BLACK BOX WARNING
- fetal risk (women of childbearing potential require pregnancy test before use)
- nephrotoxicity risk — increased in patients with pre-existing renal disease, diabetes, heart failure, or concurrent nephrotoxins
telavancin
Brand: Vibativ
⚠ BBW Prototype: vancomycin
Drug Class: lipoglycopeptide antibiotic
Drug Family: antibiotic
Subclass: semisynthetic lipoglycopeptide
Organ Systems: infectious-disease
Mechanism of Action
Telavancin inhibits bacterial cell wall synthesis by binding to D-Ala-D-Ala peptidoglycan precursors (like vancomycin) and additionally disrupts bacterial membrane potential and permeability, providing dual bactericidal mechanism.
D-Ala-D-Ala peptidoglycan precursorsbacterial cell membrane
Indications
- complicated skin and skin structure infections (cSSSI) due to gram-positive organisms including MRSA
- hospital-acquired and ventilator-associated pneumonia due to susceptible S. aureus
Contraindications
- telavancin hypersensitivity
- pregnancy (fetal harm)
- concurrent use of unfractionated heparin sodium (IV) — interferes with aPTT assay
Adverse Effects
Common
- nausea
- vomiting
- foamy urine
- taste disturbance
Serious
- nephrotoxicity
- QTc prolongation
- Red Man Syndrome (infusion-related)
- fetal toxicity
- coagulopathy (falsely elevated PT/INR/aPTT due to assay interference)
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | widely distributed; low protein binding relative to other glycopeptides |
| Metabolism | minimal hepatic metabolism |
| Excretion | renal (76% unchanged) |
| Half-life | 8–9 hours |
| Onset | immediate (IV) |
| Peak | end of infusion |
| Duration | 24 hours (once-daily dosing) |
| Protein Binding | 93% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| drugs prolonging QTc | additive QTc prolongation | major |
| nephrotoxic agents (aminoglycosides, NSAIDs, loop diuretics) | additive nephrotoxicity | major |
| warfarin/heparin monitoring | telavancin artificially prolongs PT/INR/aPTT — draw labs before infusion | moderate |
Nursing Considerations
- Perform a serum pregnancy test before initiating therapy in women of reproductive age; document result — telavancin is teratogenic.
- Draw coagulation studies (PT/INR, aPTT) before the next dose rather than during or after infusion to avoid artifactually elevated results.
- Monitor renal function daily; reduce dose when CrCl drops; discontinue if SCr rises >50% from baseline.
- Administer over 60 minutes; infusion-related reactions (Red Man Syndrome-like) can occur; pre-medicate with antihistamines if history of infusion reactions.
Clinical Pearls
- Telavancin's lipophilic tail allows membrane insertion in addition to cell wall inhibition, providing dual bactericidal activity against gram-positive organisms including MRSA and heteroresistant vancomycin-intermediate S. aureus (hVISA).
- The drug artificially prolongs PT/aPTT by interfering with the phospholipid-dependent coagulation assay steps; this does NOT represent true anticoagulation and should not trigger unnecessary clinical intervention.
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.