From the Guidelines
Vancomycin is contraindicated in patients with a known hypersensitivity to the medication.
Contraindications and Precautions
- Red man syndrome: a hypersensitivity reaction that can occur with rapid infusion of vancomycin, characterized by flushing, rash, and hypotension 1, 2
- Nephrotoxicity: vancomycin can cause kidney damage, especially when used in combination with other nephrotoxic medications, such as aminoglycosides 3
- Ototoxicity: vancomycin can cause hearing loss, especially when used in high doses or in combination with other ototoxic medications 3
- Vancomycin-resistant enterococci: vancomycin is not effective against enterococci that are resistant to the medication, and alternative treatments should be used in these cases 4
Special Considerations
- Pregnancy and lactation: vancomycin should be used with caution in pregnant and breastfeeding women, as it can cross the placenta and be excreted in breast milk 5
- Renal impairment: vancomycin dosing should be adjusted in patients with renal impairment to avoid nephrotoxicity 2, 3
- Obesity: vancomycin dosing should be adjusted in obese patients to ensure adequate serum concentrations 2
From the FDA Drug Label
CONTRAINDICATIONS Vancomycin hydrochloride for injection is contraindicated in patients with known hypersensitivity to this antibiotic. The contraindications for Vancomycin are:
- Hypersensitivity to the antibiotic 6
From the Research
Contraindications for Vancomycin
The following are contraindications for vancomycin:
- Hypersensitivity to vancomycin 7, 8
- Patients with known history of vancomycin-induced nephrotoxicity or ototoxicity 7, 9
- Concomitant use of other nephrotoxic agents, as this may increase the risk of vancomycin-induced nephrotoxicity 9
- Patients with compromised renal function, as vancomycin may exacerbate existing renal impairment 9, 10
- Pregnancy and lactation, although vancomycin may be used in these situations if the benefits outweigh the risks, careful monitoring is required 11
Special Considerations
- Vancomycin should be used with caution in patients with renal impairment, as the risk of nephrotoxicity is increased 9, 10
- Patients receiving vancomycin should be monitored closely for signs of nephrotoxicity, ototoxicity, and other adverse effects 7, 9, 8, 10
- The use of vancomycin in patients with severe hepatic impairment has not been well studied, and caution is advised in these situations 11
Warnings and Precautions
- Vancomycin may cause anaphylaxis, and patients should be closely monitored for signs of allergic reactions 7, 8
- The "red man syndrome" is a known adverse effect of vancomycin, and patients should be monitored for signs of this condition 7, 8
- Vancomycin may cause neutropenia, and patients should be monitored for signs of bone marrow suppression 7