oritavancin

Binds to bacterial cell wall resulting in cell death.

Therapeutic effects:

Bactericidal action against susceptible bacteria with resolution of infection.

Spectrum:

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

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Penetrates skin/skin structures.

Metabolism/Excretion: Slowly excreted unchanged in urine (5% in 2 wk) and feces (1% in 2 wk).

Half-Life: 245 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	at least 2 wk

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity (cross-sensitivity with other glycopeptides may occur);
Heparin use for 120 hr (5 days) following administration of oritavancin (causes false ↑ aPTT);
Confirmed/suspected osteomyelitis (alternate treatment required).

Use Cautiously in:

Severe renal impairment;
Severe hepatic impairment;
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may have sensitivity to drug effects.

Adv. Reactions/Side Effects ⬆ ⬇

CV: tachycardia

GI: ↑liver enzymes, CLOSTRIDIOIDES DIFFICILE ASSOCIATED DIARRHEA (CDAD), nausea, vomiting

Local: infusion site reactions

Neuro: headache

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), infusion reactions (including infusion-related reaction resembling vancomycin flushing syndrome), limb/SUBQ abscess formation

Interactions ⬆ ⬇

Drug-drug:

↑risk of bleeding with warfarin; avoid concurrent use, if possible.
Affects the activities of several CYP450 enzymes (careful monitoring of other drugs metabolized by the CYP450 system that have narrow therapeutic indices to assess for toxicity or ineffectiveness is recommended).

Route/Dosage ⬆ ⬇

IV (Adults ): 1200 mg single dose.

Availability ⬆ ⬇

Lyophilized powder for injection (Orbactiv): 400 mg/vial
Lyophilized powder for injection (Kimyrsa): 1200 mg/vial

Assessment ⬆ ⬇

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during 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 2 mo following cessation of therapy.
Monitor for infusion-related reaction (resembling vancomycin flushing syndrome—flushing of upper body, urticaria, pruritus, rash; chest pain, back pain, chills, tremor). May resolve with stopping or slowing infusion.

Lab Test Considerations:

Monitor hepatic function tests. May cause ↑ ALT, AST, and bilirubin.
- May cause hyperuricemia and hypoglycemia.
- Causes falsely ↑ aPTT for 120 hr after infusion. Avoid heparin administration during this time. Use a nonphospholipid dependent coagulation test such as Factor Xa assay if needed.
- Artificially prolongs PT and INR for up to 12 hr. May increase risk of bleeding with warfarin.

Implementation ⬆ ⬇

0.9% NaCl
D5W

Y-Site Incompatibility:

Drugs formulated at a basic or neutral pH.
Do not use with other drugs. If same IV line must be used, flush line before and after infusion with 0.9% NaCl or D5W.

The two oritavancin products (Orabactiv and Kimyrsa) are different products. Directions for use are not interchangeable.

Orabactiv

Reconstitution: Using three 400-mg vials, add 40 mL of sterile water for injection to each vial for a 10-mg/mL solution/vial. Swirl gently to avoid foaming and ensure powder is completely reconstituted. Solution is clear and colorless to pale yellow; do not administer solutions that are discolored or contain particulate matter. Diluent: Withdraw and discard 120 mL from 1000-mL bag of D5W. Withdraw 40 mL from each vial and add to D5W bag. Do not use 0.9% NaCl; may cause precipitation.Concentration: 1.2 mg/mL. Use within 6 hr at room temperature or 12 hr if refrigerated, including 3 hr infusion.
Rate: Infuse over 3 hr.
Y-Site Incompatibility: Do not mix with other solutions or medications. Flush line before and after infusion.

Kimyrsa

Reconstitution: Add 40 mL sterile water for injection to 1200-mg vial. Swirl gently to avoid foaming. Solution is clear, colorless to pink; do not use solutions that are cloudy, discolored, or contain particulate matter. 30 mg/mL. Withdraw and discard 40 mL from a 250-mL IV bag of 0.9% NaCl or D5W. Withdraw 40 mL of the reconstituted vial and add to IV bag of 0.9% NaCl or D5W to bring volume to 250 mL. 4.8 mg/mL. Discard unused portion of reconstituted solution. Solution is stable for 4 hr at room temperature or 12 hr if refrigerated. Combined storage and infusion times should be within the stability times.
Rate: Infuse over 1 hr.

Patient/Family Teaching ⬆ ⬇

Explain purpose of oritavancin to patient.
Instruct patient to notify health care professional if signs and symptoms of hypersensitivity reactions (rash, hives, dyspnea, facial swelling) occur.
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.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Instruct the patient to notify health care professional if symptoms do not improve.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇