What are the contraindications to Vancomycin (vancomycin hydrochloride)?

From the Guidelines

Vancomycin is contraindicated in patients with a known hypersensitivity to vancomycin.

Contraindications

• Hypersensitivity to vancomycin: Although not explicitly stated in the provided evidence, it is a well-established contraindication in real-life clinical medicine.
• Red man syndrome: Not mentioned in the provided evidence, but it is a known contraindication.

Special Considerations

• Renal insufficiency: Patients with renal insufficiency may require dose adjustments and close monitoring of vancomycin levels to avoid nephrotoxicity 1.
• Obesity: Morbidly obese patients may require higher doses of vancomycin and close monitoring of trough levels 1.
• Fluctuating volumes of distribution: Patients with fluctuating volumes of distribution may require close monitoring of vancomycin levels 1. It is essential to note that the provided evidence does not explicitly state all contraindications, but in real-life clinical practice, vancomycin is contraindicated in patients with a known hypersensitivity to the medication. Additionally, patients with certain conditions, such as renal insufficiency, obesity, and fluctuating volumes of distribution, require special consideration and close monitoring when receiving vancomycin 1.

From the FDA Drug Label

Vancomycin hydrochloride for injection is contraindicated in patients with known hypersensitivity to this antibiotic. The contraindication is clearly stated in the drug label 2. Key points to consider include:

• Hypersensitivity reactions can occur with vancomycin, and patients with a known history of hypersensitivity should not receive the drug.
• The drug label does not provide a comprehensive list of contraindications beyond hypersensitivity 2, 2.
• It is essential to carefully review the patient's medical history and monitor for signs of hypersensitivity reactions when administering vancomycin.

From the Research

Contraindications to Vancomycin

The following are contraindications to vancomycin:

• Hypersensitivity to vancomycin 3, 4
• Renal impairment or nephrotoxicity, as vancomycin can cause nephrotoxicity, especially with high doses or prolonged use 5, 3, 4, 6
• Ototoxicity, as vancomycin can cause hearing loss, especially with high doses or prolonged use 5, 3, 4
• Red man syndrome, a hypersensitivity reaction that can occur with vancomycin use 3, 4
• Interstitial nephritis, a rare but potentially serious side effect of vancomycin 3
• Neutropenia, a decrease in white blood cell count, which can occur with vancomycin use 3
• Concomitant use with other nephrotoxic or ototoxic agents, as this can increase the risk of adverse effects 6

Special Considerations

• Vancomycin should be used with caution in patients with:
  • Hepatic dysfunction, as vancomycin can cause elevated liver enzymes 5
  • Hypertension or diabetes, as these conditions may increase the risk of side effects 5
  • Renal impairment, as vancomycin can cause nephrotoxicity 5, 3, 4, 6
• Vancomycin should be used with caution in patients who are allergic to penicillins or cephalosporins, as cross-reactivity can occur 7
• Vancomycin should be used with caution in patients with a history of seizures or neurotoxicity, as vancomycin can cause neurotoxicity 7