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	≥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

Derm: limb/SUBQ abscess formation

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

Local: injection site reactions

Neuro: headache

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), infusion reactions (including infusion-related reaction resembling vancomycin flushing syndrome)

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 as a single dose.

Availability ⬆ ⬇

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

Assessment ⬆ ⬇

Assess signs and symptoms of infection at baseline and during therapy.
Monitor for hypersensitivity reactions including anaphylaxis. If acute reaction occurs, immediately discontinue and initiate supportive measures.
Monitor for diarrhea, abdominal pain, fever, and bloody stools. If CDAD suspected, discontinue oritavancin and treat as clinically indicated. 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, rigor). If symptoms occur, consider stopping or slowing infusion until resolved.
Monitor for signs/symptoms of osteomyelitis (fever, local erythema and pain, chills, diaphoresis, loss of range of motion). If osteomyelitis is suspected or diagnosed, discontinue oritavancin and institute alternate antibacterial therapy.

Lab Test Considerations:

Obtain specimens for culture and sensitivity before starting therapy. 1st dose may be given before receiving results.
Monitor liver function tests. May ↑ 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.

Implementation ⬆ ⬇

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

Orbactiv

Reconstitution: Using three 400-mg vials, add 40 mL of sterile water for injection to each vial. Swirl gently to avoid foaming and ensure powder is completely dissolved. Solution is clear and colorless to pale yellow; do not administer if discolored or contains particulates. 10 mg/mL.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 infusion time.
Rate: Infuse over 3 hr. 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 if cloudy, discolored, or contains particulates. 30 mg/mL. Withdraw and discard 40 mL from a 250-mL IV bag of 0.9% NaCl or D5W. Withdraw 40 mL of 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.
Y-Site Compatibility:
- calcium gluconate
- ciprofloxacin
- dexmedetomidine
- dobutamine
- dopamine
- epinephrine
- famotidine
- fentanyl
- fluconazole
- gentamicin
- haloperidol
- insulin, regular
- lorazepam
- midazolam
- morphine
- nitroglycerin
- norepinephrine
- phenylephrine
- potassium chloride
- tobramycin
(Applies to both oritavancin products)
Y-Site Incompatibility:
- aminophylline
- amphotericin B deoxycholate
- aztreonam
- bumetanide
- clindamycin
- furosemide
- heparin
- hydrocortisone
- meropenem
- nitroprusside
- phenytoin
- trimethoprim/sulfamethoxazole
(Applies to both oritavancin products)

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
Instruct patient to notify health care provider if signs and symptoms of hypersensitivity reactions (rash, hives, dyspnea, facial swelling) occur.
Instruct patient to notify health care provider immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care provider.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇