylococcal enterocolitis and C. difficile-associated diarrhea
Dosage Forms & Strengths
capsule (Vancocin)
- 125mg
- 250mg
injection, lyophilized powder for reconstitution (generic)
- 500mg
- 750mg
- 1g
- 5g
- 10g
kit, powder for oral solution (Firvanq)
- 3.75g
- 7.5g
- 10.5g
- 15g
injection, single-dose flexible bag (generic)
- 500mg/100mL
- 750mg/150mL
- 1g/200mL
- 1.25g/250mL
- 1.5g/300mL
- 1.75g/350mL
- 2g/400mL
Staphylococcal Enterocolitis
Vancocin and Firvanq
Indicated for enterocolitis caused by Staphylococcus aureus (including methicillin-resistant strains)
Firvanq: Indicated for treatment of enterocolitis in adults and pediatric patients <18 years
0.5-2 g/day PO divided q6-8hr for 7-10 days
Clostridium difficile-associated Diarrhea
Vancocin and Firvanq
Firvanq: Indicated for treatment of C. difficile-associated diarrhea in adults and pediatric patients <18 years
125 mg PO q6hr for 10 days
Preoperative Antimicrobial Prophylaxis
GI and GU procedures: 20 mg/kg IV by slow infusion over 1 hour, beginning 1 hour before procedure (with or without gentamicin 1.5 mg/kg; not to exceed 120 mg IV or IM <30 minutes before procedure)
Infective Endocarditis
Indicated for treatment of infective endocarditis due to: susceptible isolates of MRSA, viridans group streptococci Streptococcus gallolyticus, Enterococcus species, and Corynebacterium species
For enterococcal endocarditis, use in combination with an aminoglycoside
Methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or who have failed to respond to other therapies
Indicated for treatment of early-onset prosthetic valve endocarditis caused by Staphylococcus epidermidis in combination with rifampin and an aminoglycoside
<1 month: See dosing considerations
≥1 month: 10 mg/kg/dose q6hr
Current AHA guidelines recommend using only for high-risk patients
Septicemia
Indicated for treatment of septicemia due to: susceptible isolates of methicillin-resistant Staphylococcus aureus (MRSA) and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or patients who cannot receive or who have failed to respond to other drugs, including penicillins or cephalosporins
<1 month: See dosing considerations
Skin and Skin Structure Infections
Indicated for treatment of skin and skin structure infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies
<1 month: See dosing considerations
Bone Infections
Indicated for treatment of bone infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies
<1 month: See dosing considerations
Lower Respiratory Tract Infections
Indicated for treatment of lower respiratory tract infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies
<1 month: See dosing considerations
Bacterial Meningitis
Other Infections
Dosing Considerations
Neonatal dosing
- After 20 mg/kg IV loading dose, give maintenance dose according to gestational age (GA) and serum creatinine (Scr)
-
GA ≤28 wk
- Scr <0.5: 15 mg/kg q12hr
- Scr 0.5-0.7: 20 mg/kg q24hr
- Scr 0.8-1: 15 mg/kg q24hr
- Scr 1.1-1.4: 10 mg/kg q24hr
- Scr >1.4: 15 mg/kg q48hr
-
GA >28 wk
- Scr <0.7: 15 mg/kg q12hr
- Scr 0.7-0.9: 20 mg/kg q24hr
- Scr 1-1.2: 15 mg/kg q24hr
- Scr 1.3-1.6: 10 mg/kg q24hr
- Scr >1.6: 15 mg/kg q48hr
Vancomycin is excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function
Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection and monitor renal function
Patients >65 years: Monitor during and following treatment to detect potential vancomycin induced nephrotoxicity; may take longer to respond to therapy compared to patients ≤65 years
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (5)
- bacitracin
vancomycin and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs
- BCG vaccine live
vancomycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cholera vaccine
vancomycin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
- microbiota oral
vancomycin decreases effects of microbiota oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Microbiota oral contains bacterial spores. Antibacterial agents may decrease efficacy if coadministered. Complete antibiotic regimens 2-4 days before initiating microbiota oral. .
- typhoid vaccine live
vancomycin decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
Monitor Closely (32)
- amikacin
amikacin and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- amphotericin B deoxycholate
amphotericin B deoxycholate and vancomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- bazedoxifene/conjugated estrogens
vancomycin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- carboplatin
carboplatin and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- cidofovir
cidofovir and vancomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- cisplatin
cisplatin and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- conjugated estrogens
vancomycin will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- contrast media (iodinated)
contrast media (iodinated) and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- cyclosporine
cyclosporine and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- deferasirox
deferasirox, vancomycin. Other (see comment). Use Caution/Monitor. Comment: Coadministration of deferasirox with potentially nephrotoxic drugs, including vancomycin may increase the risk of this toxicity. Monitor serum creatinine and/or creatinine clearance in patients.
- dichlorphenamide
dichlorphenamide and vancomycin both decrease serum potassium. Use Caution/Monitor.
- digoxin
vancomycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
vancomycin and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- estradiol
vancomycin will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- estrogens conjugated synthetic
vancomycin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- estropipate
vancomycin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- ifosfamide
ifosfamide, vancomycin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Monitor renal function.
- ioversol
ioversol and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- mestranol
vancomycin will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- methotrexate
vancomycin decreases levels of methotrexate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Recent exposure to vancomycin, in the absence of overt renal impairment, may adversely affect methotrexate excretion and increase risk of toxicity. Assess renal function, so appropriate methotrexate dose modifications can be made. .
- neomycin PO
neomycin PO and vancomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- oxaliplatin
oxaliplatin and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- peramivir
vancomycin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.
- piperacillin
piperacillin increases toxicity of vancomycin by unspecified interaction mechanism. Use Caution/Monitor. Monitor kidney function in patients concomitantly administered with piperacillin and vancomycin.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
vancomycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- streptozocin
streptozocin and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tacrolimus
tacrolimus and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- teicoplanin
teicoplanin and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tenofovir DF
tenofovir DF and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tobramycin inhaled
tobramycin inhaled and vancomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity
- trospium chloride
vancomycin, trospium chloride. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- voclosporin
voclosporin, vancomycin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
Minor (52)
- aceclofenac
aceclofenac increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- acemetacin
acemetacin increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- acyclovir
acyclovir and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- adefovir
adefovir and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- aspirin
aspirin increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- aspirin rectal
aspirin rectal increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- balsalazide
vancomycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- biotin
vancomycin will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- capreomycin
capreomycin and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- celecoxib
celecoxib increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- cephaloridine
cephaloridine and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- choline magnesium trisalicylate
choline magnesium trisalicylate increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- colistin
colistin and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- diclofenac
diclofenac increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- diflunisal
diflunisal increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- etodolac
etodolac increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- fenoprofen
fenoprofen increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- flurbiprofen
flurbiprofen increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- foscarnet
foscarnet and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- gentamicin
gentamicin and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- ibuprofen
ibuprofen increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- ibuprofen IV
ibuprofen IV increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- indomethacin
indomethacin increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- ketoprofen
ketoprofen increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- ketorolac
ketorolac increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- ketorolac intranasal
ketorolac intranasal increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- lornoxicam
lornoxicam increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- meclofenamate
meclofenamate increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- mefenamic acid
mefenamic acid increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- meloxicam
meloxicam increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- methoxyflurane
methoxyflurane and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- nabumetone
nabumetone increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- naproxen
naproxen increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- oxaprozin
oxaprozin increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- pantothenic acid
vancomycin will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- parecoxib
parecoxib increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- paromomycin
paromomycin and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- pentamidine
pentamidine and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- piroxicam
piroxicam increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- polymyxin B
polymyxin B and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- pyridoxine
vancomycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- pyridoxine (Antidote)
vancomycin will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- salicylates (non-asa)
salicylates (non-asa) increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- salsalate
salsalate increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- streptomycin
streptomycin and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- sulfasalazine
sulfasalazine increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- sulindac
sulindac increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- thiamine
vancomycin will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- tobramycin
tobramycin and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- tolfenamic acid
tolfenamic acid increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- tolmetin
tolmetin increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
Adverse Effects
10% (Oral)
capsule
- Nausea (17%)
- Abdominal pain (15%)
- Hypokalemia (13%)
1-10% (Oral)
capsule
- Vomiting (9%)
- Diarrhea (9%)
- Pyrexia (9%)
- Flatulence (8%)
- Urinary tract infection (8%)
- Headache (7%)
- Peripheral edema (6%)
- Back pain (6%)
- Fatigue (5%)
- Nephrotoxicity (5%)
Frequency Not Defined (IV)
Immune system disorders: Hypersensitivity reactions (eg, anaphylaxis, “red man syndrome”)
Skin and subcutaneous tissue disorders: Severe dermatologic reactions such as toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), and linear lgA bullous dermatosis (LABD)
Renal and urinary disorders: Acute kidney injury and interstitial nephritis
Ear and labyrinth disorders: Tinnitus, hearing loss, vertigo
Blood and lymphatic system disorders: Agranulocytosis, neutropenia, pancytopenia, leukopenia, thrombocytopenia, eosinophilia
Gastrointestinal disorders: Pseudomembranous colitis Cardiac disorders: Cardiac arrest, chest pain
General disorders and administration site conditions: General discomfort, fever, chills, phlebitis, injection site irritation, injection site pain and necrosis following intramuscular injection, chemical peritonitis following intraperitoneal administration (Vancomycin not approved for IM and intraperitoneal administration)
Laboratory abnormalities: Elevated blood urea nitrogen, elevated serum creatinine
Musculoskeletal and connective tissue disorders: Muscle pain
Nervous system disorders: Dizziness
Respiratory, thoracic and mediastinal disorders: Wheezing, dyspnea
Vascular disorders: Hypotension, shock, vasculitis
Postmarketing Reports (All Formulations)
Ototoxicity: Hearing loss associated IV administration (most cases had coexisting renal impairment or pre-existing hearing loss, or were coadministered an ototoxic drug), vertigo, dizziness, and tinnitus
Hematopoietic: Reversible neutropenia, thrombocytopenia
Miscellaneous: Anaphylaxis, drug fever, chills, nausea, eosinophilia, rashes, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, pruritus, flushing of the upper body (“vancomycin infusion reaction”), and vasculitis
Single-dose flexible bags only
- Skin and subcutaneous tissue disorders: Drug rash with eosinophilia and systemic symptoms (DRESS)
Warnings
Black Box Warnings
Embryo-fetal toxicity due to excipients
- Single-dose flexible bags are not recommended for use during pregnancy because it contains the excipients polyethylene glycol (PEG) 400 and N-acetyl-D-alanine (NADA), which caused fetal malformations in animal reproduction studies
- If vancomycin is needed during pregnancy, use other available formulations of vancomycin
Contraindications
Hypersensitivity
Cautions
Rapid IV administration may result in flushing, pruritus, hypotension, erythema, and urticaria
Systemic vancomycin exposure may result in acute kidney injury (AKI) and interstitial nephritis; risk of AKI increases as systemic exposure increases; additional risk factors for AKI include concomitant use of nephrotoxic drugs, patients with pre-existing renal impairment, or with comorbidities that predispose to renal impairment
Endocarditis prophylaxis: Use only for high-risk patients, per AHA guidelines
Ototoxicity may occur; toxicity proportional to amount of drug given and duration of treatment; presence of tinnitus or vertigo may indicate vestibular injury; discontinue if signs of ototoxicity occur
Risk of neutropenia increases with doses >25 g (reversible following discontinuation of therapy)
Avoid extravasation; necrosis may occur
Prolonged use may result in fungal or bacterial superinfection
Use caution in patients with renal impairment; monitor trough concentrations if multiple oral doses administered
Hemorrhagic occlusive retinal vasculitis, including permanent loss of vision, occurred in patients receiving intracameral or intravitreal administration of vancomycin during or after cataract surgery; safety and efficacy of vancomycin administered by intracameral or intravitreal route not established by adequate and well-controlled trials; vancomycin not indicated for prophylaxis of endophthalmitis
Oral vancomycin only indicated for treatment of pseudomembranous colitis due to Clostridioides difficile (C. difficile) and enterocolitis due to S. aureus; not effective for systemic infections
Clinically significant serum concentrations reported in some patients who have taken multiple oral doses of vancomycin for active C. difficile-associated diarrhea
Prescribe vancomycin only for a proven or strongly suspected bacterial infection to prevent the development of drug-resistant bacteria
Severe dermatologic reactions such as toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), and linear lgA bullous dermatosis (LABD) reported in association with vancomycin; cutaneous signs or symptoms reported include skin rashes, mucosal lesions, and blisters; discontinue therapy at first appearance of signs and symptoms of TEN, SJS, DRESS, AGEP, or LABD
Inflammation at the site of injection reported; vancomycin is irritating to tissue and must be given by a secure IV route to reduce the risk of local irritation and phlebitis
Infusion reactions
- Hypotension, including shock and cardiac arrest, wheezing, dyspnea, urticaria, muscular and chest pain may occur with rapid IV administration; reactions may be more severe in younger patients, particularly children, and in patients receiving concomitant muscle relaxant anesthetics
- Rapid administration may also be associated with “vancomycin infusion reaction”, which manifests as pruritus and erythema that involves the face, neck, and upper torso
- Infusion-related adverse reactions are related to both concentration and rate of administration of vancomycin; however, infusion-related adverse reactions may occur, at any rate, or concentration
Drug interactions overview
- Concomitant administration of vancomycin and anesthetic agents has been associated with erythema and histamine-like flushing and anaphylactoid reactions
- Monitor renal function in patients receiving vancomycin and concurrent and/or sequential systemic or topical use of other potentially neurotoxic and/or nephrotoxic drugs, (eg, amphotericin B, aminoglycosides, bacitracin, polymyxin B, colistin, viomycin, or cisplatin)
Pregnancy & Lactation
Pregnancy
Unknown whether vancomycin can affect reproduction capacity
In a controlled clinical study, potential ototoxic and nephrotoxic effects of vancomycin on infants were evaluated when administered to pregnant women for serious staphylococcal infections complicating IV drug abuse
Single-dose flexible bags only
Some formulations of Vancomycin Injection are not recommended for use during the first or second trimester of pregnancy because it contains the excipients, PEG 400 and NADA, which caused fetal malformations in animal reproduction studies; advise pregnant women of the potential risk to the fetus; if therapy with vancomycin injection is needed during first or second trimester of pregnancy, use other available formulations of vancomycin, free of PEG 400 and NADA
- Perform a pregnancy test in females of reproductive potential prior to prescribing this formulation
-
Animal data
- Reproduction studies in rabbits with intravenous doses of PEG 400 at approximately 8 times the maximum daily human dose based on systemic exposures of PEG 400 during organogenesis resulted in fetal spinal malformations
- Reproduction studies in rabbits and rats using intravenous doses of NADA at approximately 32 and 20 times the maximum daily human dose, respectively, based on systemic exposures of NADA resulted in maternal toxicity and fetal spinal and cardiovascular malformations in rabbits, and maternal toxicity with no adverse embryo-fetal effects in rats
Capsule
- Systemic absorption of vancomycin is low following oral administration of capsule; however, absorption may vary depending on various factors; there are no available data on vancomycin use in pregnant women to assess risk of major birth defects or miscarriage; available published data on intravenous vancomycin use in pregnancy during second and third trimesters have not shown an association with adverse maternal or fetal outcomes
Lactation
Intravenous
- Vancomycin is excreted in human milk
- Exercise caution when vancomycin is administered to a nursing woman
- Because of the potential for adverse events, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother
Vancocin
- There are no data on presence of vancomycin in human milk, effects on breastfed infant, or on milk production following oral administration; systemic absorption of vancomycin is low following oral administration of VANCOCIN; therefore, it is unlikely to result in clinically relevant exposure in breastfeeding infants; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Inhibits cell-wall biosynthesis; blocks glycopeptide polymerization by binding tightly to D-alanyl-D-alanine portion of cell wall precursor
Absorption
Oral
- Poorly absorbed
- After 250-mg capsules PO q8hr for 7 doses, fecal concentrations of vancomycin in volunteers exceeded 100 mcg/g in majority of samples
IV
- Peak serum time: Immediately after completion of infusion
Distribution
Distributed widely in body tissues and fluid, except for cerebrospinal fluid (CSF)
Relative diffusion from blood into CSF: Good only with inflammation (exceeds usual minimal inhibitory concentrations); CSF level nil with normal meninges, 20-30% of blood level with inflamed meninges
Protein bound: ~50%
Vd: 0.3-0.43 L/kg (IV)
Metabolism
There is no apparent metabolism of the vancomycin
Elimination
Half-life (IV): 4-6 hr (normal renal function); 7.5 days (anephric patients)
Mean clearance (flexible bag): 0.058 L/kg/hr (plasma); 0.048 L/kg/hr (renal)
Excretion: Urine (IV; 80-90% as unchanged drug); primarily feces (PO)
Administration
IV Compatibilities
Solution: D5W/0.9% NaCl, D5W, D10W, LR, sodium bicarbonate 3.75%, 0.9% NaCl, D5W and LR, Normosol and D5W, 0.9% NaCl, Isolyte
Additive: Amikacin, atracurium, calcium gluconate, cefepime, cimetidine, corticotropin, dimenhydrinate, erythromycin, famotidine, hydrocortisone, meropenem, ofloxacin, potassium chloride, ranitidine, verapamil, vitamins B and C
Syringe: Caffeine
Y-site (partial list): Acyclovir, alatrofloxacin, aldesleukin, allopurinol, amifostine, amiodarone, ampicillin, ampicillin-sulbactam, cefpirome, ceftizoxime, clarithromycin, diltiazem, esmolol, fluconazole, insulin, labetalol, lorazepam, linezolid, magnesium sulfate, midazolam, morphine, nicardipine, ondansetron, paclitaxel, pancuronium, perphenazine, remifentanil, sargramostim, sodium bicarbonate, tacrolimus, teniposide
IV Incompatibilities
Vancomycin solution has a low pH and may cause chemical or physical instability when it is mixed with other compounds
Mixtures of solutions of vancomycin and beta-lactam antibacterial drugs have been shown to be physically incompatible
Likelihood of precipitation increases with higher concentrations of vancomycin; adequately flush IV lines between administering these antibacterial drugs
IV Preparation
Add 10 mL of SWI to 500-mg vial and 20 mL of SWI to 1-g vial to yield 50 mg/mL solution; further dilution is required, depending on method of administration
Intermittent infusion: Dilute 500 mg with ≥100 mL of diluent and 1 g with ≥200 mL of diluent (NS or D5W)
Continuous infusion: Dilute in sufficient amount to permit infusion over 24 hours
Single-dose flexible bags
- Do NOT use in series connections
- Such use could result in an embolism due to residual air being drawn from the primary container before administration of the fluid from the secondary container is complete
Oral Preparation (Firvanq)
Tap bottom edges of bottle to loosen powder
Shake grape-flavored diluent for a few seconds
Open diluent and transfer about half the required volume of diluent into the vancomycin powder bottle
Shake powder bottle vertically for ~45 seconds
Add remaining grape-flavored diluent into powder bottle; shake bottle for ~30 seconds
Instruct patient to shake reconstituted solution well before each use and to use an oral dosing device that measures the appropriate volume of the oral solution in milliliters
Vancomycin concentration and volume after reconstitution
-
Reconstituted vancomycin concentration: 25 mg/mL
- 3.75 g: Dilute with 147 mL of grape-flavored diluent; final reconstituted volume: 150 mL
- 7.5 g: Dilute with 295 mL of grape-flavored diluent; final reconstituted volume: 300 mL
-
Reconstituted vancomycin concentration: 50 mg/mL
- 7.5 g: Dilute with 145 mL of grape-flavored diluent; final reconstituted volume: 150 mL
- 10.5 g: Dilute with 203 mL of grape-flavored diluent; final reconstituted volume: 210 mL
- 15 g: Dilute with 289 mL of grape-flavored diluent; final reconstituted volume: 300 mL
Oral Administration
Take with food
IV Administration
Intermittent (preferred): Administer over 60 minutes; not to exceed 10 mg/min
Continuous: Administer over 24 hours
Storage
Capsules: Store at 15-30°C (59-86°F)
Vials
- Store at room temperature, 15-30°C (59-86°F)
- Reconstituted solutions stable at 2-8°C for at least 4 days
Single-dose bags
- Store below 25°C
Powder for oral solution
- Unopened kits: Refrigerate, 2-8°C (36-46°F); do not freeze; keep container tightly closed
- Protect from light
- Reconstituted solutions: Refrigerate at 2-8°C (36-46°F); discard reconstituted solution after 14 days
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Vancocin oral - | 125 mg capsule |  | |
| Vancocin oral - | 250 mg capsule |  | |
| vancomycin oral - | 125 mg capsule |  | |
| vancomycin oral - | 50 mg/mL solution |  | |
| vancomycin oral - | 50 mg/mL solution |  | |
| vancomycin oral - | 250 mg capsule | | |
| vancomycin oral - | 50 mg/mL solution |  | |
| vancomycin oral - | 50 mg/mL solution |  | |
| vancomycin oral - | 50 mg/mL solution |  | |
| vancomycin oral - | 50 mg/mL solution |  | |
| vancomycin oral - | 250 mg capsule |  | |
| vancomycin oral - | 125 mg capsule |  | |
| vancomycin oral - | 125 mg capsule |  | |
| vancomycin oral - | 250 mg capsule |  | |
| vancomycin oral - | 250 mg capsule |  | |
| vancomycin oral - | 250 mg capsule |  | |
| vancomycin oral - | 125 mg capsule |  | |
| vancomycin oral - | 125 mg capsule | | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 500 mg vial |  | |
| vancomycin intravenous - | 10 gram vial |  | |
| vancomycin intravenous - | 5 gram vial |  | |
| vancomycin intravenous - | 10 gram vial |  | |
| vancomycin intravenous - | 10 gram vial |  | |
| vancomycin intravenous - | 5 gram vial |  | |
| vancomycin intravenous - | 500 mg vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 500 mg vial |  | |
| vancomycin intravenous - | 5 gram vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 10 gram vial |  | |
| vancomycin intravenous - | 750 mg vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 10 gram vial |  | |
| vancomycin intravenous - | 750 mg vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 5 gram vial |  | |
| vancomycin intravenous - | 10 gram vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 10 gram vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 750 mg vial |  | |
| vancomycin intravenous - | 5 gram vial |  | |
| vancomycin intravenous - | 10 gram vial |  | |
| vancomycin intravenous - | 500 mg vial |  | |
| vancomycin intravenous - | 750 mg vial |  | |
| vancomycin intravenous - | 750 mg vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 500 mg vial |  | |
| vancomycin intravenous - | 5 gram vial |  | |
| vancomycin intravenous - | 500 mg vial |  | |
| vancomycin intravenous - | 750 mg vial |  | |
| vancomycin intravenous - | 750 mg vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 500 mg vial |  | |
| vancomycin intravenous - | 1,000 mg vial |  | |
| vancomycin intravenous - | 750 mg vial |  | |
| Firvanq oral - | 50 mg/mL solution |  | |
| Firvanq oral - | 25 mg/mL solution |  | |
| Firvanq oral - | 50 mg/mL solution |  | |
| Firvanq oral - | 50 mg/mL solution |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
vancomycin oral
VANCOMYCIN SOLUTION - ORAL
(VAN-koe-MYE-sin)
COMMON BRAND NAME(S): Firvanq
USES: Vancomycin is an antibiotic used to treat infections. This form of vancomycin is used to treat a certain intestinal condition (colitis) caused by bacteria. This condition causes diarrhea and stomach/abdominal discomfort or pain. When vancomycin is taken by mouth, it stays in the intestines to stop the growth of certain bacteria that cause these symptoms.This antibiotic treats only bacterial infection in the intestines. It will not work for bacterial infections in any other part of the body or for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.
HOW TO USE: Take this medication by mouth as directed by your doctor, usually every 6 to 8 hours. Shake the bottle well before each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.The dosage is based on your medical condition and response to treatment. In children, the dosage is also based on weight.If you are also taking certain bile acid-binding cholesterol medication (such as cholestyramine, colestipol), take it at least 3 to 4 hours after taking vancomycin. Taking them together will make vancomycin work less well. Ask your pharmacist if you have questions.For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same times every day.Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: Abdominal pain, nausea, or vomiting may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor 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 have any serious side effects, including: hearing problems (such as ringing in the ears, hearing loss), signs of kidney problems (such as change in the amount of urine).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: fever that doesn't go away, new or worsening lymph node swelling, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
PRECAUTIONS: Before taking vancomycin, tell your doctor or pharmacist if you are allergic to it; 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: kidney disease, hearing problems.Before having surgery, tell your doctor or dentist about all the products you use (such as prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially kidney problems.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this form of vancomycin passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.Lab and/or medical tests (such as stool samples, kidney function) should be done while you are taking this medication. Keep all medical and lab appointments.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store this medication in the refrigerator away from light and moisture. Do not freeze. Discard any unused medication after 14 days. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised August 2021. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
