Names and pronunciation
(tel-a-van′sin) Vibativ
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Drug reference
(tel-a-van′sin) Vibativ
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Func. class.: Antiinfective, miscel- laneous
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Chem. class.: Lipoglycopeptide
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ACTION: Inhibits bacterial cell-wall synthesis, disrupts cell membrane integrity, blocks glycopeptides
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USES: Complicated skin/skin structure infections caused by T Enterococcus faecalis, E. faecium, Staphylococcus aureus (MRSA), S. aureus (MSSA), S. epidermidis, S. haemolyticus, Streptococcus agalactiae (group B), S. dysgalactiae, S. pyogenes (group A β-tremolytic), S. anginosus, S. intermedius, S. constellatus; nosocomial pneumonia caused by susceptible gram-positive bacteria
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Unlabeled uses: Bacteremia
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Breastfeeding, children, geri- atric patients, renal disease, antimicrobial resistance, diabetes mellitus, diarrhea, GI disease, heart failure, hypertension, pseudomembranous colitis, QT prolonga- tion, vancomycin hypersensitivity
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Black Box Warning: Pregnancy, renal disease Black Box Warning: Nephrotoxic- ity: I&O ratio; report hematuria, oliguria; monitor BUN, CCr, avoid in those with CCr ≤50 mL/min; more common in those with diabetes, HF, hypertension, geriatric pa- tients, renal disease • CDAD: monitor for diarrhea, fever, blood in stools, abdominal pain; may hap pen several weeks after therapy ends, report to prescriber immediately • Anaphylaxis: monitor for rash, itching, wheezing, laryngeal edema; discontinue and notify prescriber immediately; emer gency equipment and EPINEPHrine should be nearby • Auditory function during, after treat- ment; hearing loss; ringing, roaring in ears; product should be discontinued • B/P during administration; sudden drop may indicate red man syndrome; also flushing, pruritus, rash, use slow IV infusion to prevent • Respiratory status: rate, character, wheezing, tightness in chest • Adequate intake of fluids (2 L/day) to prevent nephrotoxicity Black Box Warning: Pregnancy: obtain a pregnancy test before use; if a woman has taken this product during pregnancy, the national registry should be notified Black Box Warning: To use contracep- tion while taking this product; not to breastfeed; to notify prescriber if preg- nancy is planned or suspected
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SIDE EFFECTS CNS: Anxiety, chills, flushing, headache, insomnia, dizziness CV: QT prolongation, irregular heartbeat EENT: Hearing loss GI: Nausea, vomiting, CDAD, abdominal pain, constipation, diarrhea, metallic/soapy taste GU: Nephrotoxicity, increased BUN, cre- atinine, renal failure, foamy urine HEMA: Leukopenia, eosinophilia, anemia, thrombocytopenia INTEG: Chills, fever, rash, thrombophle bitis at inj site; urticaria, pruritus, necro- sis (red man syndrome) SYST: Anaphylaxis, superinfection
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INTERACTIONS Increase: otoxicity or nephrotoxicity—ami noglycosides, cephalosporins, colistin, polymyxin, bacitracin, CISplatin, ampho tericin B, nondepolarizing muscle relax ants, cidofovir, tacrolimus, IV pentamidine, acyclovir, adefovir, cycloSPORINE, foscar net, ganciclovir, pamidronate, streptozocin, zoledronic acid, NSAIDs, salicylates, ACE inhibitors Increase: QT prolongation—class IA, III antidysrhythmics; some phenothiazines; chloroquine, clarithromycin, droperidol, dronedarone, erythromycin, haloperidol, methadone, pimozide, ziprasidone Decrease: CYP450 enzymes Drug/Lab Test False increase: INR, PT, PTT
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DOSAGE AND ROUTES Complicated skin/skin-structure infections • Adult: IV INFUSION 10 mg/kg over 60 min q24hr × 7-14 days Hospital-acquired nosocomial pneumonia • Adult: IV INFUSION 10 mg/kg q24hr × 7-21 days Renal dose • Adult: IV CCr 30-50 mL/min 7.5 mg/kg q24hr; CCr 10-29 mL/min 10 mg/kg q48hr
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Available forms: Lyophilized powder for inj 750 mg
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Administer: • Use only for susceptible organisms to prevent drug-resistant bacteria • Antihistamine if red man syndrome oc- curs: decreased B/P; flushing of neck, face • Avoid IM, subcut use Intermittent IV INFUSION route • After reconstitution with 15 mL D5W sterile water for inj; 0.9% NaCl (15 mg/mL) 250-mg vial; add 45 mL to 750-mg vial (15 mg/mL) for dose of 150-800 mg; fur- ther dilute with 100-250 mL of compatible sol; for dose <150 mg or >800 mg, further dilute to concentration of 0.6-8 mg/mL with compatible sol; give over 60 min, avoid rapid IV; reconstituted or diluted sol is sta- ble for 4 hr room temperature, 7 hr refrig- erated; avoid rapid IV; may cause red man syndrome Y-site compatibility: Amphotericin B lipid complex (Abelcet), ampicillin-sulbactam, azithromycin, calcium gluconate, caspofun- gin, cefepime, cefTAZidime, cefTRIAXone, ciprofloxacin, dexamethasone, diltiaZEM, DOBUTamine, DOPamine, doripenem, doxy- cycline, ertapenem, famotidine, fluconazole, gentamicin, hydrocortisone, labetalol, mag- nesium sulfate, mannitol, meropenem, metoclopramide, milrinone, norepineph- rine, ondansetron, pantoprazole, phenyleph- rine, piperacillin-tazobactam, potassium chloride/phosphates, raNITIdine, sodium bicarbonate, sodium phosphates, tigecy- cline, tobramycin, vasopressin
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Assess: • Infection: WBC, urine, stools, sputum, characteristics of wound throughout treatment, C&S
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Evaluate: • Therapeutic response: negative culture
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About all aspects of product therapy; that culture may be taken after com- pleted course of medication • To notify prescriber if infection continues • That bitter taste, nausea, vomiting, headache may occur • To report sore throat, fever, fatigue; could indicate superinfection; diarrhea (CDAD); hearing loss; rash, wheezing, tightness of chest, itching, tightening of throat (anaphylaxis)
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PHARMACOKINETICS Onset rapid, half-life 8-9 hr, excreted in urine (76%), protein binding 90%, hepatic metabolism
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• Adult: IV INFUSION 10 mg/kg over 60 min q24hr × 7-14 days Hospital-acquired nosocomial pneumonia
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• Adult: IV INFUSION 10 mg/kg q24hr × 7-21 days Renal dose
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• Adult: IV CCr 30-50 mL/min 7.5 mg/kg q24hr; CCr 10-29 mL/min 10 mg/kg q48hr
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