VANCOMYCIN 1000 MG POWDER FOR SOLUTION FOR INFUSION
Active substance(s): VANCOMYCIN HYDROCHLORIDE
Vancomycin 500 mg, powder for solution for infusion
Vancomycin 1000 mg, powder for solution for infusion
Read all of this leaflet carefully before you start using this medicine.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you. Do not pass it on to others. It may harm them,
even if their symptoms are the same as yours.
• If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet,
please tell your doctor or pharmacist.
In this leaflet:
1. What Vancomycin is and what it is used for
2. Before you are given Vancomycin
3. How you are given Vancomycin
4. Possible side effects
5. How to store Vancomycin
6. Further information
What Vancomycin is and what
it is used for
Vancomycin belongs to a group of glycopeptide
antibiotics which eliminate bacteria that cause
many kinds of infections, including pneumonia
and skin, bone and heart valve infections.
It is used to treat:
• serious infections caused by
vancomycin-sensitive bacteria which are
resistant (insensitive) to many other antibiotics,
• patients allergic to penicillins and cephalosporins.
Vancomycin can also be given to you at the time
of some surgical procedures to prevent bacterial
endocarditis (an infection of the heart) if you are
at high risk of developing this and can not
receive other types of antibiotics.
Your medicine is in the form of a powder for
solution. Before use, it will be dissolved and diluted with an intravenous fluid that will be given
to you slowly by a drip into your vein by a doctor
patients with prior deafness, who have received
excessive doses, or who receive concomitant
treatment with another substance toxic to
hearing. To reduce this risk, blood levels should
be determined periodically and periodic testing
of hearing function is recommended.
If you will receive vancomycin over a
longer-term period, your blood will be tested at
regular intervals. You should also be monitored
because of possible superinfection (new
infection occurring over the existing one) or
severe, sometimes bloody diarrhoea (condition
called pseudomembranous colitis).
Taking other medicines
Please tell your doctor if you are taking or have
recently taken any other medicines, including
medicines obtained without a prescription,
herbal remedies or vitamins and minerals,
because some of them could have an interaction
with vancomycin. Furthermore, do not take any
new medicine without consulting your doctor.
The following can react with vancomycin if you
take them at the same time, such as medicines
for the treatment of:
• infections caused by bacteria
(streptomycin, neomycin, gentamicin,
kanamycin, amikacin, bacitracin, tobramycin,
polimyxin B, colistin),
• tuberculosis (viomycin),
• fungal infections (amphotericin B),
• cancer (cisplatin),
• medicines for muscle relaxation during
• anaesthetic agents (if you are going to have
Before you are given
Do not have Vancomycin if you:
• are allergic (hypersensitive) to vancomycin.
Tell your doctor if you have had any problems
with this medicine or any other in the past.
Take special care with Vancomycin
Before treatment with vancomycin, make sure
that your doctor knows about your medical
history, especially if you:
• have kidney problems
• have ear problems such as deafness
• have low blood count
• are pregnant, or planning to become pregnant
• are breast-feeding
• are elderly and over 60 years of age
• are a premature infant or a child
• are going to have surgery
Your doctor may need to monitor your blood and
adjust the dosage if vancomycin is given at the
same time with other medicines.
Pregnancy and breast-feeding
If you are, or think you may be, pregnant, tell
your doctor. Vancomycin should be given during
pregnancy only if clearly needed.
Tell your doctor if you are breast-feeding as
Vancomycin passes into breast milk. Your doctor
will decide, if vancomycin is clearly needed or if
you must stop breast-feeding.
Ask your doctor or pharmacist for advice before
taking any medicine.
In case you develop severe allergic reaction,
your doctor will stop treatment with vancomycin
and give you other appropriate treatment.
If you will be given the infusion too fast, you can
get some side effects such as low blood
pressure or a rash. Stopping the infusion usually
results in a prompt cessation of these reactions.
Driving and using machines
Vancomycin has no or very little effect on your
ability to drive and operate machines.
Vancomycin must be used with caution in
patients with kidney failure or in those who
receive concomitant treatment with other
substances toxic to kidney as the possibility of
developing toxic effects is much higher. Serial
tests of kidney function should be performed
and the appropriate dose regimens adhered to
in order to reduce this risk.
How you are given
You will be given Vancomycin by medical staff
while you are in hospital.
Deafness, transitory or permanent, which may
be preceded by noises in the ears, can occur in
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The following information is intended for medical or healthcare professionals only:
This is an extract from the Summary of Product Characteristics to assist in the administration of
Vancomycin. When determining appropriateness of use in a particular patient, the prescriber should
be familiar with the Summary of Product Characteristics of the medicinal product.
Dosage and method of administration
Vancomycin is administered via an intravenous infusion and not in the form of a bolus injection or
Adults and adolescents above 12 years of age
The recommended daily intravenous dose is 2 g, divided into doses of 500 mg every 6 hours or
1000 mg every 12 hours.
Parenterally vancomycin shall only be administered as slow intravenous infusion (not more than
10 mg/min – over at least 60 min) which is sufficiently diluted (at least 100 ml per 500 mg or at least
200 ml per 1000 mg).
Patients requiring fluid restriction can receive a solution of 500 mg / 50 ml or 1000 mg / 100 ml. With
these higher concentrations the risk for infusion related side effects can be increased.
For bacterial endocarditis, the generally accepted regimen is 1000 mg vancomycin intravenously
every 12 hours for 4 weeks either alone or in combination with other antibiotics (gentamicin plus
rifampin, gentamicin, streptomycin). Enterococcal endocarditis is treated for 6 weeks with
vancomycin in combination with an aminoglycoside – according to national recommendations.
Adults receive 1000 mg vancomycin intravenously prior to surgery (prior to induction of anaesthesia)
and depending on time and type of surgery, the dose of 1000 mg of vancomycin i.v. 12 hours
postoperatively can be given.
Children one month to 12 years of age
The recommended intravenous dose is 10 mg/kg, every 6 hours or 20 mg/kg every 12 hours.
Infants and newborns
The recommended initial dose is 15 mg/kg, followed by 10 mg/kg every 12 hours during the first
week of life and every 8 hours after that age and up to 1 month of age. Careful monitoring of serum
concentration of vancomycin is recommended (see below).
Lower maintenance doses may be required due to the age-related reduction in renal function.
Modification of the usual daily doses may be required.
Patients with hepatic insufficiency
There is no evidence that the dose has to be reduced in patients with hepatic insufficiency.
Patients with impaired renal function
The dose must be adjusted in patients with impaired renal function and the following nomogram can
serve as guidance. Careful monitoring of serum concentration of vancomycin is recommended (see
In patients with mild or moderate renal failure, the starting dose must not be less than 15 mg/kg. In
patients with severe renal failure, it is preferable to administer a maintenance dose between 250 mg
and 1000 mg at a spacing of several days rather than administer lower daily doses.
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Ref: N001: Additional BR sites
Dimensions: 130 x 540 mm
Your doctor will decide how much of this
medicine you should receive each day and how
long the treatment will last.
• increase or decrease in some of the cells in
• noises (e.g. hissing) in the ears;
• feeling faint;
• red or purple skin (possible signs of blood
The dose given to you will depend on
• your age,
• the infection you have,
• how well your kidneys are working,
• your hearing ability
• any other medicines you may be taking.
Very rare side effects (affect less than 1 user in
Skin disorders resulting from an allergic reaction
(multiple skin lesions, joint aches), cardiac
arrest, or inflammation of the bowel which
causes abdominal pain or bloody diarrhoea.
Adults and children above 12 years:
the usual dose is 2000 mg daily in two or four
If any of the side effects get serious, or if you
notice any side effects not mentioned in this
leaflet, please tell your doctor.
Children under 12 years:
will be given smaller doses, depending on their
Patients with impaired kidney function, the
elderly and pre-term new-born infants:
the doctor will reduce the dose or extend the
interval between two doses.
Your doctor or nurse will ensure that
Vancomycin is properly stored.
During treatment you might have blood tests, be
asked to provide urine samples and possibly
have hearing tests to look for signs of possible
Keep out the reach and sight of children.
Do not use this medicine after the expiry date
which is stated on the vial label and the carton.
Do not store above 25°C.
How the treatment will be given
Intravenous infusion means that the medicinal
product flows from an infusion bottle or bag
through a tube to one of your blood vessels and
into your body. Your doctor, or nurse, will always
give vancomycin into your blood, never in a
muscle. Vancomycin will be diluted before being
given to you, and will slowly flow into your vein
for at least 60 minutes.
The stability of reconstituted solution is stated
below in the additional information for health
Medicines should not be disposed of via
wastewater or household waste. Ask your
pharmacist how to dispose of medicines no
longer required. These measures will help to
protect the environment.
Duration of treatment
The length of treatment depends on the infection
you have and may last a number of weeks.
If you are given more Vancomycin than you
As this medicine will be given to you while you are
in the hospital, it is unlikely that you will be given
too much vancomycin. However, tell your doctor
or nurse immediately if you have any concerns.
What Vancomycin contains
- The active substance is vancomycin
If you have any further questions on the use of
this product, ask your doctor or pharmacist.
How to store Vancomycin
Vancomycin 500 mg, powder for solution for
Each vial contains 500 mg vancomycin
(hydrochloride) equivalent to 500,000 IU.
Possible side effects
Vancomycin 1000 mg, powder for solution for
Each vial contains 1000 mg vancomycin
(hydrochloride) equivalent to 1,000,000 IU.
Like all medicines, Vancomycin can cause side
effects, although not everybody gets them.
There are no other ingredients.
Stop taking the medicine immediately and
seek medical attention if signs of an allergic
• hives; swelling of your face, lips, tongue, or
throat; difficulty breathing or swallowing or
What Vancomycin looks like and contents of
Vancomycin is a white or almost white
freeze-dried powder for solution for intravenous
infusion. It must be first dissolved in water for
injection and further diluted in an appropriate
diluent prior to use.
If you think you have any of the following side
effects or symptoms, tell your doctor as soon as
This medicine is supplied in colourless glass
vials closed with rubber closures and sealed
with aluminium and plastic flip off caps. This
medicine is available in two strengths: 500 mg
and 1000 mg.
Common side effects (affect 1 to 10 users in 100):
• decrease in blood pressure; swelling, redness and pain along a vein;
• breathlessness, a high pitched sound resulting
from turbulent air flow in the upper airway;
• generalized rash and mucosal inflammation,
itching, itchy rash;
• redness of the upper body and the face, pain
and spasm of the chest and back muscles,
• kidney problems which may be detected
primarily by increased creatinine or urea
concentrations in your blood.
Vancomycin is packed in carton boxes. Each
box can contain 1, 5, 10 or 100 vials.
Not all pack sizes may be marketed.
Marketing Authorisation Holder and
Marketing Authorisation Holder:
Sandoz Ltd, Frimley Business Park, Frimley
Camberley, Surrey, GU16 7SR, UK
Uncommon side effects (affect 1 to 10 users in
• temporary or permanent loss of hearing.
Lek Pharmaceuticals d.d., Verovškova 57
1526 Ljubljana, Slovenia. or Salutas Pharma
GmbH, Otto-von-Guericke-Allee 1, 39179
Rare side effects (affect 1 to 10 users in 10,000):
• anaphylactic reactions, allergic reactions;
• drug fever, chills,
• increased or reduced (sometimes severely
decreased) urine output, or traces of blood in
This leaflet was last approved in 04/2014
Patients with anuria (with practically no renal function) should receive a dose of 15 mg/kg body
weight until the therapeutic serum concentration is reached. The maintenance doses are 1.9 mg/kg
body weight per 24 hours. In order to facilitate the procedure, adult patients with strongly impaired
renal function may obtain a maintenance dose of 250 - 1000 mg at intervals of several days instead
of a daily dose.
Preparation of infusion solution
For a 500 mg dose, dissolve 500 mg of vancomycin in 10 ml of water for injections
For a 1000 mg dose, dissolve 1000 mg of vancomycin in 20 ml of water for injections.
One ml of reconstituted solution contains 50 mg of vancomycin. Solution prepared aseptically in this
manner may be stored for 24 hours at 25°C or for 96 hours in a refrigerator at between 2°C and 8°C.
After reconstitution, this solution should be further diluted.
The suitable diluents for further dilution are:
- 5% Glucose Injection or
- 0.9% Sodium Chloride Injection or
- 5% Glucose Injection with 0.9% Sodium Chloride Injection.
Intermittent infusion: Reconstituted solution containing 500 mg of vancomycin (50 mg/ml) must be
diluted further with at least 100 ml of the above diluent (to 5mg/ml).
Reconstituted solution containing 1000 mg vancomycin (50 mg/ml) must be diluted further with at
least 200 ml of the above diluent (to 5mg/ml).
The concentration of vancomycin in solution for infusion should not exceed 5 mg/ml.
Stability of diluted solutions
Vancomycin reconstituted solution (50 mg/ml), further diluted with 5% glucose or 0.9% sodium
chloride (5mg/ml) may be stored in a refrigerator for 48 hours, or at 25°C for 24 hours without
significant loss of potency. Solutions diluted with a combination of 5% glucose and 0.9% sodium
chloride may be stored in a refrigerator (2°C - 8°C) for 48 hours or at 25°C for 24 hours.
From a microbiological point of view the medicinal product should be used immediately unless
reconstitution and dilution has taken place in controlled and validated aseptic conditions.
If not used immediately, in - use storage times and conditions are the responsibility of the user.
Appearance of reconstituted solution
After reconstitution the solution is clear and colorless to slightly yellowish brown without visible particles.
Appearance of diluted solution
After dilution the solution is clear and colorless without visible particles.
Before administration, the reconstituted and diluted solutions should be inspected visually for particulate
matter and discoloration. Only clear and colorless solution free from particles should be used.
Monitoring of serum concentrations
The serum concentration of vancomycin should be monitored at the second day of treatment
immediately prior to the next dose, and one hour post infusion. Therapeutic vancomycin blood levels
should be between 30 and 40 mg/l (maximum 50 mg/l) one hour after the end of the infusion, the
minimum level (short prior to the next administration) between 5 and 10 mg/l.
The concentrations should normally be monitored twice or three times per week.
The solution of vancomycin has a low pH value. In combination with other substances, it may
become physically or chemically unstable.
Vancomycin solution should not be mixed with other solutions, with exceptions of those whose
compatibility has been reliably verified.
In case of combination therapy of vancomycin with other antibiotic or chemotherapeutic agent, the
preparations should be administered separately.
Mixtures of solutions of vancomycin and beta-lactam antibiotics have been shown to be physically
incompatible. The likelihood of precipitation increases with higher concentrations of vancomycin. It is
recommended to adequately flush the intravenous lines between administration of these antibiotics.
It is also recommended to dilute solutions of vancomycin to 5 mg/ml or less.
Vials are for single use only. Unused medicinal product must be discarded.
Any unused medicinal product or waste material should be disposed of in accordance with local
Artwork Proof Box
Ref: N001: Additional BR sites
Dimensions: 130 x 540 mm