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Vancomycin Disease Interactions

There are 5 disease interactions with vancomycin.

Major

Antibiotics (applies to vancomycin) colitis

Major Potential Hazard, Low plausibility. Applicable conditions: Colitis/Enteritis (Noninfectious)

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

References

  1. "Product Information. Omnipen (ampicillin)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Ceftin (cefuroxime)." Glaxo Wellcome (2002):
  3. "Product Information. Zinacef (cefuroxime)." Glaxo Wellcome (2002):
  4. "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn (2002):
  5. "Product Information. Macrobid (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  6. "Product Information. Macrodantin (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  7. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham (2001):
  8. "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals (2001):
  9. "Product Information. Coly-Mycin M Parenteral (colistimethate)." Parke-Davis (2001):
  10. "Product Information. Lincocin (lincomycin)." Pharmacia and Upjohn (2001):
  11. "Product Information. Cubicin (daptomycin)." Cubist Pharmaceuticals Inc (2003):
  12. "Product Information. Xifaxan (rifaximin)." Salix Pharmaceuticals (2004):
  13. "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical (2007):
  14. "Product Information. Penicillin G Procaine (procaine penicillin)." Monarch Pharmaceuticals Inc (2009):
  15. "Product Information. Vibativ (telavancin)." Theravance Inc (2009):
  16. "Product Information. Teflaro (ceftaroline)." Forest Pharmaceuticals (2010):
  17. "Product Information. Penicillin G Sodium (penicillin G sodium)." Sandoz Inc (2022):
  18. "Product Information. Dalvance (dalbavancin)." Durata Therapeutics, Inc. (2014):
  19. "Product Information. Orbactiv (oritavancin)." The Medicines Company (2014):
  20. "Product Information. Bicillin C-R (benzathine penicillin-procaine penicillin)." A-S Medication Solutions (2017):
  21. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
  22. "Product Information. Polymyxin B Sulfate (polymyxin B sulfate)." AuroMedics Pharma LLC (2022):
  23. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
  24. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
  25. "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc. (2018):
  26. "Product Information. Aemcolo (rifamycin)." Aries Pharmaceuticals, Inc. (2018):
  27. "Product Information. Fetroja (cefiderocol)." Shionogi USA Inc (2019):
  28. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
  29. "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2021):
  30. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):
View all 30 references
Major

Vancomycin (applies to vancomycin) ototoxicity

Major Potential Hazard, High plausibility. Applicable conditions: 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. Sorrell TC, Collignon PJ "A prospective study of adverse reactions associated with vancomycin therapy." J Antimicrob Chemother 16 (1985): 235-41
  3. "Product Information. Vancocin (vancomycin)." Lilly, Eli and Company (2001):
Major

Vancomycin (applies to vancomycin) renal dysfunction

Major Potential Hazard, High plausibility.

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. 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
  2. Eisenberg ES, Robbins N, Lenci M "Vancomycin and interstitial nephritis." Ann Intern Med 95 (1981): 658
  3. 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
  4. Dean RP, Wagner DJ, Tolpin MD "Vancomycin/aminoglycoside nephrotoxicity." J Pediatr 106 (1985): 861-2
  5. Sorrell TC, Collignon PJ "A prospective study of adverse reactions associated with vancomycin therapy." J Antimicrob Chemother 16 (1985): 235-41
  6. 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
  7. Bergman MM, Glew RH, Ebert TH "Acute intetstitial nephritis associated with vancomycin therapy." Arch Intern Med 148 (1988): 2139-40
  8. Ratner SJ "Vancomycin-induced interstitial nephritis." Am J Med 84 (1988): 561-2
  9. Downs NJ, Neihart RE, Dolezal JM, Hodges GR "Mild nephrotoxicity associated with vancomycin use." Arch Intern Med 149 (1989): 1777-81
  10. Codding CE, Ramseyer L, Allon M, Pitha J, Rodriguez M "Tubulointerstitial nephritis due to vancomycin." Am J Kidney Dis 14 (1989): 512-5
  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. 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
  13. 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
  14. Macias WL, Mueller BA, Scarim SK "Vancomycin pharmacokinetics in acute renal failure: preservation of nonrenal clearance." Clin Pharmacol Ther 50 (1991): 688-94
  15. 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
  16. Cunha BA, Quintilliani R, Deglin JM, Izard MW, Nightingale CH "Pharmacokinetics of vancomycin in anuria." Rev Infect Dis 3 Suppl (1981): s269-72
  17. 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
  18. "Product Information. Vancocin (vancomycin)." Lilly, Eli and Company (2001):
  19. Wai AO, Lo AMS, Abdo A, Marra F "Vancomycin-induced acute interstitial nephritis." Ann Pharmacother 32 (1998): 1160-4
View all 19 references
Moderate

Vancomycin (applies to vancomycin) neutropenia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. Kauffman CA, Severance PJ, Silva J, Huard TK "Neutropenia associated with vancomycin therapy." South Med J 75 (1982): 1131-3
  2. 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
  3. Mackett RL, Guay DR "Vancomycin-induced neutropenia." Can Med Assoc J 132 (1985): 39-40
  4. Koo KB, Bachand RL, Chow AW "Vancomycin-induced neutropenia." Drug Intell Clin Pharm 20 (1986): 780-2
  5. Adrouny A, Meguerditchian S, Koo CH, et al. "Agranulocytosis related to vancomycin therapy." Am J Med 81 (1986): 1059-61
  6. "Product Information. Vancocin (vancomycin)." Lilly, Eli and Company (2001):
  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) (applies to vancomycin) GI inflammation

Moderate Potential Hazard, High plausibility. Applicable conditions: 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 (2001):

Vancomycin drug interactions

There are 152 drug interactions with vancomycin.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.