ORBACTIV

Glycopeptide Antibiotics

Injectable Administration

NOTE: The 2 distinct formulations of oritavancin, Orbactiv and Kimyrsa, have different reconstitution, storage, and administration requirements.
Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.

Intravenous Administration

Orbactiv:
Reconstitution
Reconstitute each 400 mg vial with 40 mL Sterile Water for Injection. A single dose requires 3 vials.
To avoid foaming, gently swirl each vial until the contents are dissolved.
Storage: The combined storage (reconstituted solution in the vial and dilution in the bag) and 3-hour infusion time should not exceed 6 hours at room temperature or 12 hours if refrigerated.
 
Dilution
Withdraw and discard 120 mL from a 1,000 mL bag of 5% Dextrose Injection.
Transfer 40 mL of solution from each of the 3 reconstituted vials to the 5% Dextrose Injection bag to yield a final concentration of 1.2 mg/mL. Discard any unused portion of the reconstituted solution.
Storage: Refrigerate at 2 to 8 degrees C (36 to 46 degrees F) or store at room temperature. The combined storage (reconstituted solution in the vial and dilution in the bag) and 3-hour infusion time should not exceed 6 hours at room temperature or 12 hours if refrigerated.
 
Intermittent IV infusion
Infuse over 3 hours.
Do not infuse with other medications or electrolytes.
Saline-based infusion solutions may cause precipitation and MUST not be used.
If a common IV line is being used to administer other medications, flush the line with 5% Dextrose Injection before and after each oritavancin dose.
 
Kimyrsa:
Reconstitution
Reconstitute each 1,200 mg vial with 40 mL Sterile Water for Injection.
To avoid foaming, gently swirl each vial until the contents are dissolved.
Storage: The combined storage time (reconstituted solution in the vial and dilution in the bag) and 1-hour infusion time should not exceed 4 hours at room temperature or 12 hours if refrigerated.
 
Dilution
Withdraw and discard 40 mL from a 250 mL bag of 0.9% Sodium Chloride Injection or 5% Dextrose Injection.
Transfer 40 mL of the reconstituted solution to the 0.9% Sodium Chloride Injection or 5% Dextrose Injection bag to yield a final concentration of 4.8 mg/mL. Discard any unused portion of the reconstituted solution.
Storage: Refrigerate at 2 to 8 degrees C (36 to 46 degrees F) or store at room temperature. The combined storage time (reconstituted solution in the vial and dilution in the bag) and 1-hour infusion time should not exceed 4 hours at room temperature or 12 hours if refrigerated.
 
Intermittent IV infusion
Infuse over 1 hour.
If a common IV line is being used to administer other medications, flush the line with 0.9% Sodium Chloride Injection or 5% Dextrose Injection before and after each oritavancin dose.

Severe

vasculitis / Delayed / 0-1.5
erythema multiforme / Delayed / 0-1.5
bronchospasm / Rapid / 0-1.5
angioedema / Rapid / 0-1.5
C. difficile-associated diarrhea / Delayed / Incidence not known

Moderate

elevated hepatic enzymes / Delayed / 1.8-2.8
phlebitis / Rapid / 2.5-2.5
sinus tachycardia / Rapid / 2.5-2.5
infusion-related reactions / Rapid / 1.9-1.9
peripheral edema / Delayed / 0-1.5
erythema / Early / 0-1.5
wheezing / Rapid / 0-1.5
hyperuricemia / Delayed / 0-1.5
hyperbilirubinemia / Delayed / 0-1.5
hypoglycemia / Early / 0-1.5
eosinophilia / Delayed / 0-1.5
anemia / Delayed / 0-1.5
synovitis / Delayed / 0-1.5
osteomyelitis / Delayed / 0.3-0.3
chest pain (unspecified) / Early / Incidence not known
vancomycin infusion reaction / Rapid / Incidence not known
superinfection / Delayed / Incidence not known
pseudomembranous colitis / Delayed / Incidence not known
antibody formation / Delayed / Incidence not known

Mild

nausea / Early / 9.9-9.9
headache / Early / 7.1-7.1
vomiting / Early / 4.6-4.6
infection / Delayed / 0.3-3.8
diarrhea / Early / 3.7-3.7
dizziness / Early / 2.7-2.7
rash / Early / 0-1.5
urticaria / Rapid / 0-1.5
myalgia / Early / 0-1.5
chills / Rapid / 2.0
pruritus / Rapid / 2.0
fever / Early / 2.0
tremor / Early / Incidence not known
back pain / Delayed / Incidence not known
flushing / Rapid / Incidence not known

Kimyrsa, ORBACTIV

Rx

Second-generation glycopeptide antibiotic for acute bacterial skin and skin structure infections (ABSSSI) caused by certain susceptible bacteria like Staphylococcus aureus (including methicillin-resistant strains), Streptococcus species, and Enterococcus faecalis
As effective as vancomycin for the treatment of ABSSSI
Falsely elevates aPTT thus intravenous unfractionated heparin is contraindicated for 48 hours after administration

For the treatment of acute bacterial skin and skin structure infections (ABSSSI). Intravenous dosage Adults

1,200 mg IV as a single dose.

Hepatic Impairment

No dosage adjustment is needed for patients with mild to moderate hepatic impairment (Child-Pugh Class A or B). Use with caution in patients with severe hepatic impairment (Child-Pugh Class C) as no data are available to determine the appropriate dosing in these patients.

Renal Impairment

No dosage adjustment is needed for patients with mild to moderate renal impairment (CrCl 30 to 79 mL/minute). Exercise caution in patients with severe renal impairment (CrCl less than 30 mL/minute) as no data are available to determine the appropriate dosing in these patients. The solubilizer HP-beta-CD used in the Kimyrsa product is excreted in the urine and clearance may be reduced in patients with renal impairment; however, the clinical significance of this finding is unknown.
 
Intermittent hemodialysis
Oritavancin is not removed by hemodialysis.

Abacavir; Dolutegravir; Lamivudine: (Moderate) Dolutegravir plasma concentrations may be reduced when administered concurrently with oritavancin; thereby increasing the risk for HIV treatment failures or the development of viral-resistance. Data are insufficient to make dosing recommendations; however, predictions regarding this interaction can be made based on the drugs metabolic pathways. Dolutegravir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer.
Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Diphenhydramine is metabolized by CYP2C9, CYP2C19 and CYP2D6; oritavancin is a weak inducer of CYP2D6 and a weak CYP2C9 and CYP2C19 inhibitor. Coadministration may result in altered diphenhydramine plasma concentrations. If these drugs are administered concurrently, monitor for diphenydramine toxicity, such as drowsiness, or decreased effectiveness.
Acetaminophen; Caffeine; Dihydrocodeine: (Moderate) Concomitant use of dihydrocodeine with oritavancin can decrease dihydrocodeine levels, resulting in less metabolism by CYP2D6 and decreased dihydromorphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. If coadministration is necessary, monitor for reduced efficacy of dihydrocodeine and signs of opioid withdrawal; consider increasing the dose of dihydrocodeine as needed. If oritavancin is discontinued, consider a dose reduction of dihydrocodeine and frequently monitor for signs or respiratory depression and sedation. Oritavancin is a weak inducer of CYP3A4, an isoenzyme partially responsible for the metabolism of dihydrocodeine.
Acetaminophen; Chlorpheniramine: (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently.
Acetaminophen; Chlorpheniramine; Dextromethorphan: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently. (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently. (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently. (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently.
Acetaminophen; Chlorpheniramine; Phenylephrine : (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently.
Acetaminophen; Codeine: (Moderate) Codeine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of codeine may be reduced if these drugs are administered concurrently.
Acetaminophen; Dextromethorphan: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Acetaminophen; Dextromethorphan; Doxylamine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Acetaminophen; Dextromethorphan; Phenylephrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Acetaminophen; Dextromethorphan; Pseudoephedrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Acetaminophen; Diphenhydramine: (Moderate) Diphenhydramine is metabolized by CYP2C9, CYP2C19 and CYP2D6; oritavancin is a weak inducer of CYP2D6 and a weak CYP2C9 and CYP2C19 inhibitor. Coadministration may result in altered diphenhydramine plasma concentrations. If these drugs are administered concurrently, monitor for diphenydramine toxicity, such as drowsiness, or decreased effectiveness.
Acetaminophen; Hydrocodone: (Moderate) Monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of hydrocodone as needed. If oritavancin is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Acetaminophen; Ibuprofen: (Moderate) Ibuprofen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated ibuprofen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Acetaminophen; Oxycodone: (Moderate) Monitor for reduced efficacy of oxycodone and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of oxycodone as needed. If oritavancin is discontinued, consider a dose reduction of oxycodone and frequently monitor for signs of respiratory depression and sedation. Oxycodone is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease oxycodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Albuterol; Budesonide: (Minor) Budesonide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of oral budesonide may be reduced if these drugs are administered concurrently.
Alfentanil: (Moderate) Alfentanil is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of alfentanil may be reduced if these drugs are administered concurrently.
Alfuzosin: (Moderate) Alfuzosin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of alfuzosin may be reduced if these drugs are administered concurrently.
Amiodarone: (Moderate) Amiodarone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amiodarone may be reduced if these drugs are administered concurrently.
Amitriptyline: (Moderate) Coadministration of oritavancin and amitriptyline may result in increases or decreases in amitriptyline exposure and may increase side effects or decrease efficacy of amitriptyline. Amitriptyline is metabolized by CYP3A4, CYP2D6, CYP2C19, and CYP2C9. Oritavancin weakly induces CYP3A4 and CYP2D6, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Amlodipine: (Moderate) Amlodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amlodipine may be reduced if these drugs are administered concurrently.
Amlodipine; Atorvastatin: (Moderate) Amlodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amlodipine may be reduced if these drugs are administered concurrently. (Moderate) Atorvastatin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of atorvastatin may be reduced if these drugs are administered concurrently.
Amlodipine; Benazepril: (Moderate) Amlodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amlodipine may be reduced if these drugs are administered concurrently.
Amlodipine; Celecoxib: (Moderate) Amlodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amlodipine may be reduced if these drugs are administered concurrently. (Moderate) Celecoxib is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated celecoxib plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of celecoxib toxicity, such as dizziness, stomach upset, or nausea.
Amlodipine; Olmesartan: (Moderate) Amlodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amlodipine may be reduced if these drugs are administered concurrently.
Amlodipine; Valsartan: (Moderate) Amlodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amlodipine may be reduced if these drugs are administered concurrently. (Moderate) Valsartan is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated valsartan plasma concentrations. If these drugs are administered concurrently, blood pressure should be monitored closely.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Amlodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amlodipine may be reduced if these drugs are administered concurrently. (Moderate) Valsartan is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated valsartan plasma concentrations. If these drugs are administered concurrently, blood pressure should be monitored closely.
Amoxicillin; Clarithromycin; Omeprazole: (Moderate) Administration of oritavancin, a weak inhibitor of CYP2C19, with omeprazole resulted in a 15% increase in the ratio of omeprazole to 5-OH-omeprazole concentrations in the plasma. Monitor patients for omeprazole toxicities, such as headache or gastrointestinal distress, if these drugs are administered concurrently. (Moderate) Clarithromycin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of clarithromycin may be reduced if these drugs are administered concurrently.
Apixaban: (Moderate) Coadministration of oritavancin and apixaban may result in increases or decreases in apixaban exposure and may increase side effects or decrease efficacy of apixaban. Apixaban is primarily metabolized by CYP3A4, but is also metabolized by CYP2C19 and CYP2C9. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19 and CYP2C9. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Aprepitant, Fosaprepitant: (Moderate) Coadministration of oritavancin and aprepitant, fosaprepitant may result in increases or decreases in aprepitant exposure and may increase side effects or decrease efficacy of aprepitant. After administration, fosaprepitant is rapidly converted to aprepitant, which is metabolized by CYP3A4 and CYP2C19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Aripiprazole: (Moderate) Aripiprazole is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of aripiprazole may be reduced if these drugs are administered concurrently. An increase in aripiprazole dosage may be clinically warranted in some patients. Avoid concurrent use of Abilify Maintena with a CYP3A4 inducer when the combined treatment period exceeds 14 days because aripiprazole blood concentrations decline and may become suboptimal. There are no dosing recommendations for Aristada or Aristada Initio during use of a mild to moderate CYP3A4 and CYP2D6 inducer.
Artemether; Lumefantrine: (Moderate) Coadministration may decrease the exposure and potential efficacy of lumefantrine. Lumefantrine is metabolized by CYP3A4. Oritavancin weakly induces CYP3A4. If these drugs are administered concurrently, monitor the patient for signs of lack of efficacy. (Moderate) Coadministration of oritavancin and artemether; lumefantrine may result in increases or decreases in artemether exposure and may increase side effects or decrease efficacy of artemether. Artemether is primarily metabolized by CYP3A4/5, but is also metabolized by CYP2C19 and CYP2C9. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19 and CYP2C9. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Asenapine: (Moderate) Asenapine is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of asenapine may be reduced if these drugs are administered concurrently.
Aspirin, ASA; Carisoprodol: (Moderate) Carisoprodol is metabolized by CYP2C19; oritavancin is a weak CYP2C19 inhibitor. Coadministration may result in elevated carisoprodol plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of carisoprodol toxicity, such as extreme drowsiness, confusion, or a slowed rate of breathing.
Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Carisoprodol is metabolized by CYP2C19; oritavancin is a weak CYP2C19 inhibitor. Coadministration may result in elevated carisoprodol plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of carisoprodol toxicity, such as extreme drowsiness, confusion, or a slowed rate of breathing. (Moderate) Codeine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of codeine may be reduced if these drugs are administered concurrently.
Aspirin, ASA; Omeprazole: (Moderate) Administration of oritavancin, a weak inhibitor of CYP2C19, with omeprazole resulted in a 15% increase in the ratio of omeprazole to 5-OH-omeprazole concentrations in the plasma. Monitor patients for omeprazole toxicities, such as headache or gastrointestinal distress, if these drugs are administered concurrently.
Aspirin, ASA; Oxycodone: (Moderate) Monitor for reduced efficacy of oxycodone and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of oxycodone as needed. If oritavancin is discontinued, consider a dose reduction of oxycodone and frequently monitor for signs of respiratory depression and sedation. Oxycodone is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease oxycodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Atazanavir: (Major) Atazanavir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of atazanavir may be reduced if these drugs are administered concurrently.
Atazanavir; Cobicistat: (Major) Atazanavir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of atazanavir may be reduced if these drugs are administered concurrently. (Major) Plasma concentrations and efficacy of cobicistat and/or the drugs that are boosted by cobicistat may be reduced if these drugs are administered concurrently with oritavancin. Cobicistat is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Cobicistat is a CYP3A4 inhibitor indicated to increase systemic exposure of other antiretrovirals.
Atogepant: (Major) Avoid use of atogepant and oritavancin when atogepant is used for chronic migraine. Use an atogepant dose of 30 or 60 mg PO once daily for episodic migraine if coadministered with oritavancin. Concurrent use may decrease atogepant exposure and reduce efficacy. Atogepant is a CYP3A substrate and oritavancin is a weak CYP3A inducer. Coadministration with a weak CYP3A inducer resulted in a 25% reduction in atogepant overall exposure and a 24% reduction in atogepant peak concentration.
Atomoxetine: (Moderate) Atomoxetine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of atomoxetine may be reduced if these drugs are administered concurrently.
Atorvastatin: (Moderate) Atorvastatin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of atorvastatin may be reduced if these drugs are administered concurrently.
Atorvastatin; Ezetimibe: (Moderate) Atorvastatin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of atorvastatin may be reduced if these drugs are administered concurrently.
Atovaquone; Proguanil: (Moderate) Proguanil is metabolized by CYP2C19; oritavancin is a weak CYP2C19 inhibitor. Coadministration may result in elevated proguanil plasma concentrations. If oritavancin and atovaquone; proguanil are administered concurrently, monitor patients for atovaquone; proguanil toxicity such as stomach pain, nausea, vomiting, or diarrhea.
Azilsartan: (Moderate) Azilsartan is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated azilsartan plasma concentrations; however, no clinically relevant drug interactions were observed when azilsartan was given in combination with fluconazole, a potent CYP2C9 inhibitor. If these drugs are administered concurrently, blood pressure should be monitored closely.
Azilsartan; Chlorthalidone: (Moderate) Azilsartan is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated azilsartan plasma concentrations; however, no clinically relevant drug interactions were observed when azilsartan was given in combination with fluconazole, a potent CYP2C9 inhibitor. If these drugs are administered concurrently, blood pressure should be monitored closely.
Belzutifan: (Moderate) Monitor for anemia and hypoxia if concomitant use of oritavancin with belzutifan is necessary due to increased plasma exposure of belzutifan which may increase the incidence and severity of adverse reactions. Reduce the dose of belzutifan as recommended if anemia or hypoxia occur. Belzutifan is a CYP2C19 substrate and oritavancin is a CYP2C19 inhibitor.
Benzhydrocodone; Acetaminophen: (Moderate) Concurrent use of benzhydrocodone with oritavancin may decrease hydrocodone plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to opioid agonists. If concomitant use is necessary, consider increasing the benzhydrocodone dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal. Discontinuation of oritavancin may increase the risk of increased opioid-related adverse reactions, such as fatal respiratory depression. If oritavancin is discontinued, consider a benzhydrocodone dosage reduction and monitor patients for respiratory depression and sedation at frequent intervals. Benzhydrocodone is a prodrug of hydrocodone. Oritavancin is a weak inducer of CYP3A4, an isoenzyme partially responsible for the metabolism of hydrocodone.
Bortezomib: (Moderate) Bortezomib is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of bortezomib may be reduced if these drugs are administered concurrently.
Bosentan: (Moderate) Coadministration of oritavancin and bosentan may result in increases or decreases in bosentan exposure and may increase side effects or decrease efficacy of bosentan. Bosentan is metabolized by CYP3A4 and CYP2C9. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Brimonidine; Timolol: (Moderate) Timolol is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of timolol may be reduced if these drugs are administered concurrently.
Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Brompheniramine; Pseudoephedrine; Dextromethorphan: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Budesonide: (Minor) Budesonide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of oral budesonide may be reduced if these drugs are administered concurrently.
Budesonide; Formoterol: (Minor) Budesonide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of oral budesonide may be reduced if these drugs are administered concurrently.
Budesonide; Glycopyrrolate; Formoterol: (Minor) Budesonide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of oral budesonide may be reduced if these drugs are administered concurrently.
Bupivacaine Liposomal: (Minor) Bupivacaine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of bupivacaine may be reduced if these drugs are administered concurrently.
Bupivacaine: (Minor) Bupivacaine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of bupivacaine may be reduced if these drugs are administered concurrently.
Bupivacaine; Epinephrine: (Minor) Bupivacaine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of bupivacaine may be reduced if these drugs are administered concurrently.
Bupivacaine; Lidocaine: (Moderate) Lidocaine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of lidocaine may be reduced if these drugs are administered concurrently. (Minor) Bupivacaine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of bupivacaine may be reduced if these drugs are administered concurrently.
Bupivacaine; Meloxicam: (Moderate) Consider a meloxicam dose reduction and monitor for adverse reactions if coadministration with oritavancin is necessary. Concurrent use may increase meloxicam exposure. Meloxicam is a CYP2C9 substrate and oritavancin is a weak CYP2C9 inhibitor. (Minor) Bupivacaine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of bupivacaine may be reduced if these drugs are administered concurrently.
Buprenorphine: (Moderate) Buprenorphine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of buprenorphine may be reduced if these drugs are administered concurrently.
Buprenorphine; Naloxone: (Moderate) Buprenorphine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of buprenorphine may be reduced if these drugs are administered concurrently.
Buspirone: (Moderate) Buspirone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of buspirone may be reduced if these drugs are administered concurrently.
Butalbital; Acetaminophen; Caffeine; Codeine: (Moderate) Codeine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of codeine may be reduced if these drugs are administered concurrently.
Butalbital; Aspirin; Caffeine; Codeine: (Moderate) Codeine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of codeine may be reduced if these drugs are administered concurrently.
Cabotegravir; Rilpivirine: (Major) Rilpivirine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of rilpivirine may be reduced if these drugs are administered concurrently.
Candesartan: (Moderate) Candesartan is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated candesartan plasma concentrations. If these drugs are administered concurrently, blood pressure should be monitored closely.
Candesartan; Hydrochlorothiazide, HCTZ: (Moderate) Candesartan is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated candesartan plasma concentrations. If these drugs are administered concurrently, blood pressure should be monitored closely.
Carbamazepine: (Moderate) Avoid use of oritavancin with drugs that have a narrow therapeutic window, such as carbamazepine. Carbamazepine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of carbamazepine may be reduced if these drugs are administered concurrently. Monitor for lack of carbamazepine efficacy.
Carisoprodol: (Moderate) Carisoprodol is metabolized by CYP2C19; oritavancin is a weak CYP2C19 inhibitor. Coadministration may result in elevated carisoprodol plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of carisoprodol toxicity, such as extreme drowsiness, confusion, or a slowed rate of breathing.
Carvedilol: (Moderate) Carvedilol is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of carvedilol may be reduced if these drugs are administered concurrently.
Celecoxib: (Moderate) Celecoxib is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated celecoxib plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of celecoxib toxicity, such as dizziness, stomach upset, or nausea.
Celecoxib; Tramadol: (Moderate) Celecoxib is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated celecoxib plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of celecoxib toxicity, such as dizziness, stomach upset, or nausea. (Moderate) Tramadol is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of tramadol may be reduced if these drugs are administered concurrently.
Chlordiazepoxide: (Moderate) Chlordiazepoxide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of chlordiazepoxide may be reduced if these drugs are administered concurrently.
Chlordiazepoxide; Amitriptyline: (Moderate) Chlordiazepoxide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of chlordiazepoxide may be reduced if these drugs are administered concurrently. (Moderate) Coadministration of oritavancin and amitriptyline may result in increases or decreases in amitriptyline exposure and may increase side effects or decrease efficacy of amitriptyline. Amitriptyline is metabolized by CYP3A4, CYP2D6, CYP2C19, and CYP2C9. Oritavancin weakly induces CYP3A4 and CYP2D6, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Chlordiazepoxide; Clidinium: (Moderate) Chlordiazepoxide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of chlordiazepoxide may be reduced if these drugs are administered concurrently.
Chlorpheniramine: (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently.
Chlorpheniramine; Codeine: (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently. (Moderate) Codeine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of codeine may be reduced if these drugs are administered concurrently.
Chlorpheniramine; Dextromethorphan: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently. (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently.
Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently. (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently.
Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently. (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently.
Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently. (Moderate) Concomitant use of dihydrocodeine with oritavancin can decrease dihydrocodeine levels, resulting in less metabolism by CYP2D6 and decreased dihydromorphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. If coadministration is necessary, monitor for reduced efficacy of dihydrocodeine and signs of opioid withdrawal; consider increasing the dose of dihydrocodeine as needed. If oritavancin is discontinued, consider a dose reduction of dihydrocodeine and frequently monitor for signs or respiratory depression and sedation. Oritavancin is a weak inducer of CYP3A4, an isoenzyme partially responsible for the metabolism of dihydrocodeine.
Chlorpheniramine; Hydrocodone: (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently. (Moderate) Monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of hydrocodone as needed. If oritavancin is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently. (Moderate) Ibuprofen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated ibuprofen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Chlorpheniramine; Phenylephrine: (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently.
Chlorpheniramine; Pseudoephedrine: (Moderate) Chlorpheniramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpheniramine may be reduced if these drugs are administered concurrently.
Chlorpromazine: (Moderate) Chlorpromazine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of chlorpromazine may be reduced if these drugs are administered concurrently.
Chlorpropamide: (Moderate) Chlorpropamide is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated chlorpropamide plasma concentrations. If these drugs are administered concurrently, blood glucose should be monitored closely.
Cilostazol: (Major) Cilostazol is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of cilostazol may be reduced if these drugs are administered concurrently.
Cisapride: (Moderate) Cisapride is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of cisapride may be reduced if these drugs are administered concurrently.
Citalopram: (Moderate) Coadministration of oritavancin and citalopram may result in increases or decreases in citalopram exposure and may increase side effects or decrease efficacy of citalopram. Citalopram is metabolized by CYP3A4 and CYP2C19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Clarithromycin: (Moderate) Clarithromycin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of clarithromycin may be reduced if these drugs are administered concurrently.
Clomipramine: (Moderate) Coadministration of oritavancin and clomipramine may result in increases or decreases in clomipramine exposure and may increase side effects or decrease efficacy of clomipramine. Clomipramine is primarily metabolized by CYP3A4 and CYP2D6 but is also metabolized by CYP2C19. Oritavancin weakly induces CYP3A4 and CYP2D6, while weakly inhibiting CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Clonazepam: (Moderate) Clonazepam is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of clonazepam may be reduced if these drugs are administered concurrently.
Clopidogrel: (Moderate) Monitor for reduced clopidogrel efficacy during concomitant use of oritavancin. Clopidogrel is primarily metabolized to its active metabolite by CYP2C19; oritavancin is a weak CYP2C19 inhibitor.
Clorazepate: (Moderate) Coadministration of oritavancin and clorazepate may result in increases or decreases in the exposure of N-desmethyldiazepam, the active metabolite of clorazepate. N-desmethyldiazepam is metabolized by CYP3A4 and CYP2C19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Clozapine: (Moderate) Clozapine is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of clozapine may be reduced if these drugs are administered concurrently.
Cobicistat: (Major) Plasma concentrations and efficacy of cobicistat and/or the drugs that are boosted by cobicistat may be reduced if these drugs are administered concurrently with oritavancin. Cobicistat is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Cobicistat is a CYP3A4 inhibitor indicated to increase systemic exposure of other antiretrovirals.
Cobimetinib: (Moderate) If concurrent use of cobimetinib and oritavancin is necessary, use caution and monitor for decreased efficacy of cobimetinib. Cobimetinib is a CYP3A substrate in vitro, and oritavancin is a weak inducer of CYP3A. The manufacturer of cobimetinib recommends avoiding coadministration of cobimetinib with moderate or strong CYP3A inducers based on simulations demonstrating that cobimetinib exposure would decrease by 73% or 83% when coadministered with a moderate or strong CYP3A inducer, respectively. Guidance is not available regarding concomitant use of cobimetinib with weak CYP3A inducers.
Codeine: (Moderate) Codeine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of codeine may be reduced if these drugs are administered concurrently.
Codeine; Guaifenesin: (Moderate) Codeine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of codeine may be reduced if these drugs are administered concurrently.
Codeine; Guaifenesin; Pseudoephedrine: (Moderate) Codeine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of codeine may be reduced if these drugs are administered concurrently.
Codeine; Phenylephrine; Promethazine: (Moderate) Codeine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of codeine may be reduced if these drugs are administered concurrently. (Moderate) Promethazine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of promethazine may be reduced if these drugs are administered concurrently.
Codeine; Promethazine: (Moderate) Codeine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of codeine may be reduced if these drugs are administered concurrently. (Moderate) Promethazine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of promethazine may be reduced if these drugs are administered concurrently.
Colchicine: (Moderate) Colchicine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of colchicine may be reduced if these drugs are administered concurrently.
Cyclosporine: (Moderate) Avoid use of oritavancin with drugs that have a narrow therapeutic window, such as cyclosporine. Cyclosporine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of cyclosporine may be reduced if these drugs are administered concurrently. Monitor for lack of cyclosporine efficacy.
Darifenacin: (Minor) Darifenacin is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of darifenacin may be reduced if these drugs are administered concurrently. Darifenacin dosage adjustment may be necessary.
Darunavir: (Major) Darunavir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of darunavir may be reduced if these drugs are administered concurrently.
Darunavir; Cobicistat: (Major) Darunavir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of darunavir may be reduced if these drugs are administered concurrently. (Major) Plasma concentrations and efficacy of cobicistat and/or the drugs that are boosted by cobicistat may be reduced if these drugs are administered concurrently with oritavancin. Cobicistat is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Cobicistat is a CYP3A4 inhibitor indicated to increase systemic exposure of other antiretrovirals.
Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Major) Darunavir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of darunavir may be reduced if these drugs are administered concurrently. (Major) Plasma concentrations and efficacy of cobicistat and/or the drugs that are boosted by cobicistat may be reduced if these drugs are administered concurrently with oritavancin. Cobicistat is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Cobicistat is a CYP3A4 inhibitor indicated to increase systemic exposure of other antiretrovirals.
Delavirdine: (Major) Delavirdine is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of delavirdine may be reduced if these drugs are administered concurrently.
Desipramine: (Moderate) Desipramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of desipramine may be reduced if these drugs are administered concurrently.
Desogestrel; Ethinyl Estradiol: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Dextromethorphan: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Dextromethorphan; Bupropion: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Dextromethorphan; Diphenhydramine; Phenylephrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently. (Moderate) Diphenhydramine is metabolized by CYP2C9, CYP2C19 and CYP2D6; oritavancin is a weak inducer of CYP2D6 and a weak CYP2C9 and CYP2C19 inhibitor. Coadministration may result in altered diphenhydramine plasma concentrations. If these drugs are administered concurrently, monitor for diphenydramine toxicity, such as drowsiness, or decreased effectiveness.
Dextromethorphan; Guaifenesin: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Dextromethorphan; Guaifenesin; Pseudoephedrine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently.
Dextromethorphan; Quinidine: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently. (Moderate) Quinidine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of quinidine may be reduced if these drugs are administered concurrently. Quinidine concentrations should be monitored closely after oritavancin is added to the treatment regimen. No special precautions appear necessary if oritavancin is begun several weeks before quinidine is added but quinidine doses may require adjustment if oritavancin is added or discontinued during quinidine therapy.
Diazepam: (Moderate) Coadministration of oritavancin and diazepam may result in increases or decreases in diazepam exposure and may increase side effects or decrease efficacy of diazepam. Diazepam is metabolized by CYP3A4, CYP2C9, and CYP2C19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Diclofenac: (Moderate) Coadministration of oritavancin and diclofenac may result in increases or decreases in bioactivation of diclofenac, which may increase side effects or decrease efficacy of diclofenac. Diclofenac is primarily bioactivated by CYP2C9, but also by CYP3A4. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Diclofenac; Misoprostol: (Moderate) Coadministration of oritavancin and diclofenac may result in increases or decreases in bioactivation of diclofenac, which may increase side effects or decrease efficacy of diclofenac. Diclofenac is primarily bioactivated by CYP2C9, but also by CYP3A4. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Dienogest; Estradiol valerate: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Diltiazem: (Moderate) Diltiazem is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of diltiazem may be reduced if these drugs are administered concurrently.
Diphenhydramine: (Moderate) Diphenhydramine is metabolized by CYP2C9, CYP2C19 and CYP2D6; oritavancin is a weak inducer of CYP2D6 and a weak CYP2C9 and CYP2C19 inhibitor. Coadministration may result in altered diphenhydramine plasma concentrations. If these drugs are administered concurrently, monitor for diphenydramine toxicity, such as drowsiness, or decreased effectiveness.
Diphenhydramine; Ibuprofen: (Moderate) Diphenhydramine is metabolized by CYP2C9, CYP2C19 and CYP2D6; oritavancin is a weak inducer of CYP2D6 and a weak CYP2C9 and CYP2C19 inhibitor. Coadministration may result in altered diphenhydramine plasma concentrations. If these drugs are administered concurrently, monitor for diphenydramine toxicity, such as drowsiness, or decreased effectiveness. (Moderate) Ibuprofen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated ibuprofen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Diphenhydramine; Naproxen: (Moderate) Diphenhydramine is metabolized by CYP2C9, CYP2C19 and CYP2D6; oritavancin is a weak inducer of CYP2D6 and a weak CYP2C9 and CYP2C19 inhibitor. Coadministration may result in altered diphenhydramine plasma concentrations. If these drugs are administered concurrently, monitor for diphenydramine toxicity, such as drowsiness, or decreased effectiveness. (Moderate) Naproxen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated naproxen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Diphenhydramine; Phenylephrine: (Moderate) Diphenhydramine is metabolized by CYP2C9, CYP2C19 and CYP2D6; oritavancin is a weak inducer of CYP2D6 and a weak CYP2C9 and CYP2C19 inhibitor. Coadministration may result in altered diphenhydramine plasma concentrations. If these drugs are administered concurrently, monitor for diphenydramine toxicity, such as drowsiness, or decreased effectiveness.
Disopyramide: (Moderate) Disopyramide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of disopyramide may be reduced if these drugs are administered concurrently. Disopyramide doses may need to be reduced if any of these agents are stopped and disopyramide therapy is continued. Serum disopyramide concentrations should be monitored closely if hepatic enzyme inducers are either added or discontinued during disopyramide therapy.
Disulfiram: (Minor) Disulfiram is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of disulfiram may be reduced if these drugs are administered concurrently.
Docetaxel: (Moderate) Docetaxel is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of docetaxel may be reduced if these drugs are administered concurrently.
Dolasetron: (Minor) Dolasetron is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of dolasetron may be reduced if these drugs are administered concurrently.
Dolutegravir: (Moderate) Dolutegravir plasma concentrations may be reduced when administered concurrently with oritavancin; thereby increasing the risk for HIV treatment failures or the development of viral-resistance. Data are insufficient to make dosing recommendations; however, predictions regarding this interaction can be made based on the drugs metabolic pathways. Dolutegravir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer.
Dolutegravir; Lamivudine: (Moderate) Dolutegravir plasma concentrations may be reduced when administered concurrently with oritavancin; thereby increasing the risk for HIV treatment failures or the development of viral-resistance. Data are insufficient to make dosing recommendations; however, predictions regarding this interaction can be made based on the drugs metabolic pathways. Dolutegravir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer.
Dolutegravir; Rilpivirine: (Major) Rilpivirine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of rilpivirine may be reduced if these drugs are administered concurrently. (Moderate) Dolutegravir plasma concentrations may be reduced when administered concurrently with oritavancin; thereby increasing the risk for HIV treatment failures or the development of viral-resistance. Data are insufficient to make dosing recommendations; however, predictions regarding this interaction can be made based on the drugs metabolic pathways. Dolutegravir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer.
Donepezil: (Moderate) Donepezil is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of donepezil may be reduced if these drugs are administered concurrently.
Donepezil; Memantine: (Moderate) Donepezil is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of donepezil may be reduced if these drugs are administered concurrently.
Doravirine: (Minor) Concurrent administration of doravirine and oritavancin may result in decreased doravirine exposure, resulting in potential loss of virologic control. Doravirine is a CYP3A4 substrate; oritavancin is a weak CYP3A4 inducer.
Doravirine; Lamivudine; Tenofovir disoproxil fumarate: (Minor) Concurrent administration of doravirine and oritavancin may result in decreased doravirine exposure, resulting in potential loss of virologic control. Doravirine is a CYP3A4 substrate; oritavancin is a weak CYP3A4 inducer.
Dorzolamide; Timolol: (Moderate) Timolol is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of timolol may be reduced if these drugs are administered concurrently.
Doxepin: (Moderate) Monitor for an increase in doxepin-related adverse reactions if concomitant use of oritavancin is necessary. Concomitant use may increase doxepin exposure; doxepin is metabolized by CYP2C19 and oritavancin is a CYP2C19 inhibitor.
Doxorubicin Liposomal: (Major) Doxorubicin is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Inducers of CYP2D6 may decrease the concentration of doxorubicin and compromise the efficacy of chemotherapy. Avoid coadministration of oritavancin and doxorubicin if possible. If not possible, monitor the patient for signs of lack of efficacy.
Doxorubicin: (Major) Doxorubicin is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Inducers of CYP2D6 may decrease the concentration of doxorubicin and compromise the efficacy of chemotherapy. Avoid coadministration of oritavancin and doxorubicin if possible. If not possible, monitor the patient for signs of lack of efficacy.
Dronabinol: (Moderate) Use caution if coadministration of dronabinol with oritavancin is necessary, and monitor for changes in the efficacy or adverse effect profile of dronabinol (e.g., feeling high, dizziness, confusion, somnolence). Dronabinol is a CYP2C9 and 3A4 substrate. Oritavancin is a weak inhibitor of CYP2C9 as well as a weak CYP3A4 inducer. Concomitant use may result in altered plasma concentrations of dronabinol.
Dronedarone: (Major) Dronedarone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of dronedarone may be reduced if these drugs are administered concurrently.
Drospirenone: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective st

udy reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone; Estetrol: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone; Estradiol: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone; Ethinyl Estradiol: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone; Ethinyl Estradiol; Levomefolate: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Duloxetine: (Moderate) Duloxetine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of duloxetine may be reduced if these drugs are administered concurrently.
Dutasteride; Tamsulosin: (Minor) Tamsulosin is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of tamsulosin may be reduced if these drugs are administered concurrently.
Efavirenz: (Major) Efavirenz is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of efavirenz may be reduced if these drugs are administered concurrently.
Efavirenz; Emtricitabine; Tenofovir Disoproxil Fumarate: (Major) Efavirenz is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of efavirenz may be reduced if these drugs are administered concurrently.
Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: (Major) Efavirenz is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of efavirenz may be reduced if these drugs are administered concurrently.
Elagolix; Estradiol; Norethindrone acetate: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Elbasvir; Grazoprevir: (Moderate) Caution is advised when administering elbasvir; grazoprevir with oritavancin. Oritavancin is a mild CYP3A inducer, while both elbasvir and grazoprevir are substrates of CYP3A. Use of these drugs together may decrease the plasma concentrations of both elbasvir and grazoprevir, and could result in decreased virologic response.
Eletriptan: (Minor) Eletriptan is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of eletriptan may be reduced if these drugs are administered concurrently.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Major) Coadministration of elvitegravir with oritavancin is not recommended. Elvitegravir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of elvitegravir may be reduced if these drugs are administered concurrently. (Major) Plasma concentrations and efficacy of cobicistat and/or the drugs that are boosted by cobicistat may be reduced if these drugs are administered concurrently with oritavancin. Cobicistat is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Cobicistat is a CYP3A4 inhibitor indicated to increase systemic exposure of other antiretrovirals.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Major) Coadministration of elvitegravir with oritavancin is not recommended. Elvitegravir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of elvitegravir may be reduced if these drugs are administered concurrently. (Major) Plasma concentrations and efficacy of cobicistat and/or the drugs that are boosted by cobicistat may be reduced if these drugs are administered concurrently with oritavancin. Cobicistat is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Cobicistat is a CYP3A4 inhibitor indicated to increase systemic exposure of other antiretrovirals.
Emtricitabine; Rilpivirine; Tenofovir alafenamide: (Major) Rilpivirine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of rilpivirine may be reduced if these drugs are administered concurrently.
Emtricitabine; Rilpivirine; Tenofovir Disoproxil Fumarate: (Major) Rilpivirine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of rilpivirine may be reduced if these drugs are administered concurrently.
Eplerenone: (Moderate) Eplerenone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of eplerenone may be reduced if these drugs are administered concurrently.
Escitalopram: (Moderate) Coadministration of oritavancin and escitalopram may result in increases or decreases in escitalopram exposure and may increase side effects or decrease efficacy of escitalopram. Escitalopram is metabolized by CYP3A4 and CYP2C19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Esomeprazole: (Moderate) Coadministration of oritavancin and esomeprazole may result in increase in esomeprazole exposure. Esomeprazole is primarily metabolized by CYP2C19, but is also metabolized by CYP3A4. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19. Coadministration of oritavancin and omeprazole resulted in a 15% increase in the ratio of omeprazole to 5-OH-omeprazole. If these drugs are administered concurrently, monitor the patient for signs of toxicity.
Estazolam: (Moderate) Estazolam is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of estazolam may be reduced if these drugs are administered concurrently.
Estradiol; Levonorgestrel: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Estradiol; Norethindrone: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Estradiol; Norgestimate: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norelgestromin: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norethindrone Acetate: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norgestrel: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethosuximide: (Moderate) Avoid use of oritavancin with drugs that have a narrow therapeutic window, such as ethosuximide. Ethosuximide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of ethosuximide may be reduced if these drugs are administered concurrently. Monitor for lack of ethosuximide efficacy.
Ethynodiol Diacetate; Ethinyl Estradiol: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Etonogestrel; Ethinyl Estradiol: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Etravirine: (Major) Coadministration of oritavancin and etravirine may result in increases or decreases in etravirine exposure and may increase side effects or decrease efficacy of etravirine. Etravirine is metabolized by CYP3A4, CYP2C9, and CYP2C19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Felodipine: (Moderate) Ethosuximide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of ethosuximide may be reduced if these drugs are administered concurrently.
Fentanyl: (Moderate) Consider an increased dose of fentanyl and monitor for evidence of opioid withdrawal if concurrent use of oritavancin is necessary. If oritavancin is discontinued, consider reducing the fentanyl dosage and monitor for evidence of respiratory depression. Coadministration of a CYP3A4 inducer like oritavancin with fentanyl, a CYP3A4 substrate, may decrease exposure to fentanyl resulting in decreased efficacy or onset of withdrawal symptoms in a patient who has developed physical dependence to fentanyl. Fentanyl plasma concentrations will increase once the inducer is stopped, which may increase or prolong the therapeutic and adverse effects, including serious respiratory depression.
Finasteride; Tadalafil: (Minor) Concomitant use of oritavancin and tadalafil may decrease the effectiveness of tadalafil; therefore, use caution and monitor therapeutic effects of tadalafil when coadministered. Oritavancin is a weak inducer of CYP3A4 and tadalafil is a CYP3A4 substrate. Clinical studies have shown that CYP3A4 inducers may reduce tadalafil exposure. The reduced exposure of tadalafil with the coadministration of CYP3A4 inducers can be anticipated to decrease the efficacy of tadalafil for once daily use; however the magnitude of decreased efficacy is unknown. Potent CYP3A4 inducers should be avoided with tadalafil when it is used to treat pulmonary hypertension.
Flecainide: (Moderate) Flecainide is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of flecainide may be reduced if these drugs are administered concurrently.
Fluoxetine: (Moderate) Fluoxetine is metabolized by CYP2C9, CYP2C19 and CYP2D6; oritavancin is a weak inducer of CYP2D6 and a weak CYP2C9 and CYP2C19 inhibitor. Coadministration may result in altered fluoxetine plasma concentrations. If these drugs are administered concurrently, monitor for fluoxetine toxicity, such as nausea, vomiting, diarrhea, headache, or insomnia, or decreased effectiveness.
Fluphenazine: (Moderate) Fluphenazine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of fluphenazine may be reduced if these drugs are administered concurrently.
Flurazepam: (Moderate) Flurazepam is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of flurazepam may be reduced if these drugs are administered concurrently.
Flurbiprofen: (Moderate) Flurbiprofen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated flurbiprofen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Fluvastatin: (Moderate) Fluvastatin is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated fluvastatin plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of fluvastatin toxicity, such as muscle aches, muscle pain or tenderness, general weakness or fatigue, side or back pain, or decreased urination.
Fluvoxamine: (Moderate) Fluvoxamine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of fluvoxamine may be reduced if these drugs are administered concurrently.
Fosamprenavir: (Major) Coadministration of oritavancin and fosamprenavir may result in increases or decreases in fosamprenavir exposure and may increase side effects or decrease efficacy of fosamprenavir. Fosamprenavir is metabolized by CYP3A4, CYP2D6, and CYP2C9. Oritavancin weakly induces CYP3A4 and CYP2D6, while weakly inhibiting CYP2C9. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Fosphenytoin: (Moderate) Avoid use of oritavancin with drugs that have a narrow therapeutic window, such as fosphenytoin. Coadministration of oritavancin and fosphenytoin may result in increases or decreases in fosphenytoin exposure and may increase side effects or decrease efficacy of fosphenytoin. Fosphenytoin is primarily metabolized by CYP2C9, but is also metabolized by CYP3A4 and CYPC19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor for signs of fosphenytoin toxicity or lack of fosphenytoin efficacy.
Glimepiride: (Moderate) Glimepiride is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated glimepiride plasma concentrations. If these drugs are administered concurrently, blood glucose should be monitored closely.
Glipizide: (Moderate) Glipizide is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated glipizide plasma concentrations. If these drugs are administered concurrently, blood glucose should be monitored closely.
Glipizide; Metformin: (Moderate) Glipizide is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated glipizide plasma concentrations. If these drugs are administered concurrently, blood glucose should be monitored closely.
Glyburide: (Moderate) Glyburide is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated glyburide plasma concentrations. If these drugs are administered concurrently, blood glucose should be monitored closely.
Glyburide; Metformin: (Moderate) Glyburide is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated glyburide plasma concentrations. If these drugs are administered concurrently, blood glucose should be monitored closely.
Granisetron: (Minor) Granisetron is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of granisetron may be reduced if these drugs are administered concurrently.
Guaifenesin; Hydrocodone: (Moderate) Monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of hydrocodone as needed. If oritavancin is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Haloperidol: (Moderate) Haloperidol is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of haloperidol may be reduced if these drugs are administered concurrently.
Heparin: (Contraindicated) Use of intravenous unfractionated heparin for 120 hours (5 days) after oritavancin administration is contraindicated. Although oritavancin has no effect on the coagulation cascade, it does interfere with some coagulation tests by binding to and preventing activation of coagulation by phospholipid reagents commonly used in laboratory tests. The activated partial throboplastin time (aPTT) is artificially elevated for up to 120 hours (5 days) after oritavancin dosing. Consider use of an alternate anticoagulant, as appropriate. For patients who require aPTT monitoring within 120 hours (5 days) after oritavancin use, a non-phospholipid dependent coagulation test, such as Factor Xa, which is chromogenic, may be considered.
Homatropine; Hydrocodone: (Moderate) Monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of hydrocodone as needed. If oritavancin is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Hydrocodone: (Moderate) Monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of hydrocodone as needed. If oritavancin is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Hydrocodone; Ibuprofen: (Moderate) Ibuprofen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated ibuprofen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction. (Moderate) Monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of hydrocodone as needed. If oritavancin is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Hydrocodone; Pseudoephedrine: (Moderate) Monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of hydrocodone as needed. If oritavancin is discontinued, consider a dose reduction of hydrocodone and frequently monitor for signs or respiratory depression and sedation. Hydrocodone is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease hydrocodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Ibuprofen: (Moderate) Ibuprofen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated ibuprofen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Ibuprofen; Famotidine: (Moderate) Ibuprofen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated ibuprofen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Ibuprofen; Oxycodone: (Moderate) Ibuprofen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated ibuprofen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction. (Moderate) Monitor for reduced efficacy of oxycodone and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of oxycodone as needed. If oritavancin is discontinued, consider a dose reduction of oxycodone and frequently monitor for signs of respiratory depression and sedation. Oxycodone is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease oxycodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Ibuprofen; Pseudoephedrine: (Moderate) Ibuprofen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated ibuprofen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Imatinib: (Moderate) Coadministration of oritavancin and imatinib, STI-571 may result in increases or decreases in imatinib exposure and may increase side effects or decrease efficacy of imatinib. Imatinib is primarily metabolized by CYP3A4, but is also metabolized by CYP2D6, CYP2C9, and CYP2C19. Oritavancin weakly induces CYP3A4 and CYP2D6, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Imipramine: (Moderate) Coadministration of oritavancin and imipramine may result in increases or decreases in imipramine exposure and may increase side effects or decrease efficacy of imipramine. Imipramine is metabolized by CYP3A4, CYP2D6, and CYP2C19. Oritavancin weakly induces CYP3A4 and CYP2D6, while weakly inhibiting CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Indinavir: (Major) Concomitant use of oritavancin with indinavir may decrease the effectiveness of indinavir; therefore, use caution, and monitor therapeutic effects of indinavir when coadministered. Oritavancin is a weak inducer of CYP3A4 and indinavir is a CYP3A4 substrate.
Indomethacin: (Moderate) Indomethacin is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated indomethacin plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Isavuconazonium: (Major) Caution and close monitoring are warranted when isavuconazonium is administered with oritavancin as there is a potential for decreased concentrations of isavuconazonium. Decreased isavuconazonium concentrations may lead to a reduction of antifungal efficacy and the potential for treatment failure. Isavuconazole, the active moiety of isavuconazonium, is a sensitive substrate of hepatic isoenzyme CYP3A4; oritavancin is an inducer of this enzyme.
Isradipine: (Moderate) Isradipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of isradipine may be reduced if these drugs are administered concurrently.
Itraconazole: (Moderate) Itraconazole is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of itraconazole may be reduced if these drugs are administered concurrently.
Ketoconazole: (Moderate) Ketoconazole is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of ketoconazole may be reduced if these drugs are administered concurrently.
Lacosamide: (Moderate) Lacosamide is metabolized by CYP2C19; oritavancin is a weak CYP2C19 inhibitor. Coadministration may result in elevated lacosamide plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of lacosamide toxicity, such as fainting or falling spells, low blood pressure, or changes in heart rate (fast, slow, or irregular).
Lansoprazole: (Moderate) Coadministration of oritavancin and lansoprazole may result in increases or decreases in lansoprazole exposure and may increase side effects or decrease efficacy of lansoprazole. Lansoprazole is metabolized by CYP3A4 and CYP2C19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Lansoprazole; Amoxicillin; Clarithromycin: (Moderate) Clarithromycin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of clarithromycin may be reduced if these drugs are administered concurrently. (Moderate) Coadministration of oritavancin and lansoprazole may result in increases or decreases in lansoprazole exposure and may increase side effects or decrease efficacy of lansoprazole. Lansoprazole is metabolized by CYP3A4 and CYP2C19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Lesinurad: (Moderate) Use lesinurad and oritavancin together with caution; oritavancin may increase the systemic exposure of lesinurad. Oritavancin is a mild inhibitor of CYP2C9, and lesinurad is a CYP2C9 substrate.
Lesinurad; Allopurinol: (Moderate) Use lesinurad and oritavancin together with caution; oritavancin may increase the systemic exposure of lesinurad. Oritavancin is a mild inhibitor of CYP2C9, and lesinurad is a CYP2C9 substrate.
Leuprolide; Norethindrone: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Levamlodipine: (Moderate) Amlodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amlodipine may be reduced if these drugs are administered concurrently.
Levoketoconazole: (Moderate) Ketoconazole is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of ketoconazole may be reduced if these drugs are administered concurrently.
Levonorgestrel: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Levonorgestrel; Ethinyl Estradiol: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Lidocaine: (Moderate) Lidocaine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of lidocaine may be reduced if these drugs are administered concurrently.
Lidocaine; Epinephrine: (Moderate) Lidocaine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of lidocaine may be reduced if these drugs are administered concurrently.
Lidocaine; Prilocaine: (Moderate) Lidocaine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of lidocaine may be reduced if these drugs are administered concurrently.
Lonafarnib: (Major) Avoid coadministration of lonafarnib and oritavancin; concurrent use may increase the exposure of lonafarnib and the risk of adverse effects. If coadministration is unavoidable, closely monitor patients for lonafarnib-related adverse reactions. Lonafarnib is a CYP2C9 substrate and oritavancin is a CYP2C9 inhibitor.
Lopinavir; Ritonavir: (Major) Ritonavir is metabolized by CYP3A4 and CYP2D6 (minor); oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of ritonavir may be reduced if these drugs are administered concurrently. (Moderate) Lopinavir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of lopinavir may be reduced if these drugs are administered concurrently.
Lovastatin: (Moderate) Lovastatin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of lovastatin may be reduced if these drugs are administered concurrently.
Lumateperone: (Major) Avoid coadministration of lumateperone and oritavancin as concurrent use may decrease lumateperone exposure which may reduce efficacy. Lumateperone is a CYP3A4 substrate; oritavancin is a weak CYP3A4 inducer.
Lurasidone: (Moderate) Lurasidone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of lurasidone may be reduced if these drugs are administered concurrently.
Maraviroc: (Minor) Use caution if coadministration of maraviroc with oritavancin is necessary, due to a possible decrease in maraviroc exposure. Maraviroc is a CYP3A substrate and oritavancin is a weak CYP3A4 inducer. Monitor for a decrease in maraviroc efficacy with concomitant use.
Mavacamten: (Major) Reduce the mavacamten dose by 1 level (i.e., 15 to 10 mg, 10 to 5 mg, or 5 to 2.5 mg) in patients receiving mavacamten and starting oritavancin therapy. Avoid initiation of oritavancin in patients who are on stable treatment with mavacamten 2.5 mg per day because a lower dose of mavacamten is not available. Initiate mavacamten at the recommended starting dose of 5 mg PO once daily in patients who are on stable oritavancin therapy. Concomitant use increases mavacamten exposure, which may increase the risk of adverse drug reactions. Mavacamten is a CYP2C19 substrate and oritavancin is a weak CYP2C19 inhibitor. Concomitant use with another weak CYP2C19 inhibitor in CYP2C19 normal and rapid metabolizers increased overall mavacamten exposure by 48%.
Meclizine: (Moderate) Meclizine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of meclizine may be reduced if these drugs are administered concurrently.
Mefloquine: (Moderate) Mefloquine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of mefloquine may be reduced if these drugs are administered concurrently.
Meloxicam: (Moderate) Consider a meloxicam dose reduction and monitor for adverse reactions if coadministration with oritavancin is necessary. Concurrent use may increase meloxicam exposure. Meloxicam is a CYP2C9 substrate and oritavancin is a weak CYP2C9 inhibitor.
Metformin; Repaglinide: (Moderate) Repaglinide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of repaglinide may be reduced if these drugs are administered concurrently.
Metformin; Rosiglitazone: (Moderate) Rosiglitazone is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated rosiglitazone plasma concentrations. If these drugs are administered concurrently, blood glucose should be monitored closely.
Methadone: (Moderate) Coadministration of oritavancin and methadone may result in increases or decreases in methadone exposure and may increase side effects or decrease efficacy of methadone. Methadone is metabolized by CYP3A4, CYP2D6, CYP2C9, and CYP2C19. Oritavancin weakly induces CYP3A4 and CYP2D6, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy, including abstinence syndrome in a patient who had developed physical dependence.
Methamphetamine: (Moderate) Methamphetamine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of methamphetamine may be reduced if these drugs are administered concurrently.
Methylprednisolone: (Minor) Methylprednisolone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of methylprednisolone may be reduced if these drugs are administered concurrently.
Metoclopramide: (Moderate) Metoclopramide is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of metoclopramide may be reduced if these drugs are administered concurrently.
Metoprolol: (Moderate) Metoprolol is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of metoprolol may be reduced if these drugs are administered concurrently.
Metoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Metoprolol is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of metoprolol may be reduced if these drugs are administered concurrently.
Mexiletine: (Moderate) Mexiletine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of mexiletine may be reduced if these drugs are administered concurrently.
Midazolam: (Moderate) Administration of oritavancin, a weak inducer of CYP3A4, with midazolam resulted in an 18% reduction in the midazolam mean AUC. Higher doses of midazolam may be necessary when these drugs are administered concurrently.
Mifepristone: (Moderate) Mifepristone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of mifepristone may be reduced if these drugs are administered concurrently. Specific drug interactions with mifepristone have not been studied; it is not known if lowered mifepristone serum concentrations would lead to therapeutic failures.
Modafinil: (Moderate) Modafinil is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of modafinil may be reduced if these drugs are administered concurrently.
Nanoparticle Albumin-Bound Paclitaxel: (Moderate) Monitor for decreased efficacy of nab-paclitaxel if coadministration with oritavancin is necessary due to the risk of decreased plasma concentrations of paclitaxel. Nab-paclitaxel is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer.
Nanoparticle Albumin-Bound Sirolimus: (Moderate) Monitor for reduced sirolimus efficacy if sirolimus is coadministered with oritavancin. Concomitant use may decrease sirolimus exposure. Sirolimus is a CYP3A substrate and oritavancin is a weak CYP3A inducer.
Naproxen: (Moderate) Naproxen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated naproxen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Naproxen; Esomeprazole: (Moderate) Coadministration of oritavancin and esomeprazole may result in increase in esomeprazole exposure. Esomeprazole is primarily metabolized by CYP2C19, but is also metabolized by CYP3A4. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19. Coadministration of oritavancin and omeprazole resulted in a 15% increase in the ratio of omeprazole to 5-OH-omeprazole. If these drugs are administered concurrently, monitor the patient for signs of toxicity. (Moderate) Naproxen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated naproxen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Naproxen; Pseudoephedrine: (Moderate) Naproxen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated naproxen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Nebivolol: (Moderate) Nebivolol is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of nebivolol may be reduced if these drugs are administered concurrently.
Nebivolol; Valsartan: (Moderate) Nebivolol is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of nebivolol may be reduced if these drugs are administered concurrently. (Moderate) Valsartan is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated valsartan plasma concentrations. If these drugs are administered concurrently, blood pressure should be monitored closely.
Nefazodone: (Moderate) Nefazodone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of nefazodone may be reduced if these drugs are administered concurrently.
Nelfinavir: (Major) Coadministration of oritavancin and nelfinavir may result in increases or decreases in nelfinavir exposure and may increase side effects or decrease efficacy of nelfinavir. Nelfinavir is metabolized by CYP3A4 and CYP2C19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Nifedipine: (Moderate) Nifedipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of nifedipine may be reduced if these drugs are administered concurrently.
Nimodipine: (Moderate) Nimodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of nimodipine may be reduced if these drugs are administered concurrently.
Nirmatrelvir; Ritonavir: (Major) Ritonavir is metabolized by CYP3A4 and CYP2D6 (minor); oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of ritonavir may be reduced if these drugs are administered concurrently. (Moderate) Monitor for a diminished response to nirmatrelvir if concomitant use of oritavancin is necessary. Concomitant use of nirmatrelvir and oritavancin may reduce the therapeutic effect of nirmatrelvir. Nirmatrelvir is a CYP3A substrate and oritavancin is a weak CYP3A inducer.
Nisoldipine: (Major) Avoid coadministration of nisoldipine with oritavancin due to decreased plasma concentrations of nisoldipine. Alternative antihypertensive therapy should be considered. Nisoldipine is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Coadministration with a strong CYP3A4 inducer lowered nisoldipine plasma concentrations to undetectable levels.
Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norethindrone: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norethindrone; Ethinyl Estradiol: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norgestimate; Ethinyl Estradiol: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norgestrel: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Nortriptyline: (Moderate) Nortriptyline is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of nortriptyline may be reduced if these drugs are administered concurrently.
Olanzapine: (Moderate) Olanzapine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of olanzapine may be reduced if these drugs are administered concurrently.
Olanzapine; Fluoxetine: (Moderate) Fluoxetine is metabolized by CYP2C9, CYP2C19 and CYP2D6; oritavancin is a weak inducer of CYP2D6 and a weak CYP2C9 and CYP2C19 inhibitor. Coadministration may result in altered fluoxetine plasma concentrations. If these drugs are administered concurrently, monitor for fluoxetine toxicity, such as nausea, vomiting, diarrhea, headache, or insomnia, or decreased effectiveness. (Moderate) Olanzapine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of olanzapine may be reduced if these drugs are administered concurrently.
Olanzapine; Samidorphan: (Moderate) Olanzapine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of olanzapine may be reduced if these drugs are administered concurrently.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Amlodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amlodipine may be reduced if these drugs are administered concurrently.
Omeprazole: (Moderate) Administration of oritavancin, a weak inhibitor of CYP2C19, with omeprazole resulted in a 15% increase in the ratio of omeprazole to 5-OH-omeprazole concentrations in the plasma. Monitor patients for omeprazole toxicities, such as headache or gastrointestinal distress, if these drugs are administered concurrently.
Omeprazole; Amoxicillin; Rifabutin: (Moderate) Administration of oritavancin, a weak inhibitor of CYP2C19, with omeprazole resulted in a 15% increase in the ratio of omeprazole to 5-OH-omeprazole concentrations in the plasma. Monitor patients for omeprazole toxicities, such as headache or gastrointestinal distress, if these drugs are administered concurrently. (Moderate) Rifabutin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of rifabutin may be reduced if these drugs are administered concurrently.
Omeprazole; Sodium Bicarbonate: (Moderate) Administration of oritavancin, a weak inhibitor of CYP2C19, with omeprazole resulted in a 15% increase in the ratio of omeprazole to 5-OH-omeprazole concentrations in the plasma. Monitor patients for omeprazole toxicities, such as headache or gastrointestinal distress, if these drugs are administered concurrently.
Ondansetron: (Minor) Ondansetron is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of ondansetron may be reduced if these drugs are administered concurrently.
Oral Contraceptives: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Oxybutynin: (Minor) Oxybutynin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of oxybutynin may be reduced if these drugs are administered concurrently.
Oxycodone: (Moderate) Monitor for reduced efficacy of oxycodone and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of oxycodone as needed. If oritavancin is discontinued, consider a dose reduction of oxycodone and frequently monitor for signs of respiratory depression and sedation. Oxycodone is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease oxycodone levels; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Paclitaxel: (Moderate) Paclitaxel is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of paclitaxel may be reduced if these drugs are administered concurrently.
Paricalcitol: (Moderate) Paricalcitol is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of paricalcitol may be reduced if these drugs are administered concurrently. Paricalcitol dosage adjustments may be required. Monitor plasma iPTH and serum calcium and phosphorous concentrations when oritavancin is initiated or discontinued.
Paroxetine: (Moderate) Paroxetine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of paroxetine may be reduced if these drugs are administered concurrently.
Pentamidine: (Moderate) Pentamidine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of pentamidine may be reduced if these drugs are administered concurrently.
Perindopril; Amlodipine: (Moderate) Amlodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amlodipine may be reduced if these drugs are administered concurrently.
Perphenazine: (Moderate) Perphenazine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of perphenazine may be reduced if these drugs are administered concurrently.
Perphenazine; Amitriptyline: (Moderate) Coadministration of oritavancin and amitriptyline may result in increases or decreases in amitriptyline exposure and may increase side effects or decrease efficacy of amitriptyline. Amitriptyline is metabolized by CYP3A4, CYP2D6, CYP2C19, and CYP2C9. Oritavancin weakly induces CYP3A4 and CYP2D6, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy. (Moderate) Perphenazine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of perphenazine may be reduced if these drugs are administered concurrently.
Phenobarbital: (Moderate) Phenobarbital is metabolized by CYP2C9 and CYP2C19; oritavancin is a weak inhibitor of both isoenzymes. Coadministration may result in elevated phenobarbital plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of phenobarbital toxicity, such as confusion, excessive drowsiness, falls, unsteadiness, or difficulty walking, or nystagmus.
Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Moderate) Phenobarbital is metabolized by CYP2C9 and CYP2C19; oritavancin is a weak inhibitor of both isoenzymes. Coadministration may result in elevated phenobarbital plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of phenobarbital toxicity, such as confusion, excessive drowsiness, falls, unsteadiness, or difficulty walking, or nystagmus.
Phenytoin: (Moderate) Avoid use of oritavancin with drugs that have a narrow therapeutic window, such as phenytoin. Coadministration of oritavancin and phenytoin may result in increases or decreases in phenytoin exposure and may increase side effects or decrease efficacy of phenytoin. Phenytoin is primarily metabolized by CYP2C9, but is also metabolized by CYP3A4 and CYPC19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor for signs of phenytoin toxicity or lack of phenytoin efficacy.
Pioglitazone; Glimepiride: (Moderate) Glimepiride is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated glimepiride plasma concentrations. If these drugs are administered concurrently, blood glucose should be monitored closely.
Piroxicam: (Moderate) Piroxicam is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated piroxicam plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Pitavastatin: (Moderate) Pitavastatin is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated pitavastatin plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of pitavastatin toxicity, such as muscle aches, muscle pain or tenderness, general weakness or fatigue, side or back pain, or decreased urination.
Praziquantel: (Major) Praziquantel is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of praziquantel may be reduced if these drugs are administered concurrently.
Prednisolone: (Minor) Prednisolone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of prednisolone may be reduced if these drugs are administered concurrently.
Prednisone: (Moderate) Prednisolone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of prednisolone may be reduced if these drugs are administered concurrently.
Primidone: (Moderate) Primidone is metabolized by CYP2C9 and CYP2C19; oritavancin is a weak inhibitor of both isoenzymes. Coadministration may result in elevated primidone plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of primidone toxicity, such as confusion, excessive drowsiness, falls, unsteadiness, or difficulty walking, or nystagmus.
Probenecid; Colchicine: (Moderate) Colchicine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of colchicine may be reduced if these drugs are administered concurrently.
Promethazine: (Moderate) Promethazine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of promethazine may be reduced if these drugs are administered concurrently.
Promethazine; Dextromethorphan: (Moderate) Administration of oritavancin, a weak inducer of CYP2D6 and CYP3A4, with dextromethorphan resulted in a 31% reduction in the ratio of dextromethorphan to dextrorphan concentrations in the urine. The efficacy of dextromethorphan may be reduced if these drugs are administered concurrently. (Moderate) Promethazine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of promethazine may be reduced if these drugs are administered concurrently.
Promethazine; Phenylephrine: (Moderate) Promethazine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of promethazine may be reduced if these drugs are administered concurrently.
Propafenone: (Moderate) Propafenone is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of propafenone may be reduced if these drugs are administered concurrently.
Propranolol: (Moderate) Propranolol is metabolized by CYP2C19 and CYP2D6; oritavancin is a weak inhibitor of CYP2C19 and a weak CYP2D6 inducer. Coadministration may result in altered propranolol plasma concentrations. If these drugs are administered concurrently, blood pressure should be monitored closely.
Propranolol; Hydrochlorothiazide, HCTZ: (Moderate) Propranolol is metabolized by CYP2C19 and CYP2D6; oritavancin is a weak inhibitor of CYP2C19 and a weak CYP2D6 inducer. Coadministration may result in altered propranolol plasma concentrations. If these drugs are administered concurrently, blood pressure should be monitored closely.
Protriptyline: (Moderate) Protriptyline is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of protriptyline may be reduced if these drugs are administered concurrently.
Quazepam: (Moderate) Coadministration of oritavancin and quazepam may result in increases or decreases in quazepam exposure and may increase side effects or decrease efficacy of quazepam. Quazepam is primarily metabolized by CYP3A4, but is also metabolized by CYP2C9 and CYPC19 to an active metabolite which is further metabolized primarily by CYP3A4 and CYP2C9. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Quetiapine: (Moderate) Quetiapine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of quetiapine may be reduced if these drugs are administered concurrently.
Quinidine: (Moderate) Quinidine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of quinidine may be reduced if these drugs are administered concurrently. Quinidine concentrations should be monitored closely after oritavancin is added to the treatment regimen. No special precautions appear necessary if oritavancin is begun several weeks before quinidine is added but quinidine doses may require adjustment if oritavancin is added or discontinued during quinidine therapy.
Quinine: (Moderate) Coadministration of oritavancin and quinine may result in increases or decreases in quinine exposure and may increase side effects or decrease efficacy of quinine. Quinine is primarily metabolized by CYP3A4, but is also metabolized by CYP2D6, CYP2C9, and CYP2C19. Oritavancin weakly induces CYP3A4 and CYP2D6, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Rabeprazole: (Moderate) Coadministration of oritavancin and rabeprazole may result in increases or decreases in rabeprazole exposure and may increase side effects or decrease efficacy of rabeprazole. Rabeprazole is metabolized by CYP3A4 and CYP2C19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Ramelteon: (Moderate) Coadministration of oritavancin and ramelteon may result in increases or decreases in ramelteon exposure and may increase side effects or decrease efficacy of ramelteon. Ramelteon is metabolized by CYP3A4 and CYP2C9. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Ranolazine: (Major) Ranolazine is contraindicated in patients receiving drugs known to be CYP3A inducers. Although not specifically mentioned by the manufacturer, coadministration of ranolazine with a CYP3A enzyme inducer such as oritavancin (a weak inducer) may result in decreased ranolazine plasma concentrations and decreased efficacy. Ranolazine is also a substrate of CYP2D6 and oritavancin is a weak CYP2D6 inducer.
Relugolix; Estradiol; Norethindrone acetate: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Repaglinide: (Moderate) Repaglinide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of repaglinide may be reduced if these drugs are administered concurrently.
Rifabutin: (Moderate) Rifabutin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of rifabutin may be reduced if these drugs are administered concurrently.
Rilpivirine: (Major) Rilpivirine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of rilpivirine may be reduced if these drugs are administered concurrently.
Ritonavir: (Major) Ritonavir is metabolized by CYP3A4 and CYP2D6 (minor); oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of ritonavir may be reduced if these drugs are administered concurrently.
Rivaroxaban: (Moderate) Rivaroxaban is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of rivaroxaban may be reduced if these drugs are administered concurrently.
Rosiglitazone: (Moderate) Rosiglitazone is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated rosiglitazone plasma concentrations. If these drugs are administered concurrently, blood glucose should be monitored closely.
Rosuvastatin: (Moderate) Rosuvastatin is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated rosuvastatin plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of rosuvastatin toxicity, such as muscle aches, muscle pain or tenderness, general weakness or fatigue, side or back pain, or decreased urination.
Rosuvastatin; Ezetimibe: (Moderate) Rosuvastatin is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated rosuvastatin plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of rosuvastatin toxicity, such as muscle aches, muscle pain or tenderness, general weakness or fatigue, side or back pain, or decreased urination.
Ruxolitinib: (Moderate) Coadministration of oritavancin and ruxolitinib may result in increases or decreases in ruxolitinib exposure and may increase side effects or decrease efficacy of ruxolitinib. Ruxolitinib is primarily metabolized by CYP3A4, but is also metabolized by CYP2C9. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Sacubitril; Valsartan: (Moderate) Valsartan is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated valsartan plasma concentrations. If these drugs are administered concurrently, blood pressure should be monitored closely.
Saquinavir: (Major) Saquinavir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of saquinavir may be reduced if these drugs are administered concurrently.
Segesterone Acetate; Ethinyl Estradiol: (Moderate) It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Sildenafil: (Moderate) Coadministration of oritavancin and sildenafil may result in increases or decreases in sildenafil exposure and may increase side effects or decrease efficacy of sildenafil. Sildenafil is primarily metabolized by CYP3A4, but is also metabolized by CYP2C9. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Silodosin: (Moderate) Silodosin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of silodosin may be reduced if these drugs are administered concurrently.
Sirolimus: (Moderate) Monitor sirolimus concentrations and adjust sirolimus dosage as appropriate during concomitant use of oritavancin. Concomitant use may decrease sirolimus exposure and efficacy. Sirolimus is a CYP3A substrate and oritavancin is a weak CYP3A inducer.
Sofosbuvir; Velpatasvir: (Major) Use caution when administering velpatasvir with oritavancin. Taking these drugs together may decrease velpatasvir plasma concentrations, potentially resulting in loss of antiviral efficacy. Velpatasvir is a CYP3A4 substrate; oritavancin is a weak inducer of CYP3A4.
Sofosbuvir; Velpatasvir; Voxilaprevir: (Major) Use caution when administering velpatasvir with oritavancin. Taking these drugs together may decrease velpatasvir plasma concentrations, potentially resulting in loss of antiviral efficacy. Velpatasvir is a CYP3A4 substrate; oritavancin is a weak inducer of CYP3A4.
Solifenacin: (Minor) Solifenacin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of solifenacin may be reduced if these drugs are administered concurrently.
Sonidegib: (Moderate) Use caution with the concomitant use of sonidegib and oritavancin; sonidegib levels may be decreased and its efficacy reduced. Sonidegib is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Physiologic-based pharmacokinetics (PBPK) simulations indicate that the sonidegib geometric mean steady-state AUC (0-24 hours) would decrease by 56% in cancer patients who received 14 days of sonidegib 200 mg/day with a moderate CYP3A inducer. Additionally, the PBPK model predicts that the sonidegib geometric mean steady-state AUC (0-24 hours) would decrease by 69% in cancer patients who received sonidegib 200 mg/day with a moderate CYP3A inducer for 4 months.
Sufentanil: (Moderate) Because the dose of the sufentanil sublingual tablets cannot be titrated, consider an alternate opiate if oritavancin must be administered. Monitor for reduced efficacy of sufentanil injection and signs of opioid withdrawal if coadministration with oritavancin is necessary; consider increasing the dose of sufentanil injection as needed. If oritavancin is discontinued, consider a dose reduction of sufentanil injection and frequently monitor for signs or respiratory depression and sedation. Sufentanil is a CYP3A4 substrate and oritavancin is a weak CYP3A4 inducer. Concomitant use with CYP3A4 inducers can decrease sufentanil concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence.
Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole: (Moderate) Sulfamethoxazole is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated sulfamethoxazole plasma concentrations. If these drugs are administered concurrently, monitor for sulfamethoxazole toxicity such as diarrhea, anorexia, or nausea.
Sumatriptan; Naproxen: (Moderate) Naproxen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated naproxen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction.
Tacrolimus: (Moderate) Monitor tacrolimus serum concentrations as appropriate if coadministration with oritavancin is necessary; a tacrolimus dose adjustment may be needed. Concurrent administration may decrease tacrolimus concentrations. Tacrolimus is a sensitive CYP3A substrate with a narrow therapeutic range; oritavancin is a weak CYP3A inducer.
Tadalafil: (Minor) Concomitant use of oritavancin and tadalafil may decrease the effectiveness of tadalafil; therefore, use caution and monitor therapeutic effects of tadalafil when coadministered. Oritavancin is a weak inducer of CYP3A4 and tadalafil is a CYP3A4 substrate. Clinical studies have shown that CYP3A4 inducers may reduce tadalafil exposure. The reduced exposure of tadalafil with the coadministration of CYP3A4 inducers can be anticipated to decrease the efficacy of tadalafil for once daily use; however the magnitude of decreased efficacy is unknown. Potent CYP3A4 inducers should be avoided with tadalafil when it is used to treat pulmonary hypertension.
Tamsulosin: (Minor) Tamsulosin is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of tamsulosin may be reduced if these drugs are administered concurrently.
Telmisartan; Amlodipine: (Moderate) Amlodipine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of amlodipine may be reduced if these drugs are administered concurrently.
Teniposide: (Moderate) Teniposide is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of teniposide may be reduced if these drugs are administered concurrently.
Terbinafine: (Moderate) Coadministration of oritavancin and systemic terbinafine may result in increases or decreases in terbinafine exposure and may increase side effects or decrease efficacy of terbinafine. Terbinafine is metabolized by CYP3A4, CYP2C9, and CYP2C19. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9 and CYP2C19. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy. Topical formulations are not extensively absorbed and are unlikely to exhibit significant drug interactions.
Tetrabenazine: (Moderate) The active metabolites of tetrabenazine are metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. The efficacy of tetrabenazine may be reduced if these drugs are administered concurrently.
Thalidomide: (Moderate) Thalidomide is metabolized by CYP2C19; oritavancin is a weak CYP2C19 inhibitor. Coadministration may result in elevated thalidomide plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of thalidomide toxicity, such as increased fatigue, drowsiness, or neuropathy.
Theophylline, Aminophylline: (Moderate) Avoid oritavancin with drugs that have a narrow therapeutic window, such as aminophylline. Aminophylline is a derivative of theophylline. Theophylline metabolism by CYP3A4 is minor and independent of theophylline plasma concentration; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of aminophylline may be reduced if these drugs are administered concurrently. Monitor for lack of aminophylline efficacy. (Moderate) Avoid oritavancin with drugs that have a narrow therapeutic window, such as theophylline. Theophylline metabolism by CYP3A4 is minor and independent of theophylline plasma concentration; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of theophylline may be reduced if these drugs are administered concurrently. Monitor for lack of theophylline efficacy.
Thioridazine: (Moderate) Thioridazine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of thioridazine may be reduced if these drugs are administered concurrently.
Tiagabine: (Moderate) Tiagabine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of tiagabine may be reduced if these drugs are administered concurrently.
Timolol: (Moderate) Timolol is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of timolol may be reduced if these drugs are administered concurrently.
Tinidazole: (Minor) Tinidazole is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of tinidazole may be reduced if these drugs are administered concurrently.
Tipranavir: (Major) Tipranavir is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of tipranavir may be reduced if these drugs are administered concurrently.
Tolbutamide: (Moderate) Tolbutamide is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated tolbutamide plasma concentrations. If these drugs are administered concurrently, blood glucose should be monitored closely.
Tolterodine: (Minor) Tolterodine is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of tolterodine may be reduced if these drugs are administered concurrently.
Torsemide: (Moderate) Torsemide is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated torsemide plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of torsemide toxicity, such as dehydration, hypokalemia, or hypomagnesemia.
Tramadol: (Moderate) Tramadol is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of tramadol may be reduced if these drugs are administered concurrently.
Tramadol; Acetaminophen: (Moderate) Tramadol is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of tramadol may be reduced if these drugs are administered concurrently.
Trandolapril; Verapamil: (Moderate) Coadministration of oritavancin and verapamil may result in increases or decreases in verapamil exposure and may increase side effects or decrease efficacy of verapamil. Verapamil is metabolized by CYP3A4 and CYP2C9. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Trazodone: (Moderate) Trazodone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of trazodone may be reduced if these drugs are administered concurrently.
Trimipramine: (Moderate) Trimipramine is metabolized by CYP2D6; oritavancin is a weak CYP2D6 inducer. Plasma concentrations and efficacy of trimipramine may be reduced if these drugs are administered concurrently.
Ubrogepant: (Major) Increase the initial and second dose of ubrogepant to 100 mg if coadministered with oritavancin as concurrent use may decrease ubrogepant exposure and reduce its efficacy. Ubrogepant is a CYP3A4 substrate; oritavancin is a weak CYP3A4 inducer.
Valproic Acid, Divalproex Sodium: (Moderate) Valproic acid is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated valproic acid plasma concentrations. If these drugs are administered concurrently, monitor patients for signs of valproic acid toxicity, such as diarrhea, bruising, tremor, changes in mood or behavior, yellowing of skin or eyes, unusual tiredness or weakness, or severe stomach pain with nausea and vomiting.
Valsartan: (Moderate) Valsartan is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated valsartan plasma concentrations. If these drugs are administered concurrently, blood pressure should be monitored closely.
Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Valsartan is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated valsartan plasma concentrations. If these drugs are administered concurrently, blood pressure should be monitored closely.
Vemurafenib: (Moderate) Vemurafenib is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of vemurafenib may be reduced if these drugs are administered concurrently.
Venlafaxine: (Moderate) Venlafaxine is metabolized by CYP3A4 and CYP2D6; oritavancin is a weak CYP3A4 and CYP2D6 inducer. Plasma concentrations and efficacy of venlafaxine may be reduced if these drugs are administered concurrently.
Verapamil: (Moderate) Coadministration of oritavancin and verapamil may result in increases or decreases in verapamil exposure and may increase side effects or decrease efficacy of verapamil. Verapamil is metabolized by CYP3A4 and CYP2C9. Oritavancin weakly induces CYP3A4, while weakly inhibiting CYP2C9. If these drugs are administered concurrently, monitor the patient for signs of toxicity or lack of efficacy.
Vincristine Liposomal: (Minor) Vincristine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of vincristine may be reduced if these drugs are administered concurrently.
Vincristine: (Minor) Vincristine is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of vincristine may be reduced if these drugs are administered concurrently.
Vonoprazan; Amoxicillin; Clarithromycin: (Moderate) Clarithromycin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of clarithromycin may be reduced if these drugs are administered concurrently.
Warfarin: (Moderate) Closely monitor the INR if coadministration of warfarin with oritavancin is necessary as concurrent use may increase or decrease the exposure of warfarin leading to increased bleeding risk or reduced efficacy. Oritavancin is a weak CYP2C9 inhibitor and the S-enantiomer, the active metabolite of warfarin, is a CYP2C9 substrate. Additionally, oritavancin is a weak CYP3A4 inducer and warfarin is a CYP3A4 substrate.
Zafirlukast: (Moderate) Zafirlukast is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated zafirlukast plasma concentrations. If these drugs are administered concurrently, monitor patients for zafirlukast toxicity such as headache, nausea, or diarrhea.
Ziprasidone: (Moderate) Ziprasidone is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of ziprasidone may be reduced if these drugs are administered concurrently.
Zolmitriptan: (Minor) Zolmitriptan is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of zolmitriptan may be reduced if these drugs are administered concurrently.
Zolpidem: (Moderate) Zolpidem is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Plasma concentrations and efficacy of zolpidem may be reduced if these drugs are administered concurrently.

Kimyrsa/ORBACTIV Intravenous Inj Pwd: 400mg, 1200mg

Adults

1200 mg IV.

Geriatric

1200 mg IV.

Adolescents

Safety and efficacy have not been established.

Children

Safety and efficacy have not been established.

Infants

Safety and efficacy have not been established.

Neonates

Safety and efficacy have not been established.

Oritavancin is a semisynthetic lipoglycopeptide antibiotic with bactericidal activity against many gram-positive bacteria. Oritavancin inhibits bacterial cell wall biosynthesis by preventing transglycosylation (polymerization) by binding to the stem peptide of peptidoglycan precursors as well as by preventing transpeptidation (cross-linking) by binding to the peptide bridging segments of the cell wall. Oritavancin also disrupts the bacterial cell membrane integrity, resulting in depolarization, increased permeability, and eventual cell death.[57741]
 
Oritavancin exerts concentration-dependent, bactericidal activity; therefore, antibacterial activity for the drug is best predicted by the ratio of area under the concentration-time curve to minimal inhibitory concentration (AUC/MIC).[57741]
 
The susceptibility interpretive criteria for oritavancin are delineated by pathogen. The MICs for beta-hemolytic streptococci and Streptococcus viridans group are defined as susceptible at concentrations of 0.25 mcg/mL or less. The MICs for E. faecalis (vancomycin-susceptible) and S. aureus (including MRSA) are defined as susceptible at concentrations of 0.12 mcg/mL or less. Breakpoints are based on a dosage regimen of 1,200 mg IV as a single dose.[63320] [63321]
 
In vitro studies have demonstrated synergistic bactericidal effects with gentamicin, moxifloxacin, or rifampicin for methicillin-susceptible S. aureus; with gentamicin or linezolid for vancomycin-intermediate and vancomycin-resistant S. aureus; and with rifampin for vancomycin-resistant S. aureus.[57741]

Oritavancin is administered intravenously. After administration, 85% of the dose is bound to human plasma proteins. The drug is widely distributed into tissues with an approximate volume of distribution of 87.6 L. An evaluation of healthy subjects with skin blisters found drug concentrations in the blister fluid to be approximately 20% of those in plasma after a single 800 mg dose. In vitro studies indicated oritavancin does not undergo metabolism, but rather, is slowly excreted unchanged in the feces and urine. A 2-week collection of feces and urine recovered less than 1% and 5%, respectively, of an administered dose. Oritavancin has a terminal half-life of approximately 245 hours and clearance of 0.445 L/hour.
 
Affected cytochrome P450 isoenzymes and transporters: CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A4
Data from a screening drug-drug interaction study found oritavancin to be a weak inducer of CYP3A4 and CYP2D6 and a weak inhibitor of CYP2C9 and CYP2C19. In vitro studies showed that in addition to inhibiting CYP2C9 and CYP2C19, the drug also inhibited CYP3A4, CYP2D6, CYP1A2, and CYP2B6. However, a single oritavancin dose showed no effect on S-warfarin (a CYP2C9 probe substrate) Cmax or AUC in a drug-drug interaction study. The inhibition of these multiple CYP isoforms observed during the in vitro studies is likely to be reversible and non-competitive.

Intravenous Route

Oritavancin displays linear pharmacokinetics up to the recommended dose of 1,200 mg; an evaluation of the concentration-time profile shows the drug undergoes a multi-exponential decline with a long terminal half-life. In a population pharmacokinetic analysis of patients who received a single oritavancin 1,200 mg IV dose over 3 hours (n = 297), the Cmax was 138 mcg/mL, and the AUC0-24 was 1,110 mcg x hour/mL. In another study in patients who received a single oritavancin 1,200 mg IV dose over 3 hours (n = 50), the Cmax was 112 mcg/mL and the AUC0-72 was 1,470 mcg x hour/mL, and in patients who received a single oritavancin 1,200 mg IV dose over 1 hour (n = 50), the Cmax was 148 mcg/mL and the AUC0-72 was 1,460 mcg x hour/mL.

Pregnancy

There are no available data on oritavancin use during human pregnancy to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. In animal reproduction studies, no effects on embryofetal development or survival were observed in pregnant rats or rabbits treated throughout organogenesis with intravenous oritavancin at doses equivalent to 25% of the single clinical dose of 1,200 mg.

There are no data on the presence of oritavancin in human milk, the effects on the breast-fed child, or the effects on milk production. Oritavancin is present in rat milk. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for oritavancin and any potential adverse effects on the breast-fed infant from oritavancin or the underlying maternal condition. Vancomycin, daptomycin, clindamycin, and sulfamethoxazole; trimethoprim may be potential alternatives to consider during breast-feeding. Site of infection, patient factors, local susceptibility patterns, and specific microbial susceptibility should be assessed before choosing an alternative agent. Alternative antimicrobials that previous American Academy of Pediatrics (AAP) recommendations considered as usually compatible with breast-feeding include clindamycin and sulfamethoxazole; trimethoprim.