Is vancomycin (Vancomycin) compatible with dextrose (Dextrose) for infusion into Intravenous (IV) access?

Vancomycin and Dextrose Compatibility for IV Infusion

Yes, vancomycin is compatible with dextrose solutions for IV infusion. Vancomycin can be safely diluted and administered in 5% dextrose injection (D5W) as well as other dextrose-containing solutions 1.

Compatible Dextrose-Containing Solutions

The FDA-approved vancomycin label explicitly lists the following dextrose-containing diluents as physically and chemically compatible with vancomycin hydrochloride at 4 g/L 1:

• 5% Dextrose Injection, USP 1
• 5% Dextrose Injection and 0.9% Sodium Chloride Injection, USP 1
• 5% Dextrose and Lactated Ringer's Injection 1
• Normosol®-M and 5% Dextrose 1

Preparation and Dilution Requirements

Vancomycin must be adequately diluted before administration to ensure compatibility and prevent complications 1:

• Reconstitute vancomycin to 50 mg/mL with Sterile Water for Injection 1
• For a 500 mg dose, further dilute in at least 100 mL of compatible solution 1
• For a 1 gram dose (20 mL reconstituted), use at least 200 mL of diluent 1
• Administer by intermittent IV infusion over at least 60 minutes 1

Concentration-Dependent Stability Considerations

The concentration of vancomycin in dextrose solutions affects compatibility with other medications 2, 3:

• Vancomycin concentrations ≤5 mg/mL in D5W demonstrate better compatibility with co-administered antibiotics 2, 3
• Higher vancomycin concentrations (≥10 mg/mL) in D5W may precipitate when mixed with certain beta-lactam antibiotics 2, 3
• The FDA label recommends diluting vancomycin solutions to 5 mg/mL or less when chemical or physical instability is a concern 1

Storage Stability in Dextrose Solutions

Vancomycin diluted in dextrose solutions maintains stability for extended periods under refrigeration 1:

• Solutions diluted with 5% Dextrose Injection may be stored refrigerated for 14 days without significant potency loss 1
• Solutions diluted with 5% Dextrose and 0.9% Sodium Chloride Injection can be refrigerated for 14 days 1
• Solutions diluted with Lactated Ringer's and 5% Dextrose Injection remain stable refrigerated for 96 hours 1

Critical Compatibility Warnings

Vancomycin has a low pH and may cause physical instability when mixed with other compounds 1:

• Adequately flush IV lines between administration of vancomycin and beta-lactam antibiotics 1
• Mixtures of vancomycin and beta-lactam antibiotics have demonstrated physical incompatibility 1
• The likelihood of precipitation increases with higher vancomycin concentrations 1
• Visual inspection for particulate matter and discoloration should occur before administration 1

Infusion Rate Requirements

Prolonged infusion time is essential to prevent adverse reactions 4:

• Vancomycin should be infused over at least 1 hour to reduce "red man syndrome" risk 4
• For loading doses of 25-30 mg/kg, consider extending infusion to 2 hours and premedication with antihistamines 4
• Complete infusion within 30 minutes of starting procedures requiring prophylaxis 4