VANCOR
Clinical safety rating: caution
Comprehensive clinical and safety monograph for VANCOR (VANCOR).
Inhibits cell wall synthesis by binding to the D-alanyl-D-alanine terminus of peptidoglycan precursors, blocking transglycosylation and transpeptidation.
| Metabolism | Primarily eliminated by glomerular filtration; negligible hepatic metabolism. No major cytochrome P450 involvement. |
| Excretion | Renal excretion of unchanged drug accounts for 80-90% of clearance via glomerular filtration; minor biliary excretion (<5%) and fecal elimination (<5%). |
| Half-life | Terminal elimination half-life is 4-6 hours in adults with normal renal function; can extend to 7-9 days in anuric patients, necessitating therapeutic drug monitoring. |
| Protein binding | 30-55% bound to serum proteins (primarily albumin); binding is reversible and non-saturable. |
| Volume of Distribution | 0.4-1.0 L/kg (approximately 0.7 L/kg in adults); distributes into extracellular fluid, pleural, pericardial, ascitic, and synovial fluids; poor CNS penetration unless inflamed meninges. |
| Bioavailability | IV: 100% bioavailability; oral: <5% (negligible systemic absorption), used solely for intraluminal effects in C. difficile colitis. |
| Onset of Action | IV: Onset of antibacterial action within 6-8 hours after first dose; oral: not absorbed, onset limited to intraluminal effects (for C. difficile colitis) within 24-48 hours. |
| Duration of Action | Antibacterial effect persists for 6-12 hours after IV dose, but post-antibiotic effect against gram-positive cocci may extend 2-4 hours; duration is prolonged in renal impairment. |
| Molecular Weight | 1449.3 |
Vancomycin 15-20 mg/kg IV every 8-12 hours, with target trough 10-20 mcg/mL; for serious infections, consider loading dose 25-30 mg/kg IV.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl >50 mL/min: no adjustment; CrCl 20-50 mL/min: 15-20 mg/kg IV every 24-36 hours; CrCl 10-19 mL/min: 15-20 mg/kg IV every 48-72 hours; CrCl <10 mL/min: 15-20 mg/kg IV every 96-120 hours; hemodialysis: 15-20 mg/kg IV post-dialysis. |
| Liver impairment | No dose adjustment required for hepatic impairment; vancomycin is primarily renally eliminated. |
| Pediatric use | Neonates: 15 mg/kg IV every 12-24 hours (adjusted by postmenstrual age and serum creatinine); Infants and children: 15-20 mg/kg IV every 6-12 hours; maximum 2 g/day; monitor troughs. |
| Geriatric use | Initiate at lower dose (e.g., 15 mg/kg IV every 12 hours) and adjust based on renal function; frequent monitoring of trough levels and renal function recommended due to age-related decline in GFR. |
| 1st trimester | Vancomycin crosses the placenta. Limited human data; animal studies show no teratogenic effects. Use only if clearly needed. |
| 2nd trimester | Considered safe in pregnancy when used for serious infections; monitor maternal renal function and serum levels. |
| 3rd trimester | Safe for use; no known risk of fetal harm. Adjust dosing based on renal function. |
Clinical note
Comprehensive clinical and safety monograph for VANCOR (VANCOR).
| Placental transfer | Vancomycin crosses the placenta; fetal serum concentrations reach 20-50% of maternal levels. |
| Breastfeeding | Vancomycin is excreted into breast milk in small amounts. Oral bioavailability is poor, so systemic exposure in the infant is minimal. Considered compatible with breastfeeding. |
■ FDA Black Box Warning
Vancomycin has a black box warning for nephrotoxicity and ototoxicity, especially with high doses or prolonged use. It also warns about 'red man syndrome' (infusion-related reaction) due to histamine release.
| Serious Effects |
Hypersensitivity to vancomycin
| Precautions | Monitor renal function (serum creatinine, BUN) and hearing (audiometry) in patients with renal impairment, elderly, or those receiving other nephrotoxic/ototoxic drugs. Infuse over at least 60 minutes to avoid infusion-related reactions. Use with caution in patients with pre-existing hearing loss or renal insufficiency. |
| Food/Dietary | No significant food interactions with vancomycin. Oral vancomycin should be taken with water on an empty stomach or as directed. Avoid alcohol during therapy (may worsen side effects). For IV form, no dietary restrictions. |
Loading safety data…
| Lactation Rating |
| L2 (Safer) |
| Teratogenic Risk | Vancomycin crosses the placenta. In first trimester, no well-controlled studies, but animal studies show no evidence of fetal harm. In second and third trimesters, no increased risk of major malformations reported with IV vancomycin. However, one study suggested possible association with hearing loss or nephrotoxicity in neonates if maternal serum levels >30 mcg/mL; maintain therapeutic monitoring. Overall, FDA Category B: limited human data suggest low risk; use if clearly needed. |
| Fetal Monitoring | Monitor maternal vancomycin trough levels (target 10-20 mcg/mL for most infections). Assess maternal renal function (serum creatinine, BUN) regularly. In fetus, consider serial growth ultrasounds if prolonged therapy. In neonate, monitor serum creatinine and hearing (auditory brainstem response) if maternal levels were elevated or therapy prolonged. |
| Fertility Effects | No known adverse effects on female fertility. In males, no studies; systemic toxicity (nephrotoxicity, ototoxicity) could theoretically impair spermatogenesis if severe, but no evidence. Vancomycin is not associated with gonadal toxicity. |
| Clinical Pearls | Vancomycin trough levels should be monitored (target 10-20 mcg/mL for most indications, 15-20 for complicated infections). Red man syndrome can be prevented by infusing over at least 60 minutes. Nephrotoxicity and ototoxicity risks increase with concurrent aminoglycosides. Oral vancomycin is only used for C. difficile colitis; it is not absorbed systemically. Vancomycin penetration into CSF is poor; consider intrathecal administration for ventriculitis. Hypersensitivity reactions, including DRESS syndrome, may occur. Serum creatinine should be monitored at least weekly. |
| Patient Advice | Take the full course of antibiotic exactly as prescribed. · Report any signs of allergic reaction: rash, itching, swelling, or trouble breathing. · Drink plenty of fluids unless instructed otherwise. · Intravenous vancomycin must be infused slowly over at least 1 hour to prevent red man syndrome (flushing, itching, rapid heartbeat). · Report any hearing loss, ringing in ears, dizziness, or changes in urination. · Oral vancomycin is only for C. difficile infection; do not share or use for other infections. · Do not stop the medication early even if you feel better. · Store at room temperature; keep out of reach of children. |