For additional guidance, please review data available through the International Journal of Pharmaceutical Compounding: Direct quote: "The best method of addressing the p H of vancomycin is that of infusing the drug through a catheter with a tip location in a vessel that will allow for adequate hemodilution. Patients with Impaired Renal Function and Elderly Patients Dosage adjustment must be made in patients with impaired renal function.
If ideal venous access is not possible, routine rotation of the site and informing the patient of the signs and symptoms of phlebitis are important in preventing morbidity." Kastango, ES, Hadaway, L. In premature infants and the elderly, greater dosage reductions than expected may be necessary because of decreased renal function.
* A peripheral IV site should be monitored for pain, redness or swelling prior to initiating the infusion and every 30 minutes until the completion of the infusion.
Reconstituted solutions containing 1 g must be diluted with at least 200 m L of diluent.
The desired dose, diluted in this manner, should be administered by intermittent intravenous infusion over a period of at least 60 minutes.
PREPARATION AND STABILITY At the time of use, reconstitute by adding either 10 m L of Sterile Water for Injection to the 500-mg vial or 20 m L of Sterile Water for Injection to the 1-g vial of dry, sterile vancomycin powder. After reconstitution with Sterile Water for Injection, 5% Dextrose Injection, or 0.9% Sodium Chloride Injection, the vials may be stored in a refrigerator for 14 days without significant loss of potency.
Reconstituted solutions containing 500 mg of vancomycin must be diluted with at least 100 m L of diluent.
It is recommended to adequately flush the intravenous linesbetween the administration of these antibiotics.
It is also recommended to dilute solutions of vancomycin to 5 mg/m L or less.
The dose required to maintain stable concentrations is 1.9 mg/kg/24 h.
In patients with marked renal impairment, it may be more convenient to give maintenance doses of 250 to 1000 mg once every several days rather than administering the drug on a daily basis.
Compatibility with Other Drugs and Intravenous Fluids Solutions that are diluted with 5% Dextrose Injection or 0.9% Sodium Chloride Injection may be stored in a refrigerator for 14 days without significant loss of potency.
Solutions that are diluted with the following infusion fluids may be stored in a refrigerator for 96 hours: 5% Dextrose Injection, USP 5% Dextrose and 0.9% Sodium Chloride Injection, USP Lactated Ringer’s Injection, USP Lactated Ringer’s and 5% Dextrose Injection, USP Normosol®-M and 5% Dextrose ISOLYTE® E Vancomycin solution has a low p H and may cause chemical or physical instability when it is mixed with other compounds.
Concentration less than or equal to 5 mg/ml [0 to 500 mg] [100 ml] [ 30 minutes ] [501-1250 mg] [250 ml] [ 60 minutes ] [1251-1750mg] [500ml] [ ≥ 90 minutes ] [1751-2250mg] [500 ml] [ ≥120 minutes ](Concentration less than or equal to 2.5 mg/ml ) [Amount of drug] [Infusion volume] [Infusion rate] [0 to 250 mg] [100 ml] [30 minutes] [251 - 625 mg] [250 ml] [60 minutes] [626 - 1250mg] [500ml] [≥ 90 minutes ]Minimum Dilutions - Monitor for infusion related reactions [500-1000mg] [100ml] [60 minutes ]* [1001-1500mg] [150ml] [60 - 90 minutes - slower rate for upper range ]* [1251-1750mg] [250ml] [≥ 90 minutes ]* [1751-2250mg] [250 ml] [≥ 120 minutes ]* *Consider central line Premixed bags: Vancomycin Injection, USP is supplied as a frozen, iso-osmotic, premixed solution in a 100 m L or 200 m L single dose GALAXY plastic container in the following vancomycin-equivalent dose: Solution: Iso-osmotic [500 mg ] [100 m L] [ 30 minutes] [1000 mg ] [200 m L] [ 60 minutes] Additional support / Important points: Package Insert Data: Thrombophlebitis may occur, the frequency and severity of which can be minimized by administering the medicine slowly as a dilute solution (2.5 to 5 mg/ml) and by rotating the sites of infusion.