Names and pronunciation
(dal-ba-van′sin) Dalvance
PDF page 341
Loading InternPractice…
Drug reference
(dal-ba-van′sin) Dalvance
PDF page 341
Func. class.: Antiinfective
PDF page 341
Chem. class.: Glycopeptide
PDF page 341
ACTION: Binds to the bacterial cell walls, inhibiting their synthesis
PDF page 341
USES: Treatment of acute bacterial skin and skin structure infections due to gram-positive organisms (cellulitis, major abscess, wound infections); D Enterococcus faecalis, Enterococcus fae- cium, Staphylococcus aureus (MRSA), Staphylococcus aureus (MSSA), Strepto- coccus agalactiae (group B streptococci), Streptococcus anginosus, Streptococcus constellatus, Streptococcus dysgalactiae, Streptococcus intermedius, Streptococ- cus pyogenes (group A beta-hemolytic streptococci)
PDF page 341
CONTRAINDICATIONS: Hyper- sensitivity Precautions: Antimicrobial resistance, breastfeeding, infusion-related reactions, pregnancy, CDAD, ulcerative colitis, vanco- mycin or glycopeptide hypersensitivity, viral infection, elderly, children, hepatic disease
PDF page 341
SIDE EFFECTS CNS: Dizziness, headache, flushing GI: Nausea, CDAD, abdominal pain, diar- rhea, vomiting RESP: Bronchospasm SYST: Red man syndrome, hypersensitiv- ity reactions GU: Mycotic vulvovaginal infections ENDO: Hypoglycemia INTEG: Rash, urticaria, infusion-related reactions, pruritus, petechiae, phlebitis
PDF page 342
INTERACTIONS None known
PDF page 342
DOSAGE AND ROUTES • Adult: IV 1500 mg once; or 1000 mg once, then 500 mg IV 1 wk later Renal dose • Adult: IV CCr <30 mL/min 1125 mg as a single dose or 750 mg once then 375 mg 1 wk later
PDF page 341
Available forms: Injection 500 mg/vial (single use)
PDF page 341
Administer: IV INFUSION route • Visually inspect parenteral products for particulate matter and discolor- ation • Reconstitution: Reconstitute each 500 mg/25 mL (20 mg/mL) sterile water for injection or D5W; to avoid foaming, alter- nate between gentle swirling and inver- sion until completely dissolved, do not shake; further dilution is required • Storage: Refrigerate or store at room temperature. Do not freeze. The total time from reconstitution to dilution to use max 48 hr • Dilution: Transfer the dose of reconsti- tuted solution from the vial(s) to an IV bag or bottle containing D5W (1-5 mg/mL), discard unused product Intermittent IV INFUSION • Give over 30 min, do not infuse with other medications or electrolytes, sa- line-based infusion solutions may cause precipitation and should not be used; if a common IV line is being used to administer other drugs, the line should be flushed prior to and after each dose
PDF pages 341, 342
Assess: • Monitor CBC with differential, LFTs • BUN/creatinine; lower dose may be required in severe renal disease • CDAD: monitor for bowel pattern daily; if severe diarrhea occurs, product should be discontinued, may occur ≥8 wk after last dose • Infection: B/P, pulse, temperature, characteristics of urine, stools, sputum baseline and during treatment, make sure use is for a bacterial infection • Anaphylaxis: rash, urticaria, pruritus, wheezing; may occur a few days after administration • Infusion site reactions: monitor for reactions, discontinue if present • Red man–like syndrome: assess for flushing, rash over upper torso and neck; may occur after a few minutes of infu- sion; may be treated with antihistamines and a slower infusion, usually caused by too rapid an infusion
PDF page 342
Evaluate: • Therapeutic response: decreased symptoms of infection, negative C&S
PDF page 342
CLINICAL CONSIDERATIONS
PDF page 342
Patient and caregiver information: • To report allergic reactions to this product, vancomycin, or other glycopep- tides • That product is used for bacterial in- fections only • To report sore throat, bruising, bleed- ing, joint pain (blood dyscrasias); diar- rhea with mucus, blood (CDAD); rash, pruritus, wheezing (hypersensitivity re- actions) • Pregnancy/breastfeeding: to notify health care professional if pregnancy is planned or suspected or if breastfeeding • To notify prescriber of all OTC, pre- scription medications, and herbals used
PDF page 342
PHARMACOKINETICS Protein binding 93%, primarily to albu- min, excreted in feces and urine, metab- olism decreased in renal disease, half-life 8 days, peak infusion’s end, duration 1 wk
PDF page 342
• Adult: IV 1500 mg once; or 1000 mg once, then 500 mg IV 1 wk later Renal dose
PDF page 341
• Adult: IV CCr <30 mL/min 1125 mg as a single dose or 750 mg once then 375 mg 1 wk later
PDF page 341