Vancomycin 500mg Vial Forinjection
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
Antibiotic
Pharmacologic Class
Glycopeptide antibiotic
Pregnancy Category
Category C
FDA Approved
Aug 1986
DEA Schedule
Not Controlled
Overview
What is this medicine?
Vancomycin is an antibiotic given by IV infusion to treat serious bacterial infections, especially those caused by bacteria resistant to other antibiotics, like MRSA. It works by stopping bacteria from building their cell walls, which kills them.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. This medication is typically administered as an infusion into a vein over a period of time. In some cases, it may be given orally or through a feeding tube instead of as an injection, if deemed necessary by your healthcare provider.
Storing and Disposing of Your Medication
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist for guidance on proper storage.
Missing a Dose
If you miss a dose, contact your doctor to determine the best course of action.
To use this medication correctly, follow your doctor's instructions and read all the information provided. This medication is typically administered as an infusion into a vein over a period of time. In some cases, it may be given orally or through a feeding tube instead of as an injection, if deemed necessary by your healthcare provider.
Storing and Disposing of Your Medication
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist for guidance on proper storage.
Missing a Dose
If you miss a dose, contact your doctor to determine the best course of action.
Lifestyle & Tips
- Stay well-hydrated during treatment to help protect your kidneys.
- Report any new or worsening symptoms to your healthcare provider immediately.
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, infused over at least 60 minutes
Dose Range:
15 - 20 mg
Condition-Specific Dosing:
severeInfections:
Loading dose of 25-30 mg/kg may be considered for critically ill patients (e.g., sepsis, meningitis) to achieve target trough levels rapidly, followed by maintenance dosing.
endocarditis:
15-20 mg/kg IV every 8-12 hours, targeting trough levels of 15-20 mcg/mL.
Pediatric Dosing
Neonatal:
Initial dose 15 mg/kg IV, then 10 mg/kg IV every 12-24 hours depending on post-natal age and gestational age. Close monitoring of trough levels is essential.
Infant:
15 mg/kg IV every 6 hours or 10-15 mg/kg IV every 6-12 hours. Dosing interval depends on age and renal function.
Child:
15 mg/kg IV every 6 hours or 10-15 mg/kg IV every 6-12 hours. Max single dose typically 1g. Target trough levels 10-20 mcg/mL.
Adolescent:
15-20 mg/kg IV every 8-12 hours, similar to adult dosing, with target trough levels 10-20 mcg/mL (or 15-20 mcg/mL for serious infections).
Dose Adjustments
Renal Impairment:
Mild:
CrCl 50-79 mL/min: Consider extending interval to every 12-24 hours or reducing dose. Monitor trough levels.
Moderate:
CrCl 30-49 mL/min: Extend interval to every 24-48 hours or reduce dose significantly. Monitor trough levels closely.
Severe:
CrCl <30 mL/min: Extend interval to every 48-96 hours or administer a single dose and then dose based on trough levels. Often, a loading dose followed by subsequent doses guided by TDM.
Dialysis:
Hemodialysis: Administer 15 mg/kg IV loading dose, then 500-1000 mg after each dialysis session or 10-15 mg/kg IV every 5-7 days. Peritoneal Dialysis: 15-30 mg/kg IV every 5-7 days or 20 mg/L in each dialysate exchange. Monitor trough levels to guide dosing.
Hepatic Impairment:
Mild:
No specific dose adjustment required as vancomycin is minimally metabolized by the liver.
Moderate:
No specific dose adjustment required.
Severe:
No specific dose adjustment required.
Pharmacology
Mechanism of Action
Vancomycin is a tricyclic glycopeptide antibiotic that inhibits bacterial cell wall synthesis. It binds with high affinity to the D-Ala-D-Ala terminus of the peptidoglycan precursor units, preventing the transpeptidation (cross-linking) and transglycosylation (elongation) steps necessary for cell wall formation. This leads to osmotic instability and cell lysis. It also alters bacterial cell membrane permeability and RNA synthesis.
Pharmacokinetics
Absorption:
Bioavailability:
Poor (<5%) orally for systemic effect; nearly 100% IV
Tmax:
End of infusion (IV)
FoodEffect:
Not applicable for IV formulation
Distribution:
Vd:
0.4-1 L/kg (adults), higher in children and neonates
ProteinBinding:
10-50%
CnssPenetration:
Limited (poor in uninflamed meninges, increased in inflamed meninges)
Elimination:
HalfLife:
4-11 hours (normal renal function); significantly prolonged in renal impairment (up to 200 hours)
Clearance:
Primarily renal clearance (glomerular filtration)
ExcretionRoute:
Renal (urine)
Unchanged:
>80-90% (in urine)
Pharmacodynamics
OnsetOfAction:
Rapid (within minutes of IV infusion)
PeakEffect:
End of infusion (IV)
DurationOfAction:
Dose-dependent, typically 8-12 hours for therapeutic levels with standard dosing, but antibacterial effect persists as long as concentrations are above MIC.
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 injection (intravenously):
+ 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 administered too quickly, you may experience:
+ 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. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. Contact your doctor or seek medical attention if you experience:
Diarrhea
Stomach pain
Upset stomach
Vomiting
* Any other side effects that bother you or do not go away
Reporting 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 injection (intravenously):
+ 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 administered too quickly, you may experience:
+ 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. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. Contact your doctor or seek medical attention if you experience:
Diarrhea
Stomach pain
Upset stomach
Vomiting
* Any other side effects that bother you or do not go away
Reporting 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 itching, flushing, rash, or dizziness during or shortly after the infusion (Red Man Syndrome)
- Decreased urination, swelling in legs or feet, unusual tiredness (signs of kidney problems)
- Ringing in the ears (tinnitus), dizziness, or hearing loss (signs of ear problems)
- Severe diarrhea, especially if it's watery or bloody (could be C. difficile infection)
- Signs of an allergic reaction (hives, difficulty breathing, swelling of face/lips/tongue/throat)
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 information will help your doctor and pharmacist assess potential interactions between this medication and other substances you are taking.
* Any existing health problems, as this medication may interact with certain conditions.
To ensure your safety, it is crucial to verify that it is safe to take this medication with all your current medications and health conditions. Do not initiate, discontinue, or modify the dosage of any medication without first consulting 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 information will help your doctor and pharmacist assess potential interactions between this medication and other substances you are taking.
* Any existing health problems, as this medication may interact with certain conditions.
To ensure your safety, it is crucial to verify that it is safe to take this medication with all your current medications and health conditions. Do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor.
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 also recommend periodic hearing tests during treatment.
To minimize the risk of a secondary infection, do not use this medication for longer than prescribed.
As with many antibiotics, diarrhea is a common side effect. 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 with your doctor.
This medication is not approved 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, plan to become pregnant, or are 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 also recommend periodic hearing tests during treatment.
To minimize the risk of a secondary infection, do not use this medication for longer than prescribed.
As with many antibiotics, diarrhea is a common side effect. 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 with your doctor.
This medication is not approved 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, plan to become pregnant, or are 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 (acute kidney injury)
- Ototoxicity (hearing loss, tinnitus, vertigo)
- Hypotension
- Red Man Syndrome
What to Do:
Treatment is supportive. Hemodialysis may be useful for removing vancomycin from the blood in cases of severe overdose or renal failure. Call 1-800-222-1222 (Poison Control).
Drug Interactions
Major Interactions
- Aminoglycosides (e.g., gentamicin, tobramycin, amikacin): Increased risk of nephrotoxicity and ototoxicity.
- Loop diuretics (e.g., furosemide, bumetanide): Increased risk of ototoxicity.
- Cyclosporine, Tacrolimus: Increased risk of nephrotoxicity.
- Cisplatin: Increased risk of nephrotoxicity and ototoxicity.
- Amphotericin B: Increased risk of nephrotoxicity.
Moderate Interactions
- Neuromuscular blocking agents (e.g., succinylcholine, rocuronium): Vancomycin may potentiate or prolong neuromuscular blockade.
- Metformin: Vancomycin may increase metformin concentrations by inhibiting OCT1/2 transporters, though clinical significance is often low.
- Radiocontrast agents: Potential for increased nephrotoxicity, especially in patients with pre-existing renal impairment.
Monitoring
Baseline Monitoring
Renal function (SCr, BUN)
Rationale: Vancomycin is primarily renally eliminated and can cause nephrotoxicity. Baseline assessment is crucial for dose calculation.
Timing: Prior to initiation of therapy
Complete Blood Count (CBC)
Rationale: To assess for potential hematologic adverse effects (e.g., neutropenia, thrombocytopenia), though rare.
Timing: Prior to initiation of therapy
Hearing assessment (if risk factors present)
Rationale: To establish baseline for potential ototoxicity, especially in patients with pre-existing hearing impairment or concurrent ototoxic drugs.
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 or more frequently in unstable patients or those with changing renal function.
Target: 10-15 mcg/mL for most infections; 15-20 mcg/mL for serious infections (e.g., endocarditis, osteomyelitis, meningitis, hospital-acquired pneumonia, bacteremia with MRSA).
Action Threshold: Trough levels outside target range warrant dose adjustment. Levels >20 mcg/mL increase risk of nephrotoxicity.
Renal function (SCr, BUN)
Frequency: At least 2-3 times per week, or daily in critically ill patients or those with unstable renal function.
Target: Stable SCr and BUN within patient's baseline range.
Action Threshold: Increase in SCr by âĨ0.5 mg/dL or âĨ50% from baseline (whichever is smaller) on two consecutive measurements, or an absolute increase to >1.5 mg/dL, suggests nephrotoxicity and requires dose adjustment or discontinuation.
Fluid balance and urine output
Frequency: Daily
Target: Adequate hydration and urine output.
Action Threshold: Oliguria or signs of dehydration may indicate renal compromise.
Symptom Monitoring
- Red Man Syndrome (flushing, rash, pruritus, urticaria, tachycardia, hypotension, muscle spasms, dyspnea, chest pain) - usually related to rapid infusion
- Signs of nephrotoxicity (decreased urine output, swelling, fatigue)
- Signs of ototoxicity (tinnitus, vertigo, hearing loss)
- Hypersensitivity reactions (rash, fever, chills)
- Injection site reactions (pain, phlebitis)
Special Patient Groups
Pregnancy
Vancomycin is classified as Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Vancomycin crosses the placenta. Fetal exposure may lead to ototoxicity and nephrotoxicity, though clinical data are limited and conflicting.
Trimester-Specific Risks:
First Trimester:
Potential for fetal exposure, but data on teratogenicity are limited. Use only if clearly needed.
Second Trimester:
Fetal exposure can occur. Monitor maternal trough levels closely to minimize fetal exposure.
Third Trimester:
Fetal exposure can occur. Monitor maternal trough levels closely. Potential for fetal ototoxicity/nephrotoxicity, especially if maternal levels are high.
Lactation
Vancomycin is excreted into breast milk in small amounts. The risk to the infant is generally considered low, but potential for disruption of infant gut flora, allergic sensitization, or direct effects on the infant's kidneys/ears exists. Monitor breastfed infants for diarrhea, thrush, or rash. L3 (Moderately Safe).
Infant Risk:
Low risk, but monitor for adverse effects (e.g., diarrhea, thrush, rash, signs of ototoxicity/nephrotoxicity).
Pediatric Use
Dosing is weight-based and often requires therapeutic drug monitoring (TDM) due to variable pharmacokinetics in different age groups, especially neonates and infants. Renal function matures over time, impacting clearance. Higher doses per kg may be needed compared to adults due to higher volume of distribution and faster clearance.
Geriatric Use
Elderly patients are more likely to have age-related decline in renal function, which necessitates careful dose adjustment and more frequent monitoring of vancomycin trough levels and renal function. They may also be more susceptible to nephrotoxicity and ototoxicity.
Clinical Information
Clinical Pearls
- Always administer vancomycin IV infusions slowly, over at least 60 minutes (or longer for doses >1g), to minimize the risk of Red Man Syndrome.
- Therapeutic Drug Monitoring (TDM) with trough levels is essential for optimizing efficacy and minimizing toxicity, especially for serious infections or in patients with unstable renal function.
- Maintain adequate hydration to reduce the risk of nephrotoxicity.
- Vancomycin is NOT absorbed orally for systemic infections; oral vancomycin is used only for Clostridioides difficile infection.
- Consider a loading dose in critically ill patients to achieve target concentrations more rapidly.
- Be vigilant for signs of nephrotoxicity (rising SCr) and ototoxicity (tinnitus, hearing changes), especially with concomitant nephrotoxic/ototoxic agents.
Alternative Therapies
- Linezolid (for MRSA, VRE)
- Daptomycin (for MRSA, VRE)
- Ceftaroline (for MRSA)
- Tedizolid (for MRSA)
- Dalbavancin (for MRSA)
- Oritavancin (for MRSA)
- Quinupristin/Dalfopristin (for VRE, MRSA)
Cost & Coverage
Average Cost:
Varies widely, typically $10-$50 per 500mg vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (Generic)
General Drug Facts
If your symptoms or health problems do not improve or worsen over time, it is essential to contact your doctor for further evaluation and guidance.
To ensure safe use, do not share your medication with others, and never take someone else's medication. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion.
Proper disposal of unused or expired medications is crucial. Do not flush medications down the toilet or pour them down the drain unless specifically instructed to do so by a healthcare professional or pharmacist. If you are unsure about the correct disposal method, consult with your pharmacist, who can provide guidance on safe disposal practices or inform you about potential drug take-back programs in your area.
Some medications may come with an additional patient information leaflet, so it is a good idea to check with your pharmacist for more information. If you have any questions or concerns about your medication, do not hesitate to 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 critical information, including the name of the medication taken, the amount, and the time it was taken, to ensure prompt and effective treatment.
To ensure safe use, do not share your medication with others, and never take someone else's medication. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion.
Proper disposal of unused or expired medications is crucial. Do not flush medications down the toilet or pour them down the drain unless specifically instructed to do so by a healthcare professional or pharmacist. If you are unsure about the correct disposal method, consult with your pharmacist, who can provide guidance on safe disposal practices or inform you about potential drug take-back programs in your area.
Some medications may come with an additional patient information leaflet, so it is a good idea to check with your pharmacist for more information. If you have any questions or concerns about your medication, do not hesitate to 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 critical information, including the name of the medication taken, the amount, and the time it was taken, to ensure prompt and effective treatment.