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Vancocin HCl (vancomycin) Disease Interactions

There are 5 disease interactions with Vancocin HCl (vancomycin):

Major

Vancomycin (Includes Vancocin HCl) ↔ Ototoxicity

Severe Potential Hazard, High plausibility

Applies to: Hearing Loss, Tinnitus

Intravenous use of vancomycin may cause damage to the auditory branch of the eighth cranial nerve. Permanent hearing loss has been reported. Tinnitus sometimes precedes the onset of deafness, which may progress despite withdrawal of the drug. Therapy with vancomycin, particularly if prolonged (> 10 days), should be administered cautiously in patients with preexisting auditory impairment or tinnitus, since it may delay the recognition or confound the diagnosis of a drug-induced ototoxic effect. To minimize the risk of toxicity, the usual dosage should not be exceeded, use with other ototoxic agents should be avoided, and serum drug concentrations should be periodically determined and dosage adjusted to maintain desired levels. Ototoxicity has generally been associated with serum vancomycin levels of 80 to 100 mcg/mL, although toxic reactions have also been reported at levels as low as 25 mcg/mL. Serial audiograms should be obtained in patients old enough to be tested, and the dosage reduced or therapy withdrawn promptly if signs and symptoms of toxicity develop.

Oral vancomycin is generally not associated with systemic toxicity due to poor absorption from the gastrointestinal tract. However, clinically significant serum concentrations have been reported in some patients following multiple oral doses of vancomycin for active Clostridium difficile pseudomembranous colitis. Therefore, when vancomycin is administered orally, clinicians may want to heed the usual warnings and precautions associated with intravenous use of the drug.

References

  1. Traber PG, Levine DP "Vancomycin ototoxicity in a patient with normal renal function." Ann Intern Med 95 (1981): 458-60
  2. "Product Information. Vancocin (vancomycin)." Lilly, Eli and Company, Indianapolis, IN.
  3. Sorrell TC, Collignon PJ "A prospective study of adverse reactions associated with vancomycin therapy." J Antimicrob Chemother 16 (1985): 235-41
Major

Vancomycin (Includes Vancocin HCl) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Intravenous use of vancomycin may be associated with oto- and nephrotoxic effects. Eighth cranial nerve damage may manifest as tinnitus and varying degrees of hearing impairment. Nephrotoxicity is usually evidenced by transient elevations in BUN or serum creatinine concentrations, as well as the presence of hyaline and granular casts and albumin in the urine. Rarely, acute interstitial nephritis has been reported. Although vancomycin-induced nephrotoxicity is generally reversible following discontinuation of the drug, death from uremia has occurred. Therapy with vancomycin should be administered cautiously at reduced dosages in patients with renal impairment, since they may be at increased risk for oto- and nephrotoxicity due to drug accumulation. To minimize the risk of toxicity, the usual dosage should not be exceeded, use with other neuro- and nephrotoxic agents should be avoided, and serum drug concentrations should be periodically determined and dosage adjusted to maintain desired levels. Oto- and nephrotoxicity has generally been associated with serum vancomycin levels of 80 to 100 mcg/mL, although toxic reactions have also been reported at levels as low as 25 mcg/mL. Renal and eighth cranial nerve function should be closely monitored, and the dosage reduced or therapy withdrawn if toxicity develops.

Oral vancomycin is generally not associated with systemic toxicity due to poor absorption from the gastrointestinal tract. However, clinically significant serum concentrations have been reported in some patients following multiple oral doses of vancomycin for active Clostridium difficile pseudomembranous colitis. The risk for systemic adverse effects may be greatest in patients with preexisting renal impairment. Therefore, when vancomycin is administered orally, clinicians may want to heed the usual warnings and precautions associated with intravenous use of the drug.

References

  1. Masur H, Francioli P, Ruddy M, Murray HW "Vancomycin serum levels and toxicity in chronic hemodialysis patients with staphylococcus aureus bacteremia." Clin Nephrol 20 (1983): 85-8
  2. Tan CC, Lee HS, Ti TY, Lee JC "Pharmacokinetics of intravenous vancomycin in patients with end-stage renal failure." Ther Drug Monit 12 (1990): 29-34
  3. Codding CE, Ramseyer L, Allon M, Pitha J, Rodriguez M "Tubulointerstitial nephritis due to vancomycin." Am J Kidney Dis 14 (1989): 512-5
  4. Wai AO, Lo AMS, Abdo A, Marra F "Vancomycin-induced acute interstitial nephritis." Ann Pharmacother 32 (1998): 1160-4
  5. Downs NJ, Neihart RE, Dolezal JM, Hodges GR "Mild nephrotoxicity associated with vancomycin use." Arch Intern Med 149 (1989): 1777-81
  6. "Product Information. Vancocin (vancomycin)." Lilly, Eli and Company, Indianapolis, IN.
  7. Bergman MM, Glew RH, Ebert TH "Acute intetstitial nephritis associated with vancomycin therapy." Arch Intern Med 148 (1988): 2139-40
  8. Sorrell TC, Collignon PJ "A prospective study of adverse reactions associated with vancomycin therapy." J Antimicrob Chemother 16 (1985): 235-41
  9. Cunha BA, Quintilliani R, Deglin JM, Izard MW, Nightingale CH "Pharmacokinetics of vancomycin in anuria." Rev Infect Dis 3 Suppl (1981): s269-72
  10. Matzke GR, McGory RW, Halstenson CE, Keane WF "Pharmacokinetics of vancomycin in patients with various degrees of renal function." Antimicrob Agents Chemother 25 (1984): 433-7
  11. Rodvold KA, Blum RA, Fischer JH, et al "Vancomycin pharmacokinetics in patients with various degrees of renal function." Antimicrob Agents Chemother 32 (1988): 848-52
  12. Ratner SJ "Vancomycin-induced interstitial nephritis." Am J Med 84 (1988): 561-2
  13. Moellering RC, Krogstad DJ, Greenblatt DJ "Vancomycin therapy in patients with impaired renal function: a nomogram for dosage." Ann Intern Med 94 (1981): 343-6
  14. Eisenberg ES, Robbins N, Lenci M "Vancomycin and interstitial nephritis." Ann Intern Med 95 (1981): 658
  15. Dean RP, Wagner DJ, Tolpin MD "Vancomycin/aminoglycoside nephrotoxicity." J Pediatr 106 (1985): 861-2
  16. Moellering RC, Krogstad DJ, Greenblatt DJ "Pharmacokinetics of vancomycin in normal subjects and in patients with reduced renal function." Rev Infect Dis 3 Suppl (1981): s230-5
  17. Lindholm DD, Murray JS "Persistence of vancomycin in the blood during renal failure and its treatment by hemodialysis." N Engl J Med 274 (1966): 1047-51
  18. Macias WL, Mueller BA, Scarim SK "Vancomycin pharmacokinetics in acute renal failure: preservation of nonrenal clearance." Clin Pharmacol Ther 50 (1991): 688-94
  19. Cimino MA, Rotstein C, Slaughter RL, Emrich LJ "Relationship of serum antibiotic concentrations to nephrotoxicity in cancer patients receiving concurrent aminoglycoside and vancomycin therapy." Am J Med 83 (1987): 1091-7
View all 19 references
Moderate

Antibiotics (Includes Vancocin HCl) ↔ Colitis

Moderate Potential Hazard, Low plausibility

Applies to: Colitis/Enteritis (Noninfectious)

Pseudomembranous colitis has been reported with most antibacterial agents and may range in severity from mild to life-threatening, with an onset of up to two months following cessation of therapy. Antibiotic therapy can alter the normal flora of the colon and permit overgrowth of Clostridium difficile, whose toxin is believed to be a primary cause of antibiotic- associated colitis. The colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus. The most common culprits are clindamycin, lincomycin, the aminopenicillins (amoxicillin, ampicillin), and the cephalosporins. Therapy with broad-spectrum antibiotics and other agents with significant antibacterial activity should be administered cautiously in patients with a history of gastrointestinal diseases, particularly colitis. There is some evidence that pseudomembranous colitis, if it occurs, may run a more severe course in these patients and that it may be associated with flares in their underlying disease activity. The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically. A large bowel endoscopy may be considered to establish a definitive diagnosis in cases of severe diarrhea.

References

  1. Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
  2. Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
  3. Davies J, Beck E "Recurrent colitis following antibiotic-associated pseudomembranous colitis." Postgrad Med J 57 (1981): 599-601
  4. Saadah HA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 93 (1980): 645
  5. Trexler MF, Fraser TG, Jones MP "Fulminant pseudomembranous colitis caused by clindamycin phosphate vaginal cream." Am J Gastroenterol 92 (1997): 2112-3
  6. Lyon JA "Imipenem/cilastatin: the first carbapenem antibiotic." Drug Intell Clin Pharm 19 (1985): 894-8
  7. Daly JJ, Chowdary KV "Pseudomembranous colitis secondary to metronidazole." Dig Dis Sci 28 (1983): 573-4
  8. Milstone EB, McDonald AJ, Scholhamer CF Jr "Pseudomembranous colitis after topical application of clindamycin." Arch Dermatol 117 (1981): 154-5
  9. O'Meara TF, Simmons RA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 92 (1980): 440-1
  10. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
  11. Meadowcroft AM, Diaz PR, Latham GS "Clostridium difficile toxin-induced colitis after use of clindmycin phosphate vaginal cream." Ann Pharmacother 32 (1998): 309-11
  12. Burt RA "A review of the drug events reported by 12,917 patients treated with cephalexin." Postgrad Med J 59 (1983): 47-50,51-3
  13. Ehrenpreis ED, Lievens MW, Craig RM "Clostridium difficile-associated diarrhea after norfloxacin." J Clin Gastroenterol 12 (1990): 188-9
  14. Calandra GB, Brown KR, Grad LC, et al "Review of adverse experiences and tolerability in the first 2,516 patients treated with imipenem/cilastatin." Am J Med 78 (1985): 73-8
  15. Bauwens JE, McFarland LV, Melcher SA "Recurrent clostridium difficile disease following ciprofloxacin use." Ann Pharmacother 31 (1997): 1090
  16. Parry MF, Rha CK "Pseudomembranous colitis caused by topical clindamycin phosphate." Arch Dermatol 122 (1986): 583-4
  17. Osler T, Lott D, Bordley J, et al "Cefazolin-induced pseudomembranous colitis resulting in perforation of the sigmoid colon." Dis Colon Rectum 29 (1986): 140-3
  18. Clissold SP, Todd PA, Campoli-Richards DM "Imipenem/cilastatin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy." Drugs 33 (1987): 185-241
  19. Bernstein L "Adverse reaction to trimethoprim-sulfamethoxazole, with particular reference to long-term therapy." Can Med Assoc J 112 (1975): s96-8
  20. Bingley PJ, Harding GM "Clostridium difficile colitis following treatment with metronidazole and vancomycin." Postgrad Med J 63 (1987): 993-4
  21. Hutcheon DF, Milligan FD, Yardley JH, Hendrix TR "Cephalosporin-associated pseudomembranous colitis." Am J Dig Dis 23 (1978): 321-6
  22. Van Ness MM, Cattau EL Jr "Fulminant colitis complicating antibiotic-associated pseudomembranous colitis: case report and review of the clinical manifestations and treatment." Am J Gastroenterol 82 (1987): 374-7
  23. Dan M, Samra Z "Clostridium difficile colitis associated with ofloxacin therapy." Am J Med 87 (1989): 479
  24. Hinton NA "The effect of oral tetracycline HCl and doxycycline on the intestinal flora." Curr Ther Res Clin Exp 12 (1970): 341-52
  25. Sugarman B "Trimethoprim-sulfamethoxazole, pseudomembranous colitis, and spinal cord injury." South Med J 78 (1985): 711-3
  26. Cone JB, Wetzel W "Toxic megacolon secondary to pseudomembranous colitis." Dis Colon Rectum 25 (1982): 478-82
  27. Midtvedt T, Carlstedt-Duke B, Hoverstad T, et al "Influence of peroral antibiotics upon the biotransformatory activity of the intestinal microflora in healthy subjects." Eur J Clin Invest 16 (1986): 11-7
  28. Altamirano A, Bondani A "Adverse reactions to furazolidone and other drugs. A comparative review." Scand J Gastroenterol Suppl 169 (1989): 70-80
  29. Saginur R, Hawley CR, Bartlett JG "Colitis associated with metronidazole therapy." J Infect Dis 141 (1980): 772-4
  30. Golledge CL, Riley TV "Clostridium difficile-associated diarrhoea after doxycycline malaria prophylaxis." Lancet 345 (1995): 1377-8
  31. Boriello SP, Jones RH, Phillips I "Rifampicin-associated pseudomembranous colitis." Br Med J 281 (1980): 1180-1
  32. Cannon SR, Dyson PH, Sanderson PJ "Pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery." J Bone Joint Surg Br 70-B (1988): 600-2
  33. Klinger D, Radford P, Collin J "Pneumoperitoneum without faecal peritonitis in a patient with pseudomembranous colitis." Br Med J 288 (1984): 1271-2
  34. Edlund C, Lidbeck A, Kager L, Nord CE "Effect of enoxacin on colonic microflora of healthy volunteers." Eur J Clin Microbiol 6 (1987): 298-300
  35. Miller DL, Sedlack JD, Holt RW "Perforation complicating rifampin-associated pseudomembranous enteritis." Arch Surg 124 (1989): 1082
  36. Miller SN, Ringler RP "Vancomycin-induced pseudomembranous colitis." J Clin Gastroenterol 9 (1987): 114-5
  37. Wang C, Calandra GB, Aziz MA, Brown KR "Efficacy and safety of imipenem/cilastatin: a review of worldwide clinical experience." Rev Infect Dis 7 (1985): s528-36
  38. Edlund C, Brismar B, Nord CE "Effect of lomefloxacin on the normal oral and intestinal microflora." Eur J Clin Microbiol Infect Dis 1 (1990): 35-9
  39. Pokorney BH, Nichols TW, Jr "Pseudomembranous colitis. A complication of sulfasalazine therapy in a patient with Crohn's colitis." Am J Gastroenterol 76 (1981): 374-6
  40. Sankarankutty M, McGeorge D, Galasko CS "Pseudomembranous colitis following cephradine prophylaxis." Postgrad Med J 58 (1982): 726-8
  41. Gordin F, Gibert C, Schmidt ME "Clostridium difficile colitis associated with trimethoprim-sulfamethoxazole given as prophylaxis for pneumocystis carinii pneumonia." Am J Med 96 (1994): 94-5
  42. Ring FA, Hershfield NB, Machin GA, Scott RB "Sulfasalazine-induced colitis complicating idiopathic ulcerative colitis." Can Med Assoc J 131 (1984): 43-5
  43. Friedman RJ, Mayer IE, Galambos JT, Hersh T "Oxacillin-induced pseudomembranous colitis." Am J Gastroenterol 73 (1980): 445-7
  44. "Multum Information Services, Inc. Expert Review Panel"
  45. Leigh DA, Simmons K, Williams S "Gastrointestinal side effects following clindamycin and lincomycin treatment: a follow up study." J Antimicrob Chemother 6 (1980): 639-45
  46. Hecht JR, Olinger EJ "Clostridium difficile colitis secondary to intravenous vancomycin." Dig Dis Sci 34 (1989): 148-9
  47. Brause BD, Romankiewicz JA, Gotz V, Franklin JE Jr, Roberts RB "Comparative study of diarrhea associated with clindamycin and ampicillin therapy." Am J Gastroenterol 73 (1980): 244-8
View all 47 references
Moderate

Vancomycin (Includes Vancocin HCl) ↔ Neutropenia

Moderate Potential Hazard, Moderate plausibility

Applies to: Neutropenia, Thrombocytopenia

Reversible neutropenia has been reported with intravenous use of vancomycin, usually starting one week or more after initiation of therapy or after a total dosage of more than 25 g. Thrombocytopenia and agranulocytosis (granulocytes < 500/mm3) has occurred rarely. Patients with preexisting neutropenia should be monitored closely during vancomycin therapy for further decreases in leukocyte counts, and therapy discontinued if appropriate.

References

  1. "Product Information. Vancocin (vancomycin)." Lilly, Eli and Company, Indianapolis, IN.
  2. Adrouny A, Meguerditchian S, Koo CH, et al "Agranulocytosis related to vancomycin therapy." Am J Med 81 (1986): 1059-61
  3. Farwell AP, Kendall LG, Vakil RD, Glew RH "Delayed appearance of vancomycin-induced neutropenia in a patient with chronic renal failure." South Med J 77 (1984): 664-5
  4. Mackett RL, Guay DR "Vancomycin-induced neutropenia." Can Med Assoc J 132 (1985): 39-40
  5. Kauffman CA, Severance PJ, Silva J, Huard TK "Neutropenia associated with vancomycin therapy." South Med J 75 (1982): 1131-3
  6. Koo KB, Bachand RL, Chow AW "Vancomycin-induced neutropenia." Drug Intell Clin Pharm 20 (1986): 780-2
  7. Mandl DL, Garrison MW, Palpant SD "Agranulocytosis induced by vancomycin or ticarcillin/clavulanate." Ann Pharmacother 31 (1997): 1321-4
View all 7 references
Moderate

Vancomycin (Oral) (Includes Vancocin HCl) ↔ Gi Inflammation

Moderate Potential Hazard, High plausibility

Applies to: Colitis/Enteritis (Noninfectious), Colonic Ulceration

Vancomycin is potentially oto- and nephrotoxic. While it is poorly absorbed from the gastrointestinal tract, significant systemic absorption may occur if intestinal mucosal integrity is compromised. Therapy with oral vancomycin should be administered cautiously in patients with inflammatory or ulcerative gastrointestinal diseases because of the potential for enhanced absorption of the drug.

References

  1. "Product Information. Vancocin (vancomycin)." Lilly, Eli and Company, Indianapolis, IN.

Vancocin HCl (vancomycin) drug Interactions

There are 163 drug interactions with Vancocin HCl (vancomycin)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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