Excreted Unchanged %
90-100
Half-Life (Normalesrd) Hours
4-6/200-250
Plasma Protein Binding %
52-60
Volume Of Distribution L/Kg
0.47-1.1
Dose For Normal Renal Function
500 mg-1.25 g q12h
Adjustment For Renal Failure Method
D, I
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
1 g q12-24h [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
1 gq24-96h [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
1 g q4-7d [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: Dose for GFR <10
Supplement For Dialysis [Recommendation Level]: Pd
PD: Dose for GFR <10
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50, [A]
References
Barth RH, DeVincenzo N. Use of vancomycin in high-flux hemodialysis: experience with 130 courses of therapy. Kidney Int. 1996; 50: 929-36. [PMID: 8872968] / Boereboom FT, Ververs FF, Blankestijn PJ, Savelkoul TJ, van Dijk A. Vancomycin clearance during continuous venovenous haemofiltration in critically ill patients. Intensive Care Med. 1999; 25: 1100-4. [PMID: 10551965] / Brown DL, Mauro LS. Vancomycin dosing chart for use in patients with renal impairment. Am J Kidney Dis. 1988; 11: 15-9. [PMID: 3337096] / Cutler NR, Narang PK, Lesko LJ, Ninos M, Power M. Vancomycin disposition: the importance of age. Clin Pharmacol Ther. 1984; 36: 803-10. [PMID: 6499360] / Davies SP, Azadian BS, Kox WJ, Brown EA. Pharmacokinetics of ciprofloxacin and vancomycin in patients with acute renal failure treated by continuous haemodialysis. Nephrol Dial Transplant. 1992; 7: 848-54. [PMID: 1325620] / DeSoi CA, Sahm DF, Umans JG. Vancomycin elimination during high-flux hemodialysis: kinetic model and comparison of four membranes. Am J Kidney Dis. 1992; 20: 354-60. [PMID: 1415203] / Golper TA, Noonan HM, Elzinga L, Gilbert D, Brummett R, Anderson JL, et al. Vancomycin pharmacokinetics, renal handling, and nonrenal clearances in normal human subjects. Clin Pharmacol Ther. 1988; 43: 565-70. [PMID: 3365918] / Joy MS, Matzke GR, Frye RF, Palevsky PM. Determinants of vancomycin clearance by continuous venovenous hemofiltration and continuous venovenous hemodialysis. Am J Kidney Dis. 1998; 31: 1019-27. [PMID: 9631848] / Magera BE, Arroyo JC, Rosansky SJ, Postic B. Vancomycin pharmacokinetics in patients with peritonitis on peritoneal dialysis. Antimicrob Agents Chemother. 1983; 23: 710-4. [PMID: 6870220] / Moellering RC Jr, Krogstad DJ, Greenblatt DJ. Vancomycin therapy in patients with impaired renal function: a nomogram for dosage. Ann Intern Med. 1981; 94: 343-6. [PMID: 6101256] / Touchette MA, Patel RV, Anandan JV, Dumler F, Zarowitz BJ. Vancomycin removal by high-flux polysulfone hemodialysis membranes in critically ill patients with end-stage renal disease. Am J Kidney Dis. 1995; 26: 469-74. [PMID: 7645555]
Toxicity Notes
In patients with renal failure, vancomycin serum concentrations may be overestimated by fluorescence polarization immunoassay (FPIA) and radioimmunoassay (RIA) testing methods due to interference from the biologically inactive vancomycin breakdown product, crystalline degradation product (CDP-1). The monoclonal enzyme multiplied immunoassay technique (EMIT) is not affected by CDP-1 accumulation.