VANCOMYCIN HYDROCHLORIDE IN PLASTIC CONTAINER
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, blocking transglycosylation and transpeptidation.
| Metabolism | Not extensively metabolized; excreted primarily unchanged in urine via glomerular filtration. |
| Excretion | Renal elimination of unchanged drug by glomerular filtration: approximately 80-90% within 24 hours. Biliary/fecal excretion: less than 5%. |
| Half-life | Terminal half-life: 4-6 hours in adults with normal renal function. Extends significantly in renal impairment (up to 7-10 days in anuria). Requires therapeutic drug monitoring. |
| Protein binding | Approximately 30-60% bound to serum proteins, primarily albumin. |
| Volume of Distribution | Initial Vd: 0.2-0.3 L/kg (central compartment); steady-state Vd: 0.5-1.0 L/kg. Distributes into most tissues except CSF (increased in meningitis). |
| Bioavailability | Intravenous: 100% (only parenteral route for systemic infections). Oral: less than 5% (used only for C. difficile colitis). |
| Onset of Action | Intravenous: onset of antibacterial effect within 1-2 hours after infusion. Oral: not systemically absorbed; local effect in C. difficile colitis within 24-48 hours. |
| Duration of Action | Concentration-dependent activity; post-antibiotic effect lasts 2-4 hours. Dosing interval tailored by trough levels (target 10-20 mcg/mL). |
| Molecular Weight | 1485.71 |
15–20 mg/kg IV every 8–12 hours (max 2 g per dose), adjusted based on trough concentrations (target 10–20 mg/L).
| Dosage form | SOLUTION |
| Renal impairment | CrCl 30–50: 15–20 mg/kg IV every 24 hours; CrCl 10–29: 15–20 mg/kg IV every 48 hours; CrCl <10: 15–20 mg/kg IV every 96 hours or based on serum concentrations. |
| Liver impairment | Vancomycin pharmacokinetics are not significantly altered by hepatic dysfunction; no dose adjustment required based on Child-Pugh class. |
| Pediatric use | Neonates: 10–15 mg/kg IV every 12–24 hours based on postmenstrual age. Infants/Children: 15–20 mg/kg IV every 6–8 hours (max 2 g per dose). |
| Geriatric use | Elderly patients often have reduced renal function; initiate at 15–20 mg/kg IV every 12 hours and adjust dosing interval based on CrCl or trough levels; increased risk of nephrotoxicity. |
| 1st trimester | Limited human data; no evidence of teratogenicity in animal studies. Use only if clearly needed. |
| 2nd trimester | Crosses placenta; no known fetal harm. Consider maternal benefit versus fetal risk. |
| 3rd trimester | Crosses placenta; theoretical risk of ototoxicity and nephrotoxicity in fetus. Monitor therapeutic drug levels. |
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 therapeutic concentrations in fetal serum (30–50% of maternal levels). |
| Breastfeeding |
■ FDA Black Box Warning
Nephrotoxicity: Vancomycin can cause nephrotoxicity, especially with high doses or prolonged therapy. Ototoxicity: May cause hearing loss, which may be transient or permanent. Monitor renal function and hearing.
| Common Effects | MRSA) |
| Serious Effects |
Known hypersensitivity to vancomycin
| Precautions | Monitor serum vancomycin trough concentrations to ensure efficacy and avoid toxicity, Infusion-related reactions (Red Man Syndrome): rate-related, may be minimized by slow infusion, Use with caution in patients with renal impairment; adjust dose based on creatinine clearance, Risk of ototoxicity, especially in patients with renal impairment or concurrent ototoxic drugs, Hematologic toxicity: neutropenia, thrombocytopenia; monitor blood counts, Thrombophlebitis at injection site |
| Food/Dietary |
Loading safety data…
| Minimal excretion into breast milk; unlikely to cause adverse effects in infants due to low oral bioavailability. Use with caution in infants <1 month or with renal impairment. |
| Lactation Rating | L2 (Probably Compatible) |
| Teratogenic Risk | First trimester: No evidence of teratogenicity in human studies; animal studies show no fetal harm. Second/third trimester: No known teratogenic risk; use for maternal benefit only. Overall: FDA pregnancy category B; crosses placenta but not associated with congenital malformations. |
| Fetal Monitoring | Maternal: Renal function, serum vancomycin trough levels, hearing function in prolonged therapy. Fetal: Not routinely indicated; monitor for ototoxicity in prolonged maternal use. |
| Fertility Effects | No known effect on fertility in human or animal studies. |
| No specific food interactions. Oral vancomycin should be taken with or without food. For IV administration, diet does not affect therapy; however, maintain adequate hydration. |
| Clinical Pearls | Monitor trough levels before the 4th dose for efficacy (goal 15-20 mg/L for serious infections) and nephrotoxicity. Red Man Syndrome can be mitigated by premedication with antihistamines and rate of infusion >1 hour. Ototoxicity is rare but may be irreversible; audiometry is indicated if tinnitus or high-frequency hearing loss occurs. Desensitization protocols exist for IgE-mediated hypersensitivity. Nephrotoxicity risk increases with concomitant aminoglycosides or loop diuretics. |
| Patient Advice | Report any rash, itching, or difficulty breathing immediately. · Redness or flushing of the upper body during infusion is common; inform your nurse if it occurs. · This medication requires regular blood tests to check kidney function and drug levels. · Notify your doctor if you experience ringing in the ears or hearing loss. · Do not stop taking this medication abruptly unless directed by your provider. · Stay well hydrated unless advised otherwise by your healthcare team. |