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 |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Other nephrotoxic drugs increase risk of toxicity Monitor levels to minimize risk of nephrotoxicity and ototoxicity (red man syndrome).
| FDA category | Human |
| Breastfeeding | Vancomycin is excreted into breast milk in small amounts. The milk-to-plasma ratio is approximately 0.2–0.5. Oral bioavailability in infants is low, but potential for alteration of gut flora exists. Consider risk versus benefit; compatible with breastfeeding according to the American Academy of Pediatrics. |
| Teratogenic Risk |
■ 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"] |
Loading safety data…
| 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. |