telavancin

Inhibits bacterial cell wall synthesis by interfering with the polymerization and cross-linking of peptidoglycan.

Therapeutic effects:

Bactericidal action against susceptible organisms.

Spectrum:

Active against Staphylococcus aureus (including methicillin-susceptible and -resistant strains), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus anginosus (including S. anginosus, S. intermedius, and S. constellatus), and Enterococcus faecalis (vancomycin-susceptible strains only).

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Minimal distribution to tissues.

Metabolism/Excretion: Metabolism is not known; 76% excreted unchanged in urine <1% in feces.

Half-Life: 8 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	end of infusion	24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Congenital long QT syndrome, known prolongation of the QT interval, uncompensated HF, or severe left ventricular hypertrophy (↑ risk of fatal arrhythmias);
Concurrent use of unfractionated heparin (aPTT may be falsely ↑ for up to 18 hr after telavancin therapy);
OB: Pregnancy.

Use Cautiously in:

Renal impairment (dose ↓ recommended for CCr ≤50 mL/min) (efficacy may be ↓ in patients with complicated skin/skin structure infections and CCr ≤50 mL/min) (↑ risk of mortality in patients with hospital-acquired or ventilator-associated pneumonia and CCr ≤50 mL/min; use only if benefit outweighs risk);
Diabetes, HF, hypertension (↑ risk of renal impairment);
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children (may be associated with poor outcomes in children 1 yr who have immature renal function);
Geri: Consider age-related in renal function in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: QT interval prolongation

GI: nausea, taste disturbance, vomiting, abdominal pain, CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD)

GU: foamy urine, nephrotoxicity

Neuro: dizziness

Misc: ANAPHYLAXIS, infusion reactions

Interactions ⬆ ⬇

Drug-drug:

Concurrent use of QT interval prolonging medications may ↑ risk of arrhythmias.
Concurrent use of NSAIDs, ACE inhibitors, and loop diuretics may ↑ risk of nephrotoxicity.

Route/Dosage ⬆ ⬇

Complicated Skin/Skin Structure Infections

IV (Adults ): 10 mg/kg ever 24 hr for 7–14 days.

Renal Impairment

IV (Adults ): CCr 30–50 mL/min: 7.5 mg/kg every 24 hr; CCr 10–≤30 mL/min: 10 mg/kg every 48 hr.

Hospital-Acquired/Ventilator-Associated Bacterial Pneumonia

IV (Adults ): 10 mg/kg ever 24 hr for 7–21 days.

Renal Impairment

IV (Adults ): CCr 30–50 mL/min: 7.5 mg/kg every 24 hr; CCr 10–≤30 mL/min: 10 mg/kg every 48 hr.

Availability ⬆ ⬇

Lyophilized powder for injection: 750 mg/vial

Assessment ⬆ ⬇

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
Obtain specimens for culture and sensitivity prior to therapy. First dose may be given before receiving results.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of CDAD. May begin up to several wk following cessation of therapy.
Monitor for infusion-related reactions (resembling vancomycin flushing syndrome—flushing of upper body, urticaria, pruritus, rash). May resolve with stopping or slowing infusion.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify health care professional immediately if symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of anaphylactic reaction.

Lab Test Considerations:

Verify negative pregnancy test before starting therapy.Monitor renal function (serum creatinine, CCr) prior to, every 48–72 hr during, and at the end of therapy. May cause nephrotoxicity. If renal function decreases, reassess need for telavancin.
- May interfere with prothrombin time, INR, aPTT, activated clotting time, and coagulation-based factor Xa tests. Collect blood samples for these tests as close to next dose of telavancin as possible.
- Interferes with urine qualitative dipstick protein assays and quantitative dye methods; may use microalbumin assays.

Implementation ⬆ ⬇

IV Administration:

Intermittent Infusion: Reconstitution: Reconstitute the 750-mg vial with 45 mL of D5W, sterile water for injection, or 0.9% NaCl for concentrations of 15 mg/mL. Reconstitution time is usually under 2 min but may require up to 20 min. Mix thoroughly with contents dissolved completely. Do not administer solution that is discolored or contains particulate matter. Discard vial if vacuum did not pull diluent into vial. Time in vial plus time in bag should not exceed 4 hr at room temperature or 72 hr if refrigerated.Diluent: For doses of 150–800 mg, dilute further with 100–250 mL of D5W, 0.9% NaCl, or LR.Concentration: For doses 150 mg or >800 mg, dilute for a final concentration of 0.6–8 mg/mL.
Rate: Administer over at least 60 min to minimize infusion reactions. Flush line with D5W, 0.9% NaCl, or LR before and after administration.

Patient/Family Teaching ⬆ ⬇

Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professionals.
Inform patient that common side effects include taste disturbance, nausea, vomiting, headache, and foamy urine. Notify health care professional if signs of infusion reaction occur.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Rep: May cause fetal harm. Advise females of reproductive potential to use effective contraception during and for 2 days after last dose and to notify health care professional if pregnancy is suspected. Inform patient of pregnancy exposure registry that monitors pregnancy outcomes in women exposed to telavancin during pregnancy. Encourage pregnant patients to enroll in the VIBATIV pregnancy registry by calling 1-877-484-2700. May impair fertility in males.
Instruct the patient to notify health care professional if symptoms do not improve.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇