vancomycin and Baraclude Interactions

Interactions between vancomycin and Baraclude (entecavir)

vancomycin and entecavir (Moderate Drug-Drug)

MONITOR: Because entecavir is primarily eliminated by renal excretion, coadministration with drugs that affect renal function may alter the plasma concentrations of entecavir and/or the coadministered drug. In patients with renal impairment, the apparent oral clearance of entecavir has been shown to decrease as the creatinine clearance decreases. In a small pilot study consisting of nine liver transplant recipients on a stable dose of cyclosporine or tacrolimus, entecavir exposure was approximately 2-fold that in healthy subjects with normal renal function. Altered renal function contributed to the increase in entecavir exposure in these patients.

MANAGEMENT: Caution is advised if entecavir is prescribed in combination with potentially nephrotoxic drugs (e.g., aminoglycosides, polypeptide and polymyxin antibiotics, vancomycin, amphotericin B, adefovir, cidofovir, tenofovir, foscarnet, cisplatin, gallium nitrate, lithium, mesalamine, certain immunosuppressants, intravenous bisphosphonates, intravenous pentamidine, high intravenous dosages of methotrexate, high dosages of nonsteroidal anti-inflammatory agents). Renal function should be evaluated prior to and during therapy with entecavir. Dosage adjustment is required in patients with renal insufficiency (creatinine clearance below 50 mL/min) at baseline or during treatment in accordance with the manufacturer's product labeling.