Vancorus - description of the drug, instructions for use, reviews

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Manufacturers: Synthesis

Active ingredients

• Vancomycin

Disease class

• Bacterial meningitis, not elsewhere classified
• Encephalitis, myelitis and encephalomyelitis
• Acute and subacute endocarditis
• Pneumonia without specifying the pathogen
• Local infection of skin and subcutaneous tissue, unspecified
• Pyogenic arthritis, unspecified
• Osteomyelitis
• Bone disease, unspecified
• Enterocolitis caused by Clostridium difficile
• Diarrhea and gastroenteritis of suspected infectious origin
• Septicemia, unspecified

Clinical and pharmacological group

• Not indicated. See instructions

Pharmacological action

• Antibacterial
• Bactericidal

Pharmacological group

• Glycopeptides

Indications for use

Vancorus is used to treat the following infectious and inflammatory diseases caused by microorganisms sensitive to vancomycin:

• lower respiratory tract infections (pneumonia, lung abscess);
• meningitis;
• sepsis;
• endocarditis;
• skin and soft tissue infections;
• infections of bones and joints, including osteomyelitis.

The solution is prescribed internally for diseases such as:

• enterocolitis caused by Staphylococcus aureus;
• pseudomembranous colitis caused by Clostridium difficile.

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** The Drug Directory is intended for informational purposes only. For more complete information, please refer to the manufacturer's instructions. Do not self-medicate; Before starting to use the drug Vancorus, you should consult a doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal. Any information on the site does not replace medical advice and cannot serve as a guarantee of the positive effect of the drug.

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Directions for use and dosage

Intravenous administration

The solution is administered as a slow (at least 60 minutes) intravenous infusion at a rate of up to 10 mg/minute.

The injection solution is prepared immediately before administration: sterile water for injection is added to the bottle with the lyophilisate - 10 ml per dose of 500 mg, 20 ml per dose of 1000 mg. The concentration of the finished solution is 50 mg of vancomycin per 1 ml.

Before administration, the solution must be further diluted to a concentration of no more than 5 mg/ml.

As solvents, you can use a 0.9% sodium chloride solution or a 5% dextrose (glucose) solution: 100 ml for a dose of 500 mg, 200 ml for a dose of 1000 mg.

Recommended doses:

• newborns up to the 7th day of life - at the beginning of therapy, 15 mg/kg, then 10 mg/kg every 12 hours;
• children 2–4 weeks of age – 10 mg/kg every 8 hours;
• children from 1 month and older – 10 mg/kg every 6 hours;
• adults - 500 mg (7.5 mg/kg) every 6 hours or 1000 mg (15 mg/kg) every 12 hours.

If renal excretory function is impaired, the interval between administrations is increased or the dose of Vancorus is adjusted depending on creatinine clearance (CC, ml/minute).

Correction by increasing the intervals between administrations when prescribing a single dose of 1000 mg:

• CC > 80 ml/min – interval 12 hours;
• CC 50–80 ml/min – interval 1–3 days;
• CC 10–50 ml/min – interval 3–7 days;
• CC < 10 ml/min – interval 7–14 days.

Correction of a single dose of Vancorus:

• CC 100 ml/min – 1545 mg/day;
• CC 90 ml/min – 1390 mg/day;
• CC 80 ml/min – 1235 mg/day;
• CC 70 ml/min–1080 mg/day;
• CC 60 ml/min – 925 mg/day;
• CC 50 ml/min – 770 mg/day;
• CC 40 ml/min – 620 mg/day;
• CC 30 ml/min – 465 mg/day;
• CC 20 ml/min – 310 mg/day;
• CC 10 ml/min – 155 mg/day.

These dose adjustment recommendations cannot be followed in the presence of anuria. In such patients, the drug is prescribed at an initial dose of 15 mg/kg to quickly achieve therapeutic serum concentrations. Maintenance dose – 1.9 mg/kg per day.

In case of severe renal failure, it is advisable to use Vancorus in a maintenance dose of 250–1000 mg at intervals of several days.

For anuria, 1000 mg is usually prescribed every 7-14 days.

If only the serum creatinine concentration is known, the following formula is used to calculate clearance:

• for men: CC = body weight (kg) × [140 − age (years)]/ 72 × serum creatinine concentration (mg/dL);
• for women: the result should be multiplied by 0.85.

Oral administration

For pseudomembranous colitis caused by Clostridium difficile due to the use of antibiotics, as well as for staphylococcal enterocolitis, Vancorus is prescribed orally.

A solution for oral administration is prepared as follows: a single dose of the drug is dissolved in 30 ml of water. To improve the taste, it is possible to add food syrups. If it is impossible to take the drug orally, it is administered through a tube.

Recommended daily doses:

• adults – 500–2000 mg;
• children – 40 mg/kg.

The daily dose should be divided into 3-4 doses.

The highest daily dose for adults and children is 2000 mg.

Duration of therapy is 7–10 days.

Vancorus®

For intravenous (IV) infusion and oral administration.

The drug Vancorus® is administered only by intravenous drip!

The drug Vancorus® cannot be administered intramuscularly or intravenously as a bolus (bolus)!

When administered intravenously, the recommended concentration of vancomycin is no more than 5 mg/ml, the rate of administration is no more than 10 mg/min.

For adults and children over 12 years of age with normal renal function, the drug should be administered at a dose of 2.0 g per day (0.5 g every 6 hours or 1.0 g every 12 hours). Each dose should be administered at a rate of no more than 10 mg/min and over a period of at least 60 minutes. The maximum single dose is 1.0 g, the maximum daily dose is 2.0 g.

For children from 1 month to 12 years, the drug should be administered intravenously at a dose of 10 mg/kg every 6 hours. Each dose should be administered over at least 60 minutes. The recommended daily dose is 40 mg/kg.

For newborns, the initial dose is 15 mg/kg, then 10 mg/kg every 12 hours during the first week of life. Starting from the second week of life - every 8 hours until the age of 1 month. Each dose should be administered over at least 60 minutes. When prescribing to newborns, monitoring the concentration of vancomycin in the blood serum is desirable. The concentration of the prepared vancomycin solution should not exceed 5 mg/ml. The maximum single dose for newborns is 15 mg/kg body weight; the daily dose for a child should not exceed the daily dose for an adult (2.0 g).

For obese patients, the drug is prescribed in normal doses.

Patients with impaired renal function must select the dose individually. Creatinine clearance (CC) can be used to select the dose of vancomycin for this group of patients. Correction can be carried out by increasing the intervals between administrations, or reducing the single dose of the drug.

Dose adjustment by increasing the intervals between administrations

In elderly patients, vancomycin clearance is lower and the volume of distribution is larger. In this category of patients, it is advisable to select the dose based on the concentration of vancomycin in the blood plasma.

In premature infants and elderly patients, a significant dose reduction may be required as a result of decreased renal function. Vancomycin plasma concentrations should be regularly monitored. The table below shows the doses of vancomycin depending on QC.

Vancomycin dose adjustment based on creatinine clearance

These calculations cannot be used to determine the dose of the drug for anuria. In such patients, vancomycin should be prescribed at an initial dose of 15 mg/kg body weight to quickly achieve therapeutic concentrations of the drug in the blood serum. The dose required to maintain a stable drug concentration is 1.9 mg/kg/day. For anuria, vancomycin is recommended to be administered 1.0 g every 7-10 days.

For patients with severe renal failure, it is advisable to adjust the dose by increasing the intervals between doses:

- with CC 10-50 ml/min - 1.0 g every 3-7 days.

- with CC <10 ml/min - 1.0 g every 7-14 days.

Based on the known concentration of creatinine in the blood serum, creatinine clearance is calculated using the formula:

for men = body weight, kg x (140 - age, years) / [72 x serum creatinine concentration, mg/100 ml]

for women = the result obtained is multiplied by 0.85.

Patients with liver failure do not require dose adjustment.

Hemodialysis patients

The initial dose is 20-25 mg/kg when using high permeability membranes. Maintenance doses are administered based on the residual concentration of the drug in the blood plasma and are adjusted to maintain a residual drug concentration of 15-20 mcg/ml. Vancomycin is effectively removed by hemodialysis using high-permeability membranes (such as polysulfone), but is poorly removed when using normal-permeability membranes.

Perioperative prophylaxis of bacterial endocarditis in all age groups : the recommended dose is an initial dose of 15 mg/kg before anesthesia. Depending on the length of the surgery, a second dose of vancomycin may be required.

Duration of therapy: The duration of treatment depends on the type and severity of infection and individual clinical response.

The recommended duration of therapy is presented in the table below:

* Continue administration until the need for wound debridement has passed, until the patient's condition has clinically improved and there has been no fever for 48-72 hours.

**Longer courses of treatment with an oral drug should be considered for the treatment of prosthetic joint infections.

*** The duration and need for combination therapy depends on the type of valve and microorganism.

Rules for preparing a solution for intravenous administration

The solution for infusion is prepared immediately before administration of the drug. To do this, add the required volume of water for injection to a bottle with dry, sterile vancomycin powder: to obtain a solution with a concentration of 50 mg/ml, 0.5 g of vancomycin is diluted in 10 ml of water for injection or 1.0 g of vancomycin is diluted in 20 ml of water for injection . The solution prepared in this way can be stored at room temperature (up to 25 °C) for 24 hours or in the refrigerator at a temperature of 2 to 8 °C for 96 hours.

Further dilution of the prepared solution is required!

Prepared solutions of vancomycin must be further diluted before administration to a concentration of no more than 5 mg/ml. The required dose of the drug diluted in the above manner should be administered by divided intravenous infusions over at least 60 minutes. As solvents, you can use 5% dextrose (glucose) solution for injection or 0.9% sodium chloride solution for injection: for 0.5 g - 100 ml, for 1.0 g - 200 ml.

Before infusion, the prepared solution for parenteral administration should, if possible, be checked visually for the presence of mechanical impurities and color changes.

Preparation of oral solution and its use

Vancorus® can be used orally to treat pseudomembranous colitis caused by Clostridium difficile due to the use of antibiotics, as well as to treat staphylococcal enterocolitis. Intravenous vancomycin has no benefit in treating these diseases.

The drug should be used in the following doses: adults 0.5-2.0 g 3-4 times a day, children 0.04 g/kg 3-4 times a day. The maximum daily dose should not exceed 2.0 g. The appropriate dose is prepared in 30 ml of water and given to the patient to drink or administered through a tube. To improve the taste of the solution, you can add regular food syrups to it. Duration of treatment is from 7 to 10 days.

Vancomycin is not effective when taken by mouth for other types of infections.

Side effects

• from the hematopoietic organs: transient thrombocytopenia, reversible neutropenia, agranulocytosis;
• from the gastrointestinal tract: nausea, pseudomembranous colitis;
• from the urinary system: interstitial nephritis, nephrotoxicity up to the development of renal failure [more often with long-term use (more than 3 weeks) in high doses or in combination with aminoglycosides; manifested by an increase in the concentration of creatinine and urea nitrogen in the blood];
• from the senses: ototoxicity – vertigo, hearing loss, ringing in the ears;
• allergic reactions: rash (including exfoliative dermatitis), chills, fever, eosinophilia, vasculitis, toxic epidermal necrolysis, malignant exudative erythema;
• local reactions (if infusion rules are violated): pain and tissue necrosis at the site of drug administration, phlebitis;
• post-infusion reactions (due to rapid administration): “red man” syndrome (hyperemia of the upper half of the body and face, rapid heartbeat, fever, chills, muscle spasms of the chest and back), anaphylactoid reactions (skin rash, itching, dyspnea, bronchospasm, decreased blood pressure, cardiac arrest).

special instructions

The drug should only be used in a hospital setting.

Vancorus cannot be administered intravenously or intramuscularly.

The incidence and severity of thrombophlebitis can be reduced by properly diluting the original solution and alternating the sites of drug administration.

During long-term treatment, monitoring of renal function (general urinalysis, creatinine and blood urea nitrogen levels), monitoring of peripheral blood patterns, and an audiogram are indicated.

In infants and premature infants, the concentration of vancomycin in the blood plasma must be constantly monitored during treatment.

Serum levels of the drug should be monitored in patients over 60 years of age with renal failure, since this category of patients is at high risk of developing toxic effects of the drug.

Drug interactions

Vancomycin has a low pH, which may cause physical or chemical instability when mixed with other solutions. The drug should not be mixed with alkaline solutions.

Vancorus is physically incompatible with beta-lactam antibiotics. Between uses of these antibiotics and vancomycin, the intravenous system should be thoroughly flushed because the likelihood of precipitation increases with increasing concentrations of vancomycin.

Meclozine, phenothiazines, antihistamines, and thioxanthenes may mask symptoms of vancomycin ototoxicity (vertigo and tinnitus).

With simultaneous and/or sequential use (both systemic and local) of other potentially nephrotoxic and/or ototoxic drugs, the patient's condition must be carefully monitored for the development of these symptoms. This includes, but is not limited to, the following drugs: aminosalicylic acid or other salicylates, cyclosporine, capreomycin, aminoglycosides, carmustine, amphotericin B, loop diuretics, including ethacrynic acid, cisplatin, polymyxin B.

Cholestyramine reduces the effectiveness of vancomycin when taken orally.

Lyophilisate for the preparation of solution for infusion Vancorus (Vancorus)

Instructions for medical use of the drug

Description of pharmacological action

Antibiotic from the group of glycopeptides. Vancomycin is a tricyclic glycopeptide antibiotic isolated from Amycolatopsis orientalis. The bactericidal effect of vancomycin occurs as a result of inhibition of cell wall biosynthesis. In addition, vancomycin can change the permeability of the bacterial cell membrane and alter RNA synthesis. There is no cross-resistance between vancomycin and other classes of antibiotics. In vitro vancromicin is active against gram-positive microorganisms: Staphylococcus aureus and Staphylococcus Epidermidis (including their heterogeneous methicillin-resistant strains), Streptococcus pyogenes, streptococcus pneumoniae (including penicillin-resistant strains), Streptococcus Agalactiae, Streptococcus Viridans, Streptococcus Bovis and Enterococci (in T .ch. Enterococcus faecalis); Clostridium difficile (including toxigenic strains involved in the development of pseudomembranous enterocolitis) and diphtheroids. Other microorganisms that are also sensitive to vancomycin in vitro include Listeria monocytogenes, the bacterial genera Lactobacillus, Actinomyces, Clostridium and Bacillus. In vitro, some isolated strains of enterococci and staphylococci exhibit resistance to vancomycin. When vancomycin and aminoglycosides are combined, synergistic action is observed in vitro against many strains of Staphylococcus aureus, non-group D streptococci, enterococci and bacteria of the Streptococcus viridans group. Vancomycin is not active in vitro against gram-negative microorganisms, mycobacteria and fungi.

Indications for use

Infections caused by vancomycin-sensitive pathogens, including: - endocarditis caused by Streptococcus viridans or Streptococcus bovis (as monotherapy or in combination with aminoglycosides); - endocarditis caused by enterococci, for example Enterococcus faecalis (only in combination with aminoglycosides); - treatment of diphtheroid endocarditis (there is evidence of the effectiveness of vancomycin); - early endocarditis caused by Staphylococcus epidermidis or diphtheroids after valve replacement (in combination with rifampicin, aminoglycosides or both antibiotics); — prevention of endocarditis (in some cases); - sepsis; - infections of bones and joints; - lower respiratory tract infections; - infections of the skin and soft tissues; - infections caused by gram-positive microorganisms, in cases of an allergic reaction to penicillin; - with intolerance or lack of response to treatment with other antibiotics, including penicillins or cephalosporins; - infections caused by microorganisms sensitive to vancomycin but resistant to other antimicrobial drugs; - pseudomembranous colitis (in the form of an oral solution).

Release form

lyophilisate for the preparation of solution for infusion 500 mg; bottle (bottle), cardboard pack 1; lyophilisate for the preparation of solution for infusion 500 mg; bottle (bottle), cardboard pack 5; lyophilisate for the preparation of solution for infusion 500 mg; bottle (bottle), cardboard pack 10; lyophilisate for the preparation of solution for infusion 500 mg; bottle (bottle), cardboard box (box) 50; lyophilisate for the preparation of solution for infusion 1000 mg; bottle (bottle), cardboard pack 1; lyophilisate for the preparation of solution for infusion 1000 mg; bottle (bottle), cardboard pack 5; lyophilisate for the preparation of solution for infusion 1000 mg; bottle (bottle), cardboard pack 10; lyophilisate for the preparation of solution for infusion 1000 mg; bottle (bottle), cardboard box (box) 50;

Pharmacodynamics

Forms a complex with acyl-D-alanine-D-alanine of the mucopeptide of the bacterial cell wall, inhibits its formation and increases permeability, disrupts RNA synthesis. Active against aerobic gram-positive microorganisms: Staphylococcus spp. (including Staphylococcus aureus and Staphylococcus epidermidis, including methicillin-resistant strains), Streptococcus spp., incl. Streptococcus bovis, Streptococcus viridans, Streptococcus pyogenes, Streptococcus pneumoniae (including strains resistant to penicillin), Streptococcus agalactiae, Listeria monocytogenes; anaerobic gram-positive microorganisms: Actinomyces spp., Enterococcus spp. (including Enterococcus faecalis), Corynebacterium diphtheriae, Clostridium spp. In vitro, it is inactive against gram-negative microorganisms, mycobacteria, fungi, viruses, and protozoa. There is no cross-resistance between vancomycin and other antibiotics. The optimum action is at pH 8; when pH decreases to 6, the effect decreases sharply. Actively affects only microorganisms that are in the stage of reproduction.

Pharmacokinetics

Absorption In individuals with normal renal function, repeated intravenous administration of vancomycin at a dose of 1 g (15 mg/kg, infusion over 60 minutes) produces mean plasma concentrations of approximately 63 mg/L immediately after completion of the infusion; 2 hours after infusion, the average plasma concentration is about 23 mg/l, and after 11 hours it is about 8 mg/l. Repeated infusions of 500 mg over 30 minutes produce mean plasma concentrations of approximately 49 mg/L after completion of the infusion; 2 hours after infusion, average plasma concentrations are about 19 mg/l, after 6 hours - about 10 mg/l. Plasma concentrations following repeated administration are similar to plasma concentrations following a single dose. The Vd distribution ranges from 0.3 to 0.43 l/kg. As shown by ultrafiltration, at serum concentrations from 10 mg/l to 100 mg/l, the binding of vancomycin to plasma proteins is 55%. After intravenous administration of vancomycin hydrochloride is found in pleural, pericardial, ascitic, synovial fluids and atrial appendage tissue, as well as in urine and peritoneal fluid in concentrations that inhibit the growth of microorganisms. Vancomycin penetrates slowly into the cerebrospinal fluid. With meningitis, penetration of the drug into the cerebrospinal fluid is noted. Vancomycin crosses the placental barrier and is excreted in breast milk. Metabolism The drug is practically not metabolized. The elimination of T1/2 of vancomycin from plasma averages 4-6 hours in patients with normal renal function. About 75% of the administered dose of vancomycin is excreted in the urine due to glomerular filtration in the first 24 hours. The average plasma clearance is about 0.058 l/kg/h, the average renal clearance is about 0.048 l/kg/h. The renal clearance of vancomycin is fairly constant and ensures its elimination by 70-80%. Pharmacokinetics in special clinical situations Impaired renal function slows down the elimination of vancomycin. In patients with a removed or absent kidney, the average T1/2 is 7.5. The total systemic and renal clearance of vancomycin may be reduced in elderly patients as a result of a natural slowdown in glomerular filtration.

Use during pregnancy

The drug is contraindicated for use in the first trimester of pregnancy. Use in the second and third trimesters of pregnancy is possible only for health reasons in cases where the expected benefit of therapy for the mother outweighs the potential risk for the fetus. If it is necessary to use the drug during lactation, breastfeeding should be stopped during treatment with the drug.

Use for renal impairment

Patients with impaired renal function must individually select the dose. Vancomycin dose selection for this group of patients can be carried out under the control of serum creatinine levels. In premature infants and elderly patients, significant dose reduction may be required due to deterioration of renal function. Vancomycin plasma concentrations should be regularly monitored.

Contraindications for use

- neuritis of the auditory nerve; - renal failure; — I trimester of pregnancy; - lactation period (breastfeeding); - hypersensitivity to vancomycin. The drug should be used with caution in case of hearing impairment (including a history of hearing), in the second and third trimesters of pregnancy.

Side effects

From the cardiovascular system: cardiac arrest, hot flashes, decreased blood pressure, shock (these symptoms are mainly associated with rapid infusion of the drug). From the digestive system: nausea, pseudomembranous colitis. From the hematopoietic system: agranulocytosis, eosinophilia, neutropenia, thrombocytopenia. From the urinary system: interstitial nephritis, changes in renal function tests, impaired renal function. From the senses: vertigo, tinnitus, ototoxic effects. Ototoxicity was observed in a number of patients receiving vancomycin. It may be transient or permanent. It is reported that the majority of such cases were observed in patients who received excessive doses of vancomycin, with a history of hearing loss, or in patients receiving concomitant treatment with other drugs with a possible development of ototoxicity, such as aminoglycosides. Dermatological reactions: exfoliative dermatitis, benign (IgA) blistering dermatosis, pruritic dermatosis, rash. Allergic reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, vasculitis. Anaphylactoid reactions may occur during or shortly after a too-rapid infusion of vancomycin. Other: chills, drug fever, tissue necrosis at injection sites, pain at injection sites, thrombophlebitis. Rapid administration of the drug may also cause red man syndrome, flushing of the upper body, or pain and spasms of the chest and back muscles. After stopping the infusion, these reactions usually resolve within 20 minutes, but can sometimes last up to several hours.

Directions for use and doses

It is administered only intravenously. Vancorus® cannot be administered intramuscularly or intravenously as a bolus (bolus)! When administering a solution of the drug intravenously, the recommended concentration of vancomycin is no more than 5 mg/ml and the rate of administration is no more than 10 mg/min. In patients for whom fluid intake restriction is indicated, the drug can be used in concentrations of up to 10 mg/ml, the rate of administration is no more than 10 mg/min. However, when such concentrations are used, the likelihood of infusion-related side effects increases. For adults with normal renal function, the drug is prescribed in a daily dose of 2 g IV (500 mg every 6 hours or 1 g every 12 hours). Each dose should be administered at a rate of no more than 10 mg/min and over a period of at least 60 minutes. The patient's age and obesity may require changes in the usual dose based on determination of vancomycin serum concentrations. For children, the dose is usually 10 mg/kg IV every 6 hours. Each dose should be administered over at least 60 minutes. For newborns, the initial dose is 15 mg/kg, followed by 10 mg/kg every 12 hours during the first week of life. Starting from the second week of life - every 8 hours until the age of 1 month. Each dose should be administered over at least 60 minutes. Patients with impaired renal function must individually select the dose. Vancomycin dose selection for this group of patients can be carried out under the control of serum creatinine levels. In elderly patients, vancomycin clearance is lower and Vd is higher. In this category of patients, it is advisable to select the dose based on vancomycin serum concentrations. In premature infants and elderly patients, significant dose reduction may be required due to deterioration of renal function. Vancomycin plasma concentrations should be regularly monitored. Rules for preparing a solution for intravenous administration. The injection solution is prepared immediately before administration of the drug. To do this, add the required volume of water for injection to a vial of dry, sterile vancomycin lyophilisate to obtain a solution with a concentration of 50 mg/ml. Further dilution of the prepared solution is required. Prepared solutions of vancomycin must be further diluted before administration to a concentration of no more than 5 mg/ml. The required dose of vancomycin diluted in the above manner should be administered by divided intravenous infusions over at least 60 minutes. As solvents, you can use 5% dextrose (glucose) solution for injection or 0.9% sodium chloride solution for injection. Before injection, the prepared solution for parenteral administration should be checked visually, if possible, for the presence of mechanical impurities and color changes. Preparation of an oral solution and its use For the treatment of pseudomembranous colitis caused by Clostridium difficile due to the use of antibiotics, as well as for the treatment of staphylococcal enterocolitis, Vancorus® is prescribed orally. Adults are prescribed 0.5-2 g 3-4 times a day, children - a daily dose of 40 mg/kg, frequency of administration 3-4. The appropriate dose is dissolved in 30 ml of water and given to the patient to drink or administered through a tube. To improve the taste of the solution, you can add regular food syrups to it. Duration of treatment is 7-10 days. IV vancomycin has no benefit in treating these diseases. Vancomycin is not effective when taken orally for other types of infections.

Overdose

Symptoms: increased severity of side effects. Treatment: corrective therapy aimed at maintaining glomerular filtration. Vancomycin is poorly removed by dialysis. There is evidence that hemofiltration and hemoperfusion through a polysulfone ion exchange resin leads to an increase in vancomycin clearance.

Interactions with other drugs

With simultaneous intravenous administration of vancomycin and local anesthetics, erythema, redness of the skin and anaphylactoid reactions were observed, and there may be a risk of a decrease in blood pressure or the development of neuromuscular blockade. Giving vancomycin as a 60-minute infusion before administering the anesthetic may reduce the likelihood of these reactions. With simultaneous and/or sequential systemic or local use of other potentially ototoxic and/or nephrotoxic drugs (aminoglycosides, amphotericin B, aminosalicylic acid or other salicylates, bacitracin, capreomycin, carmustine, paromomycin, cyclosporine, loop diuretics, polymyxin B, cisplatin, ethacrynic acid) requires careful monitoring of the possible development of these symptoms. Cholestyramine reduces the activity of vancomycin (when taken orally). Antihistamines, meclozine, phenothiazines, thioxanthenes can mask the symptoms of vancomycin ototoxicity (tinnitus, vertigo). Pharmaceutical interactions Vancomycin solution has a low pH, which may cause physical or chemical instability when mixed with other solutions. Mixing with alkaline solutions should be avoided. Solutions of vancomycin and beta-lactam antibiotics are physically incompatible when mixed. The likelihood of precipitation increases with increasing concentrations of vancomycin. The IV system should be adequately flushed between uses of these antibiotics. In addition, it is recommended to reduce the concentration of vancomycin solution to 5 mg/ml or less.

Special instructions for use

Vancomycin should be used with caution in patients with renal failure (it is recommended to monitor the concentrations of vancomycin in the blood plasma in case of renal failure in patients over 60 years of age), since at high concentrations of the drug in the blood that persist for a long time, the risk of toxic effects of the drug may increase; the maximum concentration should not exceed 40 μg/ml, the minimum - 10 μg/ml, concentrations above 80 μg/ml are considered toxic. For patients with renal failure, vancomycin doses should be adjusted individually. Rapid administration (eg, within a few minutes) of vancomycin may be accompanied by a marked decrease in blood pressure and, in rare cases, cardiac arrest. Vancomycin should be administered as a diluted solution over at least 60 minutes to avoid infusion-related adverse reactions. Vancomycin should be administered with caution to patients allergic to teicoplanin, because Cases of cross-allergy have been reported. In patients receiving IV vancomycin, periodic blood tests and renal function monitoring should be performed. Vancomycin is an irritant, so diffusion of the dissolved drug through the vascular wall can cause necrosis of adjacent tissues. Thrombophlebitis may occur, although the likelihood of their development can be reduced by slowly administering diluted solutions (with a concentration of 2.5-5 mg/ml) and alternating the sites of drug administration. Use in pediatrics When prescribed to newborns, monitoring of plasma concentrations is recommended.

Storage conditions

List B: In a dry place, protected from light, at a temperature not exceeding 25 °C.

Best before date

24 months

ATX classification:

J Antimicrobials for systemic use

J01 Antimicrobials for systemic use

J01X Other antibacterial drugs

J01XA Antibiotics of glycopeptide structure

J01XA01 Vancomycin