Avancomycin 500 Special Precautions

Warnings: Complications of occasional severe hypotension (including shock and rare cardiac arrest), histamine like responses and maculopapular or erythematous rash ("red man syndrome" or "red neck syndrome") are thought to be related to the rate of the infusion. Vancomycin should be infused in a dilute solution at a rate not greater than 10 mg/min to avoid rapid infusion-related reactions. Stopping the infusion usually results in a prompt cessation of these reactions. Slow infusions over one hour are recommended for infants and children.
Because of its toxicity and nephrotoxicity, vancomycin should be used with care in patients with renal impairment. The risk of toxicity is increased by high blood concentrations or prolonged therapy. Therefore, blood levels should be monitored and dosage adjusted if it is necessary to use vancomycin in such patients.
The concurrent or sequential use of other nephrotoxic drugs requires careful monitoring and should be avoided if possible. Some patients with inflammatory disorders of the intestinal mucosa may have significant systemic absorption of oral vancomycin and, therefore, may be at risk for the development of adverse reactions associated with the parenteral administration of vancomycin. The risk is greater in patients with renal impairment. It should be noted that the total systemic and renal clearances of vancomycin are reduced in the elderly.
Vancomycin should, if possible, be avoided in patients with previous hearing loss. Serial testing of auditory function in those aged more than 60 years is advised. If used, it is very important that the dose be adjusted by monitoring the blood concentrations of the drug. Deafness may be preceded by tinnitus. The elderly are more susceptible to auditory damage. Experience with other antibiotics suggests that deafness may be progressive despite cessation of treatment.
Precautions: Vancomycin is very irritating to tissue and causes injection site necrosis if injected intramuscularly. Pain and thrombophlebitis occur in many patients receiving vancomycin and are occasionally severe. The frequency and severity of thrombophlebitis can be minimised if the drug is administered as a dilute solution (2.5-5 mg/ml) of Dextrose 5% or Normal Saline 0.9% solution and if the sites of injection are changed regularly.
All patients receiving vancomycin should have periodic haematological studies, urine analysis, liver and renal function tests.
Anaesthetic induced myocardial depression may be enhanced by vancomycin. During anaesthesia, doses must be well diluted and administered slowly with close cardiac monitoring. Position changes should be delayed until the infusion is completed to allow for postural adjustment.
Patients taking oral vancomycin should be warned of its offensive taste.