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Telavancin: Drug information

Telavancin: Drug information
(For additional information see "Telavancin: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Moderate to severe renal impairment:

Patients with preexisting moderate to severe renal impairment (CrCl ≤50 mL/minute) who were treated with telavancin for hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia had increased mortality observed versus vancomycin. Use of telavancin in patients with preexisting moderate to severe renal impairment (CrCl ≤50 mL/minute) should be considered only when the anticipated benefit to the patient outweighs the potential risk.

Nephrotoxicity:

New-onset or worsening renal impairment has occurred. Monitor renal function in all patients.

Embryofetal toxicity:

May cause fetal harm. In animal reproduction studies, adverse developmental outcomes were observed in 3 animal species at clinically relevant doses. Verify pregnancy status in females of reproductive potential prior to initiating telavancin. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with telavancin and for 2 days after the final dose.

Brand Names: US
  • Vibativ
Brand Names: Canada
  • Vibativ [DSC]
Pharmacologic Category
  • Glycopeptide
Dosing: Adult

Note: Reserve for patients with or at risk for methicillin-resistant S. aureus (MRSA) infection who cannot receive preferred agents (Chuan 2016; IDSA [Liu 2011]; Rodvold 2014). In patients with CrCl ≤50 mL/minute, decreased efficacy and increased mortality were observed with skin and soft tissue infection and hospital-acquired/ventilator-associated pneumonia, respectively (manufacturer’s labeling).

Bloodstream infection

Bloodstream infection (alternative agent) (off-label use):

Pathogen-directed therapy for MRSA: IV: 10 mg/kg once daily (IDSA [Liu 2011]; Stryjewski 2014). No maximum dose is recommended by the manufacturer; however, based on limited pharmacokinetic data in patients with obesity, up to 1 g/day may be safely used (Bunnell 2018). Treat uncomplicated S. aureus bacteremia for ≥14 days from day of first negative blood culture, with longer courses warranted for endocarditis or metastatic sites of infection (IDSA [Mermel 2009]).

Pneumonia, hospital-acquired or ventilator-associated

Pneumonia, hospital-acquired or ventilator-associated (alternative agent) :

Note: In patients with CrCl ≤50 mL/minute, increased mortality was observed compared to vancomycin.

As a component of empiric therapy or pathogen-directed therapy for MRSA: IV: 10 mg/kg every 24 hours. No maximum dose recommended by the manufacturer; however, based on limited pharmacokinetic data in patients with obesity, up to 1 g/day may be safely used (Bunnell 2018). Duration of therapy varies based on disease severity and response to therapy; treatment is typically given for 7 days (IDSA/ATS [Kalil 2016]; Niederman 2019; Rubinstein 2011; Rubinstein 2014).

Skin and soft tissue infection

Skin and soft tissue infection (alternative agent):

Note: In patients with CrCl ≤50 mL/minute, decreased efficacy was observed compared to vancomycin.

IV: 10 mg/kg once daily (IDSA [Liu 2011]; Stryjewski 2012). No maximum dose recommended by the manufacturer; however, based on limited pharmacokinetic data in patients with obesity, up to 1 g/day may be safely used (Bunnell 2018). Total duration of therapy is ≥5 days (including oral step-down therapy); may extend up to 14 days depending on severity and clinical response (IDSA [Stevens 2014]; Spelman 2022).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

Note: Renal function may be estimated using the Cockcroft-Gault formula for dosage adjustment purposes. In patients with CrCl ≤50 mL/min, decreased efficacy and increased mortality were observed with skin and soft tissue infection and hospital-acquired/ventilator-associated pneumonia, respectively.

US labeling:

CrCl >50 mL/minute: No dosage adjustment necessary

CrCl 30 to 50 mL/minute: 7.5 mg/kg every 24 hours

CrCl 10 to <30 mL/minute: 10 mg/kg every 48 hours

CrCl <10 mL/minute: No dosage adjustment provided in manufacturer’s labeling (has not been studied).

ESRD and hemodialysis patients: No dosage adjustment provided in manufacturer’s labeling (has not been studied).

Canadian labeling:

CrCl >50 mL/minute: No dosage adjustment necessary

CrCl 30 to 50 mL/minute: 7.5 mg/kg every 24 hours

CrCl <30 mL/minute: Not recommended.

ESRD and hemodialysis patients: Not recommended.

Dosing: Hepatic Impairment: Adult

Mild-to-moderate hepatic impairment (Child-Pugh class A or B): No dosage adjustment necessary.

Severe hepatic impairment (Child-Pugh class C): No dosage adjustment provided in manufacturer's labeling (has not been studied).

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Central nervous system: Metallic taste (33%)

Gastrointestinal: Nausea (5% to 27%), vomiting (5% to 14%)

Renal: Increased serum creatinine (8% to 16%; ≥65 years of age: 11%; <65 years of age: 8%), foamy urine (13%)

1% to 10%:

Central nervous system: Dizziness (6%), infusion site pain (4%), rigors (4%)

Dermatologic: Pruritus (3% to 6%), skin rash (4%), localized erythema (3%)

Gastrointestinal: Diarrhea (7%), decreased appetite (3%), abdominal pain (2%)

Local: Infusion site reaction (3%)

Renal: Renal insufficiency (3%; ≥65 years of age: 9%; <65 years of age: 2%), acute renal failure (5%)

<1%, postmarketing, and/or case reports: Clostridioides difficile-associated diarrhea, flushing, hypersensitivity reaction (including anaphylaxis), nephrotoxicity, prolonged QT interval on ECG, transient flushing of upper body, urticaria

Contraindications

Hypersensitivity to telavancin or any component of the formulation; concomitant use of intravenous unfractionated heparin

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylaxis/hypersensitivity reactions: Serious hypersensitivity reactions, including anaphylaxis, have been reported after first or subsequent doses; some have been fatal. Discontinue if hypersensitivity or rash occurs. Telavancin is a semisynthetic derivative of vancomycin; cross-reactivity rates are unknown. Use with caution in patients with known vancomycin hypersensitivity.

• Cardiac conduction alteration: May prolong QTc interval; avoid use in patients with congenital long QT syndrome, known QTc prolongation, uncompensated heart failure, or severe left ventricular hypertrophy (were excluded from studies); use with caution in patients with concurrent administration of other medications known to prolong the QT interval. Clinical studies indicate mean maximal QTc prolongation of 12 to 15 msec at the end of 10 mg/kg infusion.

• Infusion reactions: Rapid IV administration may result in flushing, rash, urticaria, and/or pruritus; slowing or stopping the infusion may alleviate these symptoms.

• Nephrotoxicity: [US Boxed Warning]: New onset or worsening renal impairment has occurred. Monitor renal function prior to, during (at least every 48 to 72 hours; more frequently if indicated), and following therapy in all patients. Usual risk factors include concomitant nephrotoxic medications or baseline comorbidities associated with decreased renal function (eg baseline renal dysfunction, diabetes, hypertension, or heart failure). Contains solubilizer cyclodextrin (hydroxypropyl-beta-cyclodextrin) which may accumulate in patients with renal dysfunction, although the clinical significance of this finding is uncertain (Luke 2010).

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns:

• Renal impairment: [US Boxed Warning]: In clinical studies, patients with pre-existing moderate-to-severe renal impairment (CrCl ≤50 mL/minute) treated for hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP) had increased (all cause) mortality versus vancomycin. Use in HABP/VABP only when benefit outweighs risk. In patients with complicated skin and skin structure infections, efficacy may be reduced in patients with a baseline CrCl ≤50 mL/minute.

Special populations:

• Older adult: Lower doses are often required secondary to age-related decreases in renal function.

• Pregnancy: [US Boxed Warning]: Based on animal data, may cause fetal harm. Prior to initiating telavancin, verify pregnancy status in females of reproductive potential. Advise pregnant females of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with telavancin and for 2 days after the final dose.

Other warnings/precautions:

• Coagulation tests: May interfere with tests used to monitor coagulation (eg, prothrombin time, INR, activated partial thromboplastin time, activated clotting time, coagulation based factor Xa tests) when samples drawn ≤18 hours after drug administration. Blood samples should be collected as close to the next dose of telavancin as possible or a non-phospholipid dependent coagulation test (eg, bleeding time, factor Xa [chromogenic assay], platelet aggregation study, thrombin time) should be used. Consider selecting an alternative anticoagulant not requiring aPTT monitoring; concomitant use of telavancin with IV unfractionated heparin is contraindicated.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution Reconstituted, Intravenous:

Vibativ: 750 mg (1 ea)

Solution Reconstituted, Intravenous [preservative free]:

Vibativ: 750 mg (1 ea [DSC])

Generic Equivalent Available: US

No

Pricing: US

Solution (reconstituted) (Vibativ Intravenous)

750 mg (per each): $766.29

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution Reconstituted, Intravenous:

Vibativ: 750 mg ([DSC])

Administration: Adult

IV: Administer IV over 60 minutes. Other medications should not be infused simultaneously through the same IV line. When the same intravenous line is used for sequential infusion of other medications, flush line with D5W, LR, or NS before and after infusing telavancin.

An infusion reaction (eg, hypotension, maculopapular rash appearing on the face, neck, trunk, and/or upper extremities) may occur if the infusion is too rapid; it is not an allergic reaction. If this should occur, discontinuing or slowing the infusion rate may eliminate these reactions.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and at https://www.fda.gov/media/77801/download, must be dispensed with this medication.

Use: Labeled Indications

Hospital-acquired and ventilator-associated bacterial pneumonia: Treatment of hospital-acquired and ventilator-associated bacterial pneumonia caused by susceptible isolates of Staphylococcus aureus when alternative treatments are not appropriate.

S kin and soft tissue infections: Treatment of complicated skin and soft tissue infections caused by susceptible gram-positive organisms including methicillin-susceptible or -resistant S. aureus, vancomycin-susceptible Enterococcus faecalis, and Streptococcus pyogenes, Streptococcus agalactiae, or Streptococcus anginosus group.

Use: Off-Label: Adult

Bloodstream infection

Medication Safety Issues
Sound-alike/look-alike issues:

Telavancin may be confused with telithromycin

Vibativ may be confused with Viactiv, Vibramycin, vigabatrin

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Anticoagulants: Telavancin may diminish the therapeutic effect of Anticoagulants. Specifically, telavancin may artificially increase the results of laboratory tests commonly used to monitor anticoagulant effectiveness, which could lead to incorrect decisions to decrease anticoagulant doses. Risk C: Monitor therapy

Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination

Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination

Haloperidol: QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of Haloperidol. Risk C: Monitor therapy

Heparin: Telavancin may diminish the therapeutic effect of Heparin. Specifically, telavancin may artificially increase the results of laboratory tests commonly used to monitor IV heparin effectiveness, which could lead to incorrect decisions to decrease heparin doses. Risk X: Avoid combination

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

QT-prolonging Agents (Highest Risk): QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Reproductive Considerations

[US Boxed Warning]: Verify pregnancy status in females of reproductive potential prior to initiating telavancin. Advise females of reproductive potential to use effective contraception during treatment with telavancin and for 2 days after the final dose.

Pregnancy Considerations

Telavancin crosses the placenta (Nanovskaya 2012). [US Boxed Warning]: Telavancin may cause fetal harm. In animal reproduction studies, adverse developmental outcomes were observed in 3 animal species at clinically relevant doses. Advise pregnant women of the potential risk to a fetus.

Data collection to monitor pregnancy and infant outcomes following exposure to telavancin is ongoing. Health care providers are encouraged to enroll females exposed to telavancin during pregnancy in the Vibativ Pregnancy Registry (1-877-484-2700). Pregnant females may also enroll themselves.

Breastfeeding Considerations

It is not known if telavancin is present in breast milk.

According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.

Monitoring Parameters

Renal function (prior to start, every 48 to 72 hours; more frequently if indicated, and following therapy). Evaluate pregnancy status prior to use in females of reproductive potential.

Mechanism of Action

Exerts concentration-dependent bactericidal activity; inhibits bacterial cell wall synthesis by blocking polymerization and cross-linking of peptidoglycan by binding to D-Ala-D-Ala portion of cell wall. Unlike vancomycin, additional mechanism involves disruption of membrane potential and changes cell permeability due to presence of lipophilic side chain moiety.

Pharmacokinetics (Adult Data Unless Noted)

Distribution: Vss: 0.13 L/kg

Protein binding: ~90%; primarily to albumin

Half-life elimination: 6.6 to 9.6 hours

Excretion: Urine (~76%); feces (<1%)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: The mean AUC values were approximately 13%, 29%, and 118% higher for subjects with CrCl >50 to 80 mL/minute, CrCl 30 to 50 mL/minute, and CrCl ≤30 mL/minute, respectively when compared with subjects with healthy renal function.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (DE) Germany: Vibativ;
  • (GB) United Kingdom: Vibativ;
  • (PT) Portugal: Vibativ;
  • (RO) Romania: Vibativ;
  • (RU) Russian Federation: Vibativ
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  2. Chuan J, Zhang Y, He X, et al. Systematic review and meta-analysis of the efficacy and safety of telavancin for treatment of infectious disease: are we clearer? Front Pharmacol. 2016;7:330. doi:10.3389/fphar.2016.00330 [PubMed 27721793]
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  6. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1-45. doi:10.1086/599376 [PubMed 19489710]
  7. Nanovskaya T, Patrikeeva S, Zhan Y, et al. Transplacental Transfer of Vancomycin and Telavancin. Am J Obstet Gynecol. 2012;207(4):331.e1-e6. [PubMed 22867688]
  8. Niederman MS, Lee PC, Barriere SL, Barnes CN, Castaneda-Ruiz B. Telavancin in hospital-acquired and ventilator-associated pneumonia (HAP/VAP) caused by Staphylococcus aureus: post hoc analysis of 2 randomized, controlled trials. Infect Dis Ther. 2019;8(3):445-452. doi:10.1007/s40121-019-0255-0 [PubMed 31372837]
  9. Rodvold KA, McConeghy KW. Methicillin-resistant Staphylococcus aureus therapy: past, present, and future. Clin Infect Dis. 2014;58(suppl 1):S20-S27. doi:10.1093/cid/cit614 [PubMed 24343828]
  10. Rubinstein E, Lalani T, Corey GR, et al. Telavancin versus vancomycin for hospital-acquired pneumonia due to gram-positive pathogens. Clin Infect Dis. 2011;52(1):31-40. doi:10.1093/cid/ciq031 [PubMed 21148517]
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  19. Vibativ (telavancin) [prescribing information]. Nashville, TN: Cumberland Pharmaceuticals Inc; December 2020.
  20. Vibativ (telavancin) [product monograph]. Montreal, Quebec, Canada: Pendopharm, Division of Pharmascience Inc; February 2018.
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