vancomycin (Rx)

Brand and Other Names:Vancocin, Firvanq
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Dosing & Uses

AdultPediatricGeriatric

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

≥1 month: 10 mg/kg/dose q6hr  

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

≥1 month: 10 mg/kg/dose q6hr  

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

≥1 month: 10 mg/kg/dose q6hr  

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

≥1 month: 10 mg/kg/dose q6hr  

Bacterial Meningitis

15-20 mg/kg IV q6hr  

Other Infections

40 mg/kg/day IV divided q6hr  

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

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Interactions

Interaction Checker

and vancomycin

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              Serious - Use Alternative (4)

              • 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.

              • 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.

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              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, and vasculitis

              Single-dose flexible bags only

              • Skin and subcutaneous tissue disorders: Drug rash with eosinophilia and systemic symptoms (DRESS)
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              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 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

              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

              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

              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

              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)
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              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.

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              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)

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              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
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              vancomycin intravenous
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              750 mg vial
              Vancocin oral
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              250 mg capsule
              Vancocin oral
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              125 mg capsule
              vancomycin oral
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              250 mg capsule
              vancomycin oral
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              125 mg capsule
              vancomycin oral
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              50 mg/mL solution
              vancomycin oral
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              250 mg capsule
              vancomycin oral
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              125 mg capsule
              vancomycin oral
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              50 mg/mL solution
              vancomycin oral
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              50 mg/mL solution
              vancomycin oral
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              250 mg capsule
              vancomycin oral
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              125 mg capsule
              vancomycin oral
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              125 mg capsule
              vancomycin oral
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              250 mg capsule
              vancomycin oral
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              125 mg capsule
              vancomycin oral
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              vancomycin oral
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              vancomycin oral
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              250 mg capsule
              Firvanq oral
              -
              25 mg/mL solution
              Firvanq oral
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              50 mg/mL solution
              Firvanq oral
              -
              50 mg/mL solution
              Firvanq oral
              -
              50 mg/mL solution

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

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              Patient Education
              vancomycin intravenous

              VANCOMYCIN - INJECTION

              (VAN-koe-MYE-sin)

              COMMON BRAND NAME(S): Vancocin

              USES: Vancomycin is used to treat serious bacterial infections. It is an antibiotic that works by stopping the growth of bacteria.This medication is usually given by injection into a vein. However, the form in vials may also be given by mouth to treat a certain intestinal condition (colitis) that may rarely happen after treatment with antibiotics. 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 bacteria that cause these symptoms.This antibiotic treats only bacterial infections. It will not work 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: This medication is usually given by injection into a vein as directed by your doctor. Each dose should be injected slowly over at least 1 hour. The dosage and length of treatment are based on your medical condition, weight, and response to treatment.If you are using this medication 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.If you are using the frozen mixed liquid, thaw the medication at room temperature or in the refrigerator before using. Do not thaw by putting in a water bath or microwave. After thawing, shake well and squeeze the container to check for leaks. Discard the solution if the container leaks. Do not freeze it again after thawing.If you are taking this medication by mouth, follow your doctor's directions for taking the mixed liquid. This medication must first be mixed with water if it is taken by mouth. Ask your doctor or pharmacist if you have any questions.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same times every day.Continue to use 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: Pain, redness, and tenderness at the injection site may occur. If this medication is injected too fast, a condition known as "red man syndrome" may occur. Tell your doctor promptly if you have symptoms such as flushing of the upper body, dizziness, or muscle pain/spasms of the chest and back. 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), easy bleeding/bruising, vision changes (such as blurred vision, decreased vision).Use of this medication for prolonged or repeated periods may result in oral thrush or a new 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: 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.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using 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 problems, hearing problems, stomach/intestinal problems.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Vancomycin 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.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Children may be at greater risk for severe infusion reactions when this medication is injected too fast. See also Side Effects section for details.Older adults may be at greater risk for kidney and hearing problems while using this drug.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: 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.A product that may interact with this drug is: cidofovir.

              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 kidney function, vancomycin blood levels, blood cultures, complete blood counts, hearing tests) should be done while you are using this medication. Keep all medical and lab appointments.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

              STORAGE: Consult the product instructions or your pharmacist for storage details. 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) 2021 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.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.