Vancomycin 1000mg Inj (ad-Vantage)
WARNING: Some products are not for use during the first and second trimesters of pregnancy. These products contain other things that may cause harm to the unborn baby. If you are pregnant, talk with your doctor. @ COMMON USES: It is used to treat or prevent bacterial infections.If taken by mouth, some products can be used to treat certain types of bowel infections. This includes C diff.
Drug Class
Glycopeptide antibiotic
Pharmacologic Class
Cell wall synthesis inhibitor
Pregnancy Category
Category C
FDA Approved
Jun 1958
DEA Schedule
Not Controlled
Overview
What is this medicine?
Vancomycin is a powerful antibiotic used to treat serious bacterial infections, especially those caused by bacteria that are resistant to many other antibiotics, like MRSA. It works by stopping bacteria from building their protective outer walls, which kills them. It is usually given through a vein (IV) in a hospital or clinic setting.
How to Use This Medicine
Taking Your Medication Correctly
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided to you and adhere to the instructions precisely. This medication is typically administered as an intravenous infusion, which means it is given into a vein over a period of time. In some cases, your doctor may prescribe an oral form of this medication, which can be taken by mouth or administered through a feeding tube as an alternative to injection.
Storing and Disposing of Your Medication
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
What to Do If You Miss a Dose
If you miss a dose, contact your doctor immediately to receive guidance on the next steps to take.
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided to you and adhere to the instructions precisely. This medication is typically administered as an intravenous infusion, which means it is given into a vein over a period of time. In some cases, your doctor may prescribe an oral form of this medication, which can be taken by mouth or administered through a feeding tube as an alternative to injection.
Storing and Disposing of Your Medication
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
What to Do If You Miss a Dose
If you miss a dose, contact your doctor immediately to receive guidance on the next steps to take.
Lifestyle & Tips
- Stay well-hydrated unless otherwise instructed by your doctor.
- Report any new or worsening symptoms to your healthcare provider immediately.
- Do not stop taking this medication without consulting your doctor, even if you feel better.
Available Forms & Alternatives
Available Strengths:
- Vancomycin 1000mg Inj
- Vancomycin 500mg Vial Forinjection
- Vancomycin 500mg Inj, 1 Vial
- Vancomycin 10gm Inj, 1 Vial
- Vancomycin 5gm Inj, 1 Vial
- Vancomycin 1000mg Inj (ad-Vantage)
- Vancomycin 5gm Inj, 1 Vial
- Vancomycin 750mg Inj, 1 Vial
- Vancomycin 1gm Inj, 1 Vial
- Vancomycin 125mg Capsules
- Vancomycin 250mg Capsules
- Vancomycin 1gm/200m Inj 12x200ml
- Vancomycin 250mg/5ml Oral Solution
- Vancomycin 10gm Inj, 1 Vial
- Vancomycin 1.25gm Inj 1 Vial
- Vancomycin 25mg/ml Oral Soln 300ml
- Vancomycin 25mg/ml Oral Soln 150ml
- Vancomycin 25mg/ml Oral Soln 300ml
- Vancomycin 25mg/ml Oral Soln 150ml
- Vancomycin 50mg/ml Oral Solution
- Vancomycin 1.5mg Inj, 1 Vial
- Vancomycin 1.75gm/350ml Inj, 350ml
- Vancomycin 750mg/150ml Inj, 150ml
- Vancomycin 1.5gm/300ml Inj, 300ml
- Vancomycin 500mg/100ml Inj, 100ml
- Vancomycin 125mg Capsules
- Vancomycin 250mg Capsules
- Vancomycin Hcl 1.75gm Inj, 1 Vial
- Vancomycin Hcl 2gm Sdv Inj, 1 Vial
Dosing & Administration
Adult Dosing
Standard Dose:
15-20 mg/kg IV every 8-12 hours (initial dose), not to exceed 2g per dose. Infuse over at least 60 minutes.
Dose Range:
15 - 20 mg
Condition-Specific Dosing:
severeInfections:
Target trough 15-20 mcg/mL (e.g., endocarditis, osteomyelitis, meningitis, hospital-acquired pneumonia).
moderateInfections:
Target trough 10-15 mcg/mL.
continuousInfusion:
Loading dose 15-20 mg/kg, then 25-40 mg/kg/day continuous infusion, adjusted to achieve target trough.
Pediatric Dosing
Neonatal:
Initial dose 10-15 mg/kg IV, then 10 mg/kg IV every 8-24 hours depending on post-menstrual age and postnatal age. Trough monitoring essential.
Infant:
15 mg/kg IV every 6 hours (or 10-15 mg/kg every 6-8 hours). Max 60-80 mg/kg/day.
Child:
15 mg/kg IV every 6 hours (or 10-15 mg/kg every 6-8 hours). Max 60-80 mg/kg/day.
Adolescent:
15 mg/kg IV every 6 hours (or 10-15 mg/kg every 6-8 hours). Max 60-80 mg/kg/day, or adult dosing if weight appropriate.
Dose Adjustments
Renal Impairment:
Mild:
CrCl 50-79 mL/min: Consider extending interval to 12-24 hours or reducing dose. Monitor troughs.
Moderate:
CrCl 20-49 mL/min: Extend interval to 24-72 hours or reduce dose. Monitor troughs closely.
Severe:
CrCl <20 mL/min: Dosing highly individualized, often 15 mg/kg loading dose, then subsequent doses based on trough levels (e.g., every 4-7 days).
Dialysis:
Hemodialysis: 15-20 mg/kg loading dose, then maintenance dose (e.g., 500-1000 mg) after each dialysis session, or based on trough levels. Peritoneal Dialysis: Dosing varies, often 15-30 mg/L in dialysate or intermittent IV dosing.
Hepatic Impairment:
Mild:
No specific adjustment needed.
Moderate:
No specific adjustment needed.
Severe:
No specific adjustment needed.
Pharmacology
Mechanism of Action
Vancomycin inhibits bacterial cell wall synthesis by binding with high affinity to the D-Ala-D-Ala terminus of peptidoglycan precursors. This binding prevents the transglycosylation and transpeptidation steps, leading to defective cell wall formation and increased bacterial cell membrane permeability, ultimately resulting in bacterial cell lysis and death.
Pharmacokinetics
Absorption:
Bioavailability:
100% (IV)
Tmax:
End of infusion (IV)
FoodEffect:
Not applicable (IV)
Distribution:
Vd:
0.4-1 L/kg
ProteinBinding:
10-50%
CnssPenetration:
Limited (uninflamed meninges), increased with inflammation
Elimination:
HalfLife:
4-6 hours (normal renal function)
Clearance:
0.8-1.3 mL/min/kg (normal renal function)
ExcretionRoute:
Renal (glomerular filtration)
Unchanged:
>80-90%
Pharmacodynamics
OnsetOfAction:
Rapid (IV)
PeakEffect:
End of infusion (IV)
DurationOfAction:
Dependent on half-life and MIC, typically maintained by q8-12h dosing
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of kidney problems, including:
+ Inability to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden weight gain
Severe skin reactions, such as:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other serious reactions that can affect body organs and be life-threatening
+ Symptoms may include:
- Red, swollen, blistered, or peeling skin
- Red or irritated eyes
- Sores in the mouth, throat, nose, eyes, genitals, or skin
- Fever
- Chills
- Body aches
- Shortness of breath
- Swollen glands
If you receive this medication through a vein (intravenous injection):
+ Fever
+ Chills
+ Sore throat
+ Pain when passing urine
+ Changes in balance
+ Flushing
+ Rash on the face, neck, trunk, and arms during infusion
If the medication is given too quickly, it can cause:
+ Shortness of breath or wheezing
+ Itching
+ Muscle pain
+ Chest pain
+ Signs of low blood pressure, such as dizziness or fainting
If the medication leaks from the vein, it can cause tissue damage. Inform your nurse immediately if you experience:
+ Redness
+ Burning
+ Pain
+ Swelling
+ Blisters
+ Skin sores
+ Leaking of fluid at the injection site
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or only minor ones. However, if you are bothered by any of the following side effects or if they do not go away, contact your doctor:
Diarrhea
Stomach pain
Upset stomach
Vomiting
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of kidney problems, including:
+ Inability to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden weight gain
Severe skin reactions, such as:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other serious reactions that can affect body organs and be life-threatening
+ Symptoms may include:
- Red, swollen, blistered, or peeling skin
- Red or irritated eyes
- Sores in the mouth, throat, nose, eyes, genitals, or skin
- Fever
- Chills
- Body aches
- Shortness of breath
- Swollen glands
If you receive this medication through a vein (intravenous injection):
+ Fever
+ Chills
+ Sore throat
+ Pain when passing urine
+ Changes in balance
+ Flushing
+ Rash on the face, neck, trunk, and arms during infusion
If the medication is given too quickly, it can cause:
+ Shortness of breath or wheezing
+ Itching
+ Muscle pain
+ Chest pain
+ Signs of low blood pressure, such as dizziness or fainting
If the medication leaks from the vein, it can cause tissue damage. Inform your nurse immediately if you experience:
+ Redness
+ Burning
+ Pain
+ Swelling
+ Blisters
+ Skin sores
+ Leaking of fluid at the injection site
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or only minor ones. However, if you are bothered by any of the following side effects or if they do not go away, contact your doctor:
Diarrhea
Stomach pain
Upset stomach
Vomiting
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe rash, hives, or itching, especially with flushing of the face, neck, and upper body (Red Man Syndrome).
- Ringing in the ears (tinnitus), hearing loss, or dizziness.
- Decreased urination, swelling in the legs or feet, or unusual tiredness (signs of kidney problems).
- Signs of an allergic reaction, such as difficulty breathing or swelling of the face/throat.
- Pain, redness, or swelling at the injection site.
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This is crucial to ensure safe use and avoid potential interactions.
* Any existing health problems, as this medication may interact with other medical conditions.
To guarantee your safety, carefully review all your medications and health issues with your doctor and pharmacist. Never start, stop, or adjust the dosage of any medication without first consulting your doctor to confirm it is safe to do so.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This is crucial to ensure safe use and avoid potential interactions.
* Any existing health problems, as this medication may interact with other medical conditions.
To guarantee your safety, carefully review all your medications and health issues with your doctor and pharmacist. Never start, stop, or adjust the dosage of any medication without first consulting your doctor to confirm it is safe to do so.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
If you have a history of kidney problems, such as kidney failure, notify your doctor, as this medication can cause kidney issues. Your doctor will likely recommend regular blood tests and other laboratory evaluations to monitor your condition.
Long-term use of this medication may increase the risk of permanent hearing loss. Do not exceed the prescribed duration of treatment, and immediately report any changes in your hearing or symptoms of hearing loss to your doctor. Your doctor may recommend periodic hearing tests during treatment.
To minimize the risk of a secondary infection, do not use this medication for an extended period beyond the recommended duration.
Antibiotics, including this medication, can cause diarrhea, which is usually mild. However, in rare cases, a severe form of diarrhea called Clostridioides difficile-associated diarrhea (CDAD) can occur, potentially leading to life-threatening bowel problems. CDAD may develop during or after treatment, sometimes several months later. If you experience stomach pain, cramps, or loose, watery, or bloody stools, contact your doctor promptly. Before treating diarrhea, consult your doctor for advice.
This medication is not intended for injection into the eye, as it can cause severe eye problems, including permanent vision loss.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, planning to become pregnant, or breastfeeding, discuss the potential benefits and risks with your doctor. For women of childbearing age, your doctor may require a pregnancy test before initiating treatment to confirm that you are not pregnant.
If you have a history of kidney problems, such as kidney failure, notify your doctor, as this medication can cause kidney issues. Your doctor will likely recommend regular blood tests and other laboratory evaluations to monitor your condition.
Long-term use of this medication may increase the risk of permanent hearing loss. Do not exceed the prescribed duration of treatment, and immediately report any changes in your hearing or symptoms of hearing loss to your doctor. Your doctor may recommend periodic hearing tests during treatment.
To minimize the risk of a secondary infection, do not use this medication for an extended period beyond the recommended duration.
Antibiotics, including this medication, can cause diarrhea, which is usually mild. However, in rare cases, a severe form of diarrhea called Clostridioides difficile-associated diarrhea (CDAD) can occur, potentially leading to life-threatening bowel problems. CDAD may develop during or after treatment, sometimes several months later. If you experience stomach pain, cramps, or loose, watery, or bloody stools, contact your doctor promptly. Before treating diarrhea, consult your doctor for advice.
This medication is not intended for injection into the eye, as it can cause severe eye problems, including permanent vision loss.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, planning to become pregnant, or breastfeeding, discuss the potential benefits and risks with your doctor. For women of childbearing age, your doctor may require a pregnancy test before initiating treatment to confirm that you are not pregnant.
Overdose Information
Overdose Symptoms:
- Severe nephrotoxicity (kidney damage)
- Ototoxicity (hearing loss, tinnitus)
- Hypotension
- Dizziness
What to Do:
Seek immediate medical attention. Management is primarily supportive care. Hemodialysis may be used to remove vancomycin from the blood, especially in patients with renal failure. Contact a poison control center (e.g., 1-800-222-1222) for specific guidance.
Drug Interactions
Major Interactions
- Aminoglycosides (e.g., gentamicin, tobramycin, amikacin): Increased risk of nephrotoxicity and ototoxicity.
- Amphotericin B: Increased risk of nephrotoxicity.
- Cyclosporine: Increased risk of nephrotoxicity.
- Loop diuretics (e.g., furosemide): Increased risk of ototoxicity.
- NSAIDs (e.g., ibuprofen, naproxen): Increased risk of nephrotoxicity.
Moderate Interactions
- Neuromuscular blocking agents (e.g., succinylcholine, rocuronium): Vancomycin may potentiate and prolong neuromuscular blockade.
- Contrast media: Potential for increased nephrotoxicity, especially with pre-existing renal impairment.
Monitoring
Baseline Monitoring
Renal function (Serum Creatinine, BUN)
Rationale: To establish baseline kidney function and guide initial dosing, as vancomycin is renally eliminated.
Timing: Prior to initiation of therapy.
Audiogram (if pre-existing hearing loss)
Rationale: To establish baseline hearing, especially in patients at higher risk for ototoxicity.
Timing: Prior to initiation of therapy.
Routine Monitoring
Vancomycin trough levels
Frequency: Prior to the 4th or 5th dose (at steady state), then at least weekly for prolonged therapy, or more frequently in patients with unstable renal function or serious infections.
Target: 10-15 mcg/mL for most infections; 15-20 mcg/mL for serious infections (e.g., endocarditis, osteomyelitis, meningitis, HAP/VAP).
Action Threshold: Levels outside target range require dose adjustment; levels >20 mcg/mL increase risk of toxicity.
Renal function (Serum Creatinine, BUN)
Frequency: At least 2-3 times per week, or daily in critically ill patients or those with unstable renal function.
Target: Within patient's baseline range.
Action Threshold: Increase in SCr by âĨ0.5 mg/dL or âĨ50% from baseline (whichever is greater) suggests acute kidney injury and requires dose adjustment or discontinuation.
Signs and symptoms of ototoxicity
Frequency: Daily patient assessment.
Target: Not applicable.
Action Threshold: Report new onset of tinnitus, hearing loss, vertigo, or dizziness.
Symptom Monitoring
- Red Man Syndrome (flushing, rash, pruritus, urticaria, tachycardia, hypotension, muscle spasms, dyspnea, chest pain, angioedema, dizziness, headache, chills, fever) - typically occurs with rapid infusion.
- Ototoxicity (tinnitus, hearing loss, vertigo, dizziness).
- Nephrotoxicity (decreased urine output, swelling, fatigue, nausea, confusion).
- Hypersensitivity reactions (rash, fever, chills, anaphylaxis).
- Injection site reactions (pain, phlebitis).
Special Patient Groups
Pregnancy
Vancomycin crosses the placenta. While human data are limited, it has been used in pregnant women for serious infections when other antibiotics are not effective or appropriate. Potential for fetal ototoxicity and nephrotoxicity exists, but the benefits of treating serious maternal infections often outweigh these theoretical risks. Use only if clearly needed and the potential benefit justifies the potential risk to the fetus.
Trimester-Specific Risks:
First Trimester:
Limited data, theoretical risk of organogenesis effects, but generally considered low.
Second Trimester:
Potential for fetal exposure and theoretical risk of ototoxicity/nephrotoxicity.
Third Trimester:
Potential for fetal exposure and theoretical risk of ototoxicity/nephrotoxicity, especially if maternal renal function is impaired.
Lactation
Vancomycin is excreted in breast milk in small amounts. Oral absorption by the infant is poor. Generally considered compatible with breastfeeding, but monitor the infant for potential adverse effects such as disruption of gut flora (e.g., diarrhea, candidiasis) or allergic reactions. The amount transferred is unlikely to cause significant systemic effects in the infant.
Infant Risk:
Low
Pediatric Use
Dosing is weight-based and requires careful monitoring of serum concentrations (trough levels) due to variability in pharmacokinetics, especially in neonates and infants who have immature renal function. Higher doses per kg may be needed compared to adults due to faster clearance.
Geriatric Use
Elderly patients are at increased risk of nephrotoxicity and ototoxicity due to age-related decline in renal function. Dose adjustment based on estimated creatinine clearance is crucial. Close monitoring of renal function and vancomycin trough levels is essential.
Clinical Information
Clinical Pearls
- Always infuse vancomycin slowly, typically over at least 60 minutes for 1 gram, to prevent Red Man Syndrome (a histamine-mediated reaction, not a true allergy).
- Therapeutic drug monitoring (trough levels) is critical for optimizing efficacy and minimizing toxicity, especially for serious infections, renal impairment, or prolonged therapy.
- Ensure adequate hydration to help prevent nephrotoxicity.
- Vancomycin is primarily effective against Gram-positive bacteria, including MRSA, and has no significant activity against Gram-negative bacteria.
- Oral vancomycin is used for Clostridioides difficile infection (CDI) due to its poor systemic absorption, while IV vancomycin is for systemic infections.
- Consider continuous infusion for critically ill patients or those with fluctuating renal function to maintain more stable drug levels and potentially reduce toxicity.
Alternative Therapies
- Daptomycin (for MRSA, VRE, but not pneumonia)
- Linezolid (for MRSA, VRE, including pneumonia)
- Ceftaroline (for MRSA)
- Tedizolid (for MRSA skin infections)
- Dalbavancin (for MRSA skin infections)
- Oritavancin (for MRSA skin infections)
- Teicoplanin (glycopeptide, not available in the US)
Cost & Coverage
Average Cost:
Variable, typically $10-$50 per 1000mg vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (generic)
General Drug Facts
If your symptoms or health problems persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others, and do not take medication prescribed for someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed to do so by a healthcare professional, do not flush medications down the toilet or drain. If you are unsure about the correct disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area. Some medications may come with an additional patient information leaflet, which your pharmacist can provide. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time of ingestion.