VANCOMYCIN HCL
Clinical safety rating: safe
Other nephrotoxic drugs increase risk of toxicity Monitor levels to minimize risk of nephrotoxicity and ototoxicity (red man syndrome).
Inhibits bacterial cell wall synthesis by binding to the D-alanyl-D-alanine terminus of the peptidoglycan precursor, preventing cross-linking and polymerization.
| Metabolism | Minimally metabolized; primarily excreted unchanged by glomerular filtration. |
| Excretion | Primarily renal (90-95% unchanged via glomerular filtration), with minor biliary/fecal (<5%) |
| Half-life | 4-6 hours in normal renal function; prolonged to 7-9 days in anuria/ESRD, necessitating dosing adjustments |
| Protein binding | 10-50% (primarily albumin), variable and highly influenced by concentration, hypoalbuminemia, and tissue/fluid accumulation |
| Volume of Distribution | 0.4-1.0 L/kg, indicating distribution into extracellular fluid; increased in sepsis, burns, and renal failure; may reflect tissue binding at low plasma levels |
| Bioavailability | Oral: <0.5% (negligible systemic absorption); IM: unreliable, not recommended; IV: 100% |
| Onset of Action | IV: immediate (peak concentrations); oral: not absorbed, local effect within hours for C. difficile enterocolitis |
| Duration of Action | Approximately 6-12 hours; serum levels maintained above MIC for most susceptible organisms with q12h dosing; red man syndrome resolves within 20-30 min with antihistamine |
| Molecular Weight | 1485.71 |
15-20 mg/kg IV every 8-12 hours (max 2 g/dose) for serious infections; target trough 15-20 mcg/mL.
| Dosage form | Injectable |
| Renal impairment | CrCl 30-50 mL/min: 15-20 mg/kg IV every 24 hours; CrCl 10-29 mL/min: 15-20 mg/kg IV every 48-72 hours; CrCl <10 mL/min: consider alternative or monitor levels; hemodialysis: 15-20 mg/kg IV loading dose then redose based on trough >20 mcg/mL. |
| Liver impairment | No specific hepatic adjustment required; vancomycin pharmacokinetics minimally affected by hepatic impairment. |
| Pediatric use | Neonates: 15 mg/kg IV loading, then 10-15 mg/kg IV every 12-24 hours based on postmenstrual age; Infants and children: 15-20 mg/kg IV every 6-12 hours (max 2 g/dose) targeting trough 15-20 mcg/mL. |
| Geriatric use | Start at lower end of dosing range (15 mg/kg IV every 12 hours) with close monitoring of renal function and vancomycin trough levels due to age-related decline in creatinine clearance. |
| 1st trimester | Crosses placenta; animal studies show no fetal harm; no adequate human studies. Use only if clearly needed. |
| 2nd trimester | Crosses placenta; generally considered safe; no known teratogenicity. |
| 3rd trimester | Crosses placenta; safe for use in maternal infections; monitor for ototoxicity in neonate. |
Clinical note
Other nephrotoxic drugs increase risk of toxicity Monitor levels to minimize risk of nephrotoxicity and ototoxicity (red man syndrome).
| FDA category | Human |
| Placental transfer | Crosses placenta; achieves 10-30% of maternal serum concentration in fetal circulation. |
| Breastfeeding |
■ FDA Black Box Warning
No FDA black box warning.
| Common Effects | MRSA) |
| Serious Effects |
Hypersensitivity to vancomycin
| Precautions | Nephrotoxicity, Ototoxicity (including hearing loss and tinnitus), Red Man Syndrome (infusion-related histamine release), Monitor renal function and drug levels, Thrombophlebitis at injection site |
| Food/Dietary | No significant food interactions. Oral vancomycin should be taken with or without food; consistency is key. |
Loading safety data…
| Minimally excreted into breast milk; unlikely to cause adverse effects in infant due to poor oral bioavailability. |
| Lactation Rating | L2 (Safer) |
| Teratogenic Risk | Vancomycin is classified as FDA Pregnancy Category B. Animal studies have not demonstrated fetal risk, and there are no adequate well-controlled studies in pregnant women. It crosses the placenta. No known teratogenic effects; however, use only if clearly needed. |
| Fetal Monitoring | Monitor maternal serum vancomycin concentrations (trough levels), renal function (serum creatinine, BUN), and hearing (audiometry) during prolonged therapy. For fetus, monitor ultrasound for growth and development if prolonged exposure. |
| Fertility Effects | No known adverse effects on fertility in animal studies. Human data limited; no evidence of impaired fertility. |
| Clinical Pearls | Monitor trough levels (target 10-20 mg/L for most infections; 15-20 mg/L for complicated MRSA). Red man syndrome can occur with rapid infusion; premedicate with antihistamines or slow infusion. Vancomycin has poor lung penetration; consider alternative for pneumonia. Nephrotoxicity risk increases with concomitant aminoglycosides or piperacillin-tazobactam. AUC-guided dosing preferred over trough-only monitoring. |
| Patient Advice | Take exactly as prescribed; complete the full course even if you feel better. · Report any signs of infusion reaction (flushing, rash, itching) during IV administration. · Inform your doctor if you have kidney problems or hearing loss. · You may need regular blood tests to monitor drug levels and kidney function. · Stay well hydrated to reduce risk of kidney damage. |