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).

How it works

Inhibits bacterial cell wall synthesis by binding to the D-alanyl-D-alanine terminus of the peptidoglycan precursor, blocking transglycosylation and transpeptidation.

What the body does with it

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).

Classification & Brands

Dosing & administration

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.

Use during pregnancy

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	Excreted in breast milk in trace amounts; M/P ratio 0.1-0.5. Considered compatible with breastfeeding due to low oral bioavailability in infants; monitor for diarrhea or allergic reaction.
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.

Warnings & precautions

■ 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.

Side Effect Profile

Common Effects	MRSA)
Serious Effects

Absolute Contraindications

["Hypersensitivity to vancomycin","Contraindicated for intrathecal administration (only IV/IM/oral for C. difficile)"]

Clinical Precautions

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"]

Clinical Tips & Counseling

Drug interactions

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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).

How it works

Inhibits bacterial cell wall synthesis by binding to the D-alanyl-D-alanine terminus of the peptidoglycan precursor, blocking transglycosylation and transpeptidation.

What the body does with it

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).

Classification & Brands

Dosing & administration

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.

Use during pregnancy

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	Excreted in breast milk in trace amounts; M/P ratio 0.1-0.5. Considered compatible with breastfeeding due to low oral bioavailability in infants; monitor for diarrhea or allergic reaction.
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.

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Common Effects	MRSA)
Serious Effects

Absolute Contraindications

["Hypersensitivity to vancomycin","Contraindicated for intrathecal administration (only IV/IM/oral for C. difficile)"]