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;
OB:
Pregnancy
.

Use Cautiously in:

Renal impairment (↓ dose if 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, or 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:

May artificially prolong activated partial thromboplastin time for up to 18 hr when used with unfractionated heparin; concurrent use contraindicated.
QT interval prolonging medications may ↑ risk of arrhythmias.
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 signs/symptoms of therapeutic response to treatment based on resolving infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) throughout therapy.
Assess cardiac history and ECG at baseline; avoid use in patients with long QT syndrome or cardiac arrhythmias associated with prolonged QT interval.
Monitor for signs/symptoms of CDAD, including watery diarrhea with mucus, fever, abdominal pain or cramping, anorexia, nausea, and, in severe cases, dehydration, colitis, and blood or pus in the stool. May begin up to several weeks 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/symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify health care provider 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.
Obtain specimens for culture and sensitivity prior to therapy. First dose may be given before receiving results.
Monitor CBC with differential.
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, 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 each vial with 45 mL of D5W, sterile water for injection, or 0.9% NaCl. Reconstitution time is usually 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 12 hr at room temperature or 7 days if refrigerated. Concentration: 15 mg/mL.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 ≥60 min to minimize infusion reactions.
Y-Site Compatibility:
- ampicillin/sulbactam
- azithromycin
- calcium gluconate
- caspofungin
- cefepime
- ceftazidime
- ceftriaxone
- ciprofloxacin
- dexamethasone
- diltiazem
- dobutamine
- dopamine
- doxycycline
- ertapenem
- famotidine
- fluconazole
- gentamicin
- hydrocortisone
- labetalol
- letermovir
- magnesium sulfate
- mannitol
- meropenem
- metoclopramide
- milrinone
- norepinephrine
- ondansetron
- pantoprazole
- phenylephrine
- piperacillin/tazobactam
- potassium chloride
- potassium phosphates
- sodium bicarbonate
- sodium phosphates
- tigecycline
- tobramycin
- vasopressin
Y-Site Incompatibility:
- amphotericin B deoxycholate
- amphotericin B liposomal
- digoxin
- esomeprazole
- furosemide
- levofloxacin
- micafungin

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of telavancin. If an appointment is missed, contact health care provider as soon as possible to reschedule. Advise patient to read Medication Guide before starting and periodically during therapy in case of changes.
Instruct the patient to notify health care provider if symptoms do not improve.
Advise patient to report signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools).
Instruct patient to notify health care provider if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care provider.
Inform patient that common side effects include taste disturbance, nausea, vomiting, headache, and foamy urine. Notify health care provider if difficulty breathing, chest pain, or palpitations occur.
Advise patients and family to call 911 and seek urgent treatment for signs and symptoms of infusion-related reactions or anaphylaxis (flushing; difficulty breathing; chest tightness; hives; rash; feeling light-headed; itching; swelling of the face, lips, tongue, or throat).
Instruct patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care provider before taking any new medications.
Rep:
May cause fetal harm. Advise women of reproductive potential to use effective contraception during therapy and for 2 days after last dose and to notify health care provider 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 men.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇