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    Glycopeptide Antibiotics

    BOXED WARNING

    Diabetes mellitus, hypertension, mortality, nephrotoxicity, renal disease, renal failure, renal impairment

    Prescribing telavancin to patients with preexisting renal disease (CrCl 50 mL/minute or less) should be avoided unless benefits outweigh the potential risks. This recommendation is based on pooled data from two clinical studies that found the 28 days all-cause mortality rate for nosocomial pneumonia patients with preexisting renal impairment to be higher in telavancin recipients (39%; n = 95/241) than in those treated with vancomycin (30%; n = 72/243). However, in patients with normal renal function (CrCl more than 50 mL/minute), the mortality rates for the 2 drugs were similar; 17% (n = 86/510) for telavancin vs. 18% (n = 92/510) for vancomycin. Studies have also shown that patients with baseline renal dysfunction have a decreased response to treatment with telavancin. In studies involving complicated skin and skin structure infections (cSSI), telavancin-treated patients with preexisting renal disease (CrCl 50 mL/minute or less) had a lower clinical cure rate (67.4%) when compared to patients with normal renal function (87%). In addition, treatment with telavancin may result in the development of nephrotoxicity. In clinical studies, the percentage of telavancin-treated patients experiencing an adverse event indicative of renal impairment (increased serum creatinine, renal impairment/failure) ranged from 3% to 10%. This incidence was higher than what was reported for vancomycin (1% to 8%). Nephrotoxicity was determined to occur more commonly in patients with baseline comorbid conditions (preexisting renal disease, diabetes mellitus, cardiac failure, hypertension, and elderly patients) and in patients concurrently receiving medications that affect kidney function (nonsteroidal antiinflammatory drugs, ACE inhibitors, and loop diuretics). For most patients, serum creatinine concentrations returned to baseline after telavancin discontinuation. Monitor renal function in all patients receiving telavancin; obtain serum creatinine concentrations prior to, during (at 48 to 72 hour intervals), and after treatment discontinuation. The manufacturer recommends a telavancin dose reduction for patients with preexisting renal impairment and cautions against use in patients with renal failure.

    Pregnancy

    Based on findings in animal reproduction studies, telavancin may cause fetal harm. Advise pregnant women of the potential risk to the fetus. There are no available data on telavancin use in human pregnancy to evaluate for drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. In embryo-fetal developmental studies in animals, telavancin demonstrated the potential to cause limb and skeletal malformations when given intravenously during organogenesis at doses providing 1- to 2-fold the human exposure at the maximum recommended clinical dose. Malformations observed at less than 1% included brachymelia, syndactyly, adactyly, and polydactyly. Additional findings included flexed front paw and absent ulna, deformed digits and front leg, decreased fetal body weights, and increased number of stillborn rat pups. There is a pregnancy exposure registry that monitors outcomes in pregnant patients exposed to telavancin; information about the registry can be obtained at www.clinicaltrials.gov or by calling 1-855-633-8479.[36615]

    Contraception requirements, infertility, pregnancy testing, reproductive risk

    Telavancin may be associated with reproductive risk. Verify pregnancy status with pregnancy testing in females of childbearing age before administering telavancin. Additionally, discuss contraception requirements with the patient. Advise females of childbearing potential to use effective contraception during telavancin therapy and for 2 days after the final dose. Based on findings in animals, telavancin may cause male infertility. The effects on fertility, including histopathological changes in the seminiferous tubules and epididymides of the testis, were reversible at the end of a 4-week recovery period in rats.[36615]

    DEA CLASS

    Rx

    DESCRIPTION

    Intravenous lipoglycopeptide antibiotic 
    For complicated skin/skin structure infections caused by susceptible gram-positive bacteria; nosocomial pneumonia caused by S. aureus
    Once daily dosing; carries boxed warnings for use during pregnancy and in patients with renal dysfunction

    COMMON BRAND NAMES

    Vibativ

    HOW SUPPLIED

    Telavancin/Vibativ Intravenous Inj Pwd F/Sol: 750mg

    DOSAGE & INDICATIONS

    For the treatment of complicated skin and skin structure infections caused by susceptible gram-positive bacteria.
    Intravenous dosage
    Adults

    10 mg/kg via intravenous infusion over 60 minutes once every 24 hours for 7—14 days is recommended by the manufacturer and by the Infectious Diseases Society of America (IDSA). Consider the severity and site of infection, patient's clinical status, and bacteriologic progress when determining the duration of therapy. The efficacy of telavancin for the treatment of complicated skin and skin structure infections was compared with vancomycin in two clinical studies (ATLAS 1 and ATLAS 2). Pooled data from these studies resulted in similar clinical cure rates for telavancin and vancomycin (88.3% vs. 87.1% respectively, 95% CI for cure rate difference: -2.1 to 4.6). In addition, the microbiologic response to telavancin and vancomycin were similar with baseline pathogens eradicated in 89.8% of telavancin and 87.3% of vancomycin treated patients (95% CI for response difference: -1.4 to 6.2).

    For the treatment of hospital-acquired and ventilator-associated nosocomial pneumonia caused by Staphylococcus aureus when alternative treatments are not appropriate.
    Intravenous dosage
    Adults

    10 mg/kg via intravenous infusion over 60 minutes once every 24 hours for 7—21 days. Duration of therapy to be based on severity of the infection and clinical status of the patient. Two clinical studies (ATTAIN 1 and ATTAIN 2) compared telavancin to vancomycin for the treatment of hospital-acquired/ventilator-associated pneumonia known or suspected to be caused by methicillin-resistant Staphylococcus aureus. In both studies, patients were randomized to receive telavancin 10 mg/kg IV every 24 hours or vancomycin 1 gm IV every 12 hours (with adjustments based on body weight/renal function) for a total of 7—21 days. The inclusion criteria for these studies stipulated that the pneumonia had to have been acquired after 48 hours in an inpatient acute-care or chronic-care facility, or acquired within 7 days after being discharged following a hospital stay of >= 3 days. Pooled data from these trials suggest the cure rates among clinically evaluable patients were similar for the telavancin (82.7%) and vancomycin (80.9%) treated patients.

    For the treatment of persistent Staphylococcus aureus (MRSA) bacteremia† and vancomycin failure†.
    Intravenous dosage
    Adults

    The Infectious Diseases Society of America (IDSA) 10 mg/kg IV daily in patients with reduced susceptibility to vancomycin and daptomycin. Telavancin may be administered as a single agent or in combination with other antibiotics.

    †Indicates off-label use

    MAXIMUM DOSAGE

    Adults

    10 mg/kg/day IV.

    Elderly

    10 mg/kg/day IV.

    Adolescents

    Safety and efficacy have not been established.

    Children

    Safety and efficacy have not been established.

    DOSING CONSIDERATIONS

    Hepatic Impairment

    Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

    Renal Impairment

    CrCl > 50 ml/min: No dosage adjustment needed.
    CrCl 30—50 ml/min: 7.5 mg/kg IV every 24 hours.
    CrCl 10—29 ml/min: 10 mg/kg IV every 48 hours.

    STORAGE

    Vibativ:
    - Avoid excessive heat (above 104 degrees F)
    - Discard unused portion. Do not store for later use.
    - Store original packages in refrigerator (35 to 46 degrees F), excursions permitted up to 77 degrees F
    - Store unreconstituted product in refrigerator (36 to 46 degrees F)

    CONTRAINDICATIONS / PRECAUTIONS

    General Information

    Telavancin may interfere with urine qualitative dipstick protein assays and quantitative dye methods (pyrogallol red-molybdate). Telavancin does not interfere with microalbumin assays; thus, microalbumin assays can be used to monitor protein excretion during telavancin therapy.

    C. difficile-associated diarrhea, diarrhea, pseudomembranous colitis

    Consider pseudomembranous colitis in patients presenting with diarrhea after antibacterial use. Careful medical history is necessary as pseudomembranous colitis has been reported to occur over 2 months after the administration of antibacterial agents. Almost all antibacterial agents, including telavancin, have been associated with pseudomembranous colitis or C. difficile-associated diarrhea (CDAD) which may range in severity from mild to life-threatening. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.

    Antimicrobial resistance

    When available, obtain appropriate microbiologic cultures to identify the causative pathogens and determine their susceptibility prior to initiating telavancin therapy. Empiric therapy with telavancin may be implemented prior to results of these tests; however, prescribing telavancin in the absence of a bacterial infection or for the treatment of a non-susceptible organism is unlikely to provide benefit and may result in the development of antimicrobial resistance.

    Diabetes mellitus, hypertension, mortality, nephrotoxicity, renal disease, renal failure, renal impairment

    Prescribing telavancin to patients with preexisting renal disease (CrCl 50 mL/minute or less) should be avoided unless benefits outweigh the potential risks. This recommendation is based on pooled data from two clinical studies that found the 28 days all-cause mortality rate for nosocomial pneumonia patients with preexisting renal impairment to be higher in telavancin recipients (39%; n = 95/241) than in those treated with vancomycin (30%; n = 72/243). However, in patients with normal renal function (CrCl more than 50 mL/minute), the mortality rates for the 2 drugs were similar; 17% (n = 86/510) for telavancin vs. 18% (n = 92/510) for vancomycin. Studies have also shown that patients with baseline renal dysfunction have a decreased response to treatment with telavancin. In studies involving complicated skin and skin structure infections (cSSI), telavancin-treated patients with preexisting renal disease (CrCl 50 mL/minute or less) had a lower clinical cure rate (67.4%) when compared to patients with normal renal function (87%). In addition, treatment with telavancin may result in the development of nephrotoxicity. In clinical studies, the percentage of telavancin-treated patients experiencing an adverse event indicative of renal impairment (increased serum creatinine, renal impairment/failure) ranged from 3% to 10%. This incidence was higher than what was reported for vancomycin (1% to 8%). Nephrotoxicity was determined to occur more commonly in patients with baseline comorbid conditions (preexisting renal disease, diabetes mellitus, cardiac failure, hypertension, and elderly patients) and in patients concurrently receiving medications that affect kidney function (nonsteroidal antiinflammatory drugs, ACE inhibitors, and loop diuretics). For most patients, serum creatinine concentrations returned to baseline after telavancin discontinuation. Monitor renal function in all patients receiving telavancin; obtain serum creatinine concentrations prior to, during (at 48 to 72 hour intervals), and after treatment discontinuation. The manufacturer recommends a telavancin dose reduction for patients with preexisting renal impairment and cautions against use in patients with renal failure.

    Apheresis, AV block, bradycardia, cardiomyopathy, celiac disease, females, fever, heart failure, human immunodeficiency virus (HIV) infection, hyperparathyroidism, hypocalcemia, hypokalemia, hypomagnesemia, hypothermia, hypothyroidism, long QT syndrome, myocardial infarction, pheochromocytoma, QT prolongation, rheumatoid arthritis, sickle cell disease, sleep deprivation, stroke, systemic lupus erythematosus (SLE), ventricular dysfunction

    Telavancin has been associated with QT prolongation in clinical studies. The manufacturer recommends avoiding telavancin in patients with a history of congenital long QT syndrome, known prolongation of the QTc interval, uncompensated heart failure, severe left ventricular hypertrophy (ventricular dysfunction), or receiving medications known to prolong the QTc interval, as these conditions may increase the risk of developing QT prolongation. Use telavancin with caution in patients with conditions that may increase the risk of QT prolongation including bradycardia, AV block, heart failure, stress-related cardiomyopathy, myocardial infarction, stroke, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to cause electrolyte imbalances. Females, people 65 years and older, patients with sleep deprivation, pheochromocytoma, sickle cell disease, hypothyroidism, hyperparathyroidism, hypothermia, systemic inflammation (e.g., human immunodeficiency virus (HIV) infection, fever, and some autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus (SLE), and celiac disease) and patients undergoing apheresis procedures (e.g., plasmapheresis [plasma exchange], cytapheresis) may also be at increased risk for QT prolongation. In one of the studies where telavancin was associated with QT prolongation, the effects of telavancin on the QTc interval were evaluated in 160 healthy adult subjects. In this study, subjects were administered 3 daily doses of either 7.5 mg/kg or 15 mg/kg of telavancin intravenously over 60 minutes, moxifloxacin, or placebo. The mean changes from baseline in QTcF (QT data corrected for heart rate) for the 7.5 and 15 mg/kg telavancin-treated patients (3 and 3.4 milliseconds, respectively) was significantly lower than for the moxifloxacin group (8.1 milliseconds). The placebo-corrected mean changes in QTcF were 4.1, 4.5, and 9.2 milliseconds for the 7.5 mg/kg, 15 mg/kg, and moxifloxacin groups respectively. Ten subjects in the 7.5 mg/kg group and 7 in the 15 mg/kg group had a maximum change from baseline in QTcF that equaled or exceeded 30 milliseconds; no subject in any group experienced a QTcF longer than 500 milliseconds.

    Infusion-related reactions, intramuscular administration, subcutaneous administration

    Administer telavancin by intravenous infusion over a period of 60 minutes. Too-rapid intravenous administration of telavancin can lead to infusion-related reactions such as red man syndrome. Signs and symptoms of red man syndrome include flushing of the upper body, urticaria, pruritus, and rash (unspecified). Treatment of these reactions is accomplished through stopping or slowing the infusion rate. Avoid subcutaneous administration and intramuscular administration of telavancin.

    Vancomycin hypersensitivity

    Telavancin is contraindicated for use in patients with a known hypersensitivity to telavancin. Potentially fatal hypersensitivity reactions, such as anaphylactic reactions, may develop after the first or subsequent doses. Immediately discontinue therapy in patients who develop skin rash or other signs of hypersensitivity. Although cross-reactivity with vancomycin is unknown, because telavancin is a synthetic derivative of vancomycin, caution is advised when administering telavancin to patients with a history of vancomycin hypersensitivity.

    Pregnancy

    Based on findings in animal reproduction studies, telavancin may cause fetal harm. Advise pregnant women of the potential risk to the fetus. There are no available data on telavancin use in human pregnancy to evaluate for drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. In embryo-fetal developmental studies in animals, telavancin demonstrated the potential to cause limb and skeletal malformations when given intravenously during organogenesis at doses providing 1- to 2-fold the human exposure at the maximum recommended clinical dose. Malformations observed at less than 1% included brachymelia, syndactyly, adactyly, and polydactyly. Additional findings included flexed front paw and absent ulna, deformed digits and front leg, decreased fetal body weights, and increased number of stillborn rat pups. There is a pregnancy exposure registry that monitors outcomes in pregnant patients exposed to telavancin; information about the registry can be obtained at www.clinicaltrials.gov or by calling 1-855-633-8479.[36615]

    Breast-feeding

    There are no data on the presence of telavancin in human breast milk, the effects on the breast-fed child, or the effects on milk production. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for telavancin and any potential adverse effects on the breast-fed child from telavancin or the underlying maternal condition.[36615] Vancomycin, daptomycin, clindamycin, and sulfamethoxazole; trimethoprim may be potential alternatives to consider during breast-feeding. Assess site of infection, patient factors, local susceptibility patterns, and specific microbial susceptibility before choosing an alternative agent. Vancomycin is excreted in breast milk; however, absorption from the GI tract of any ingested vancomycin would be minimal.[28468] [40955] Daptomycin has a high molecular weight; therefore, excretion into breast milk may be limited. In 1 patient with daptomycin breast milk concentration measured on day 27 of therapy (dose of 6.7 mg/kg IV), a peak concentration of 44.7 mcg/L was obtained 8 hours after the dose with an estimated milk:plasma ratio of 0.0012.[46784] Alternative antimicrobials that previous American Academy of Pediatrics (AAP) recommendations considered as usually compatible with breast-feeding include clindamycin and sulfamethoxazole; trimethoprim.[27500]

    Contraception requirements, infertility, pregnancy testing, reproductive risk

    Telavancin may be associated with reproductive risk. Verify pregnancy status with pregnancy testing in females of childbearing age before administering telavancin. Additionally, discuss contraception requirements with the patient. Advise females of childbearing potential to use effective contraception during telavancin therapy and for 2 days after the final dose. Based on findings in animals, telavancin may cause male infertility. The effects on fertility, including histopathological changes in the seminiferous tubules and epididymides of the testis, were reversible at the end of a 4-week recovery period in rats.[36615]

    Anticoagulant therapy

    By binding to and preventing the actions of phospholipid reagents used in laboratory coagulation tests, telavancin interferes with anticoagulant therapy monitoring. Specifically, telavancin affects prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time (ACT), and coagulation based factor Xa tests; however, telavancin has no effect on coagulation or platelet aggregation. The effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. It is recommended that blood samples for these coagulation tests be collected as close as possible to the patient's next telavancin dose. Concomitant intravenous heparin use is contraindicated. For patients who require aPTT monitoring while being treated with telavancin, a nonphospholipid dependent coagulation test such as a Factor Xa (chromogenic) assay or an alternative anticoagulant not requiring aPTT monitoring may be considered.

    Geriatric

    Use telavancin with caution in the geriatric patient. Treatment with telavancin may result in the development of nephrotoxicity. In clinical studies, nephrotoxicity occurred more commonly in patients with advanced age. Baseline comorbid conditions (preexisting renal dysfunction, diabetes mellitus, heart failure, hypertension) also increased risk, as did concurrent use of medications that may affect kidney function. Geriatric patients may also be at increased risk for developing a prolonged QT interval when using telavancin. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities. According to OBRA, use of antibiotics should be limited to confirmed or suspected bacterial infections. Antibiotics are non-selective and may result in the eradication of beneficial microorganisms while promoting the emergence of undesired ones, causing secondary infections such as oral thrush, colitis, or vaginitis. Any antibiotic may cause diarrhea, nausea, vomiting, anorexia, and hypersensitivity reactions.

    ADVERSE REACTIONS

    Severe

    renal failure (unspecified) / Delayed / 0-5.0
    nephrotoxicity / Delayed / Incidence not known
    C. difficile-associated diarrhea / Delayed / Incidence not known
    anaphylactoid reactions / Rapid / Incidence not known

    Moderate

    erythema / Early / 3.0-3.0
    QT prolongation / Rapid / 1.0-1.0
    infusion-related reactions / Rapid / Incidence not known
    vancomycin infusion reaction / Rapid / Incidence not known
    pseudomembranous colitis / Delayed / Incidence not known
    superinfection / Delayed / Incidence not known
    infertility / Delayed / Incidence not known

    Mild

    metallic taste / Early / 33.0-33.0
    nausea / Early / 5.0-27.0
    vomiting / Early / 5.0-14.0
    diarrhea / Early / 7.0-7.0
    dizziness / Early / 6.0-6.0
    pruritus / Rapid / 6.0-6.0
    chills / Rapid / 4.0-4.0
    rash / Early / 4.0-4.0
    abdominal pain / Early / 2.0-2.0
    headache / Early / Incidence not known
    flushing / Rapid / Incidence not known
    urticaria / Rapid / Incidence not known

    DRUG INTERACTIONS

    Acetaminophen; Aspirin, ASA; Caffeine: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Acyclovir: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as acyclovir may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Adefovir: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as adefovir may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Alfuzosin: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with alfuzosin. Telavancin has been associated with QT prolongation. Alfuzosin may also prolong the QT interval in a dose-dependent manner.
    Amikacin: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs (e.g., systemic aminoglycosides) may lead to additive nephrotoxicity. Televancin is closely related to vancomycin. In one clinical study, vancomycin coadministration, high aminoglycoside trough levels, and heart failure independently predicted acute kidney injury during aminoglycoside treatment. Closely monitor renal function and adjust telavancin doses based on creatinine clearance/renal function, and aminoglycoside doses based on renal function and serum aminoglycoside concentrations as clinically indicated.
    Aminoglycosides: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs (e.g., systemic aminoglycosides) may lead to additive nephrotoxicity. Televancin is closely related to vancomycin. In one clinical study, vancomycin coadministration, high aminoglycoside trough levels, and heart failure independently predicted acute kidney injury during aminoglycoside treatment. Closely monitor renal function and adjust telavancin doses based on creatinine clearance/renal function, and aminoglycoside doses based on renal function and serum aminoglycoside concentrations as clinically indicated.
    Aminosalicylate sodium, Aminosalicylic acid: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Amiodarone: (Major) The concomitant use of amiodarone and telavancin should only be done after careful assessment of risks versus benefits. If possible, avoid coadministration. Telavancin has been associated with QT prolongation. Amiodarone, a Class III antiarrhythmic agent, is associated with a well-established risk of QT prolongation and torsades de pointes (TdP). Although the frequency of TdP is less with amiodarone than with other Class III agents, amiodarone is still associated with a risk of TdP. Due to the extremely long half-life of amiodarone, a drug interaction is possible for days to weeks after discontinuation of amiodarone.
    Amisulpride: (Major) Monitor ECGs for QT prolongation when amisulpride is administered with telavancin. Amisulpride causes dose- and concentration- dependent QT prolongation. Telavancin has been associated with QT prolongation.
    Amlodipine; Benazepril: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Amlodipine; Celecoxib: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Amoxicillin; Clarithromycin; Omeprazole: (Major) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering clarithromycin with telavancin. Both telavancin and clarithromycin are associated with QT prolongation, while clarithromycin is also associated with an established risk for TdP.
    Amphotericin B cholesteryl sulfate complex (ABCD): (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as amphotericin B may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Amphotericin B lipid complex (ABLC): (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as amphotericin B may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Amphotericin B liposomal (LAmB): (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as amphotericin B may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Amphotericin B: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as amphotericin B may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Anagrelide: (Major) Torsades de pointes (TdP) and ventricular tachycardia have been reported during post-marketing use of anagrelide. A cardiovascular examination, including an ECG, should be obtained in all patients prior to initiating anagrelide therapy. Monitor patients during anagrelide therapy for cardiovascular effects and evaluate as necessary. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with anagrelide include telavancin.
    Angiotensin-converting enzyme inhibitors: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Antithrombin III: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with other anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Apixaban: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Apomorphine: (Moderate) Exercise caution when administering apomorphine concomitantly with telavancin since concurrent use may increase the risk of QT prolongation. Dose-related QTc prolongation is associated with therapeutic apomorphine exposure. Telavancin has been associated with QT prolongation.
    Argatroban: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Aripiprazole: (Moderate) Use caution if telavancin is administered with aripiprazole as concurrent use may increase the risk of QT prolongation. Telavancin has been associated with QT prolongation. QT prolongation has occurred during therapeutic use of aripiprazole and following overdose.
    Arsenic Trioxide: (Major) Concurrent use of arsenic trioxide and telavancin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Telavancin has been associated with QT prolongation and should be discontinued prior to initiating arsenic trioxide therapy. QT prolongation should be expected with the administration of arsenic trioxide. TdP and complete atrioventricular block have also been reported with arsenic trioxide.
    Artemether; Lumefantrine: (Major) Concurrent use of telavancin and artemether; lumefantrine should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Consider ECG monitoring if telavancin must be used with or after artemether; lumefantrine treatment. Both telavancin and artemether; lumefantrine are associated with prolongation of the QT interval.
    Asenapine: (Major) Telavancin and asenapine have been associated with QT prolongation. According to the manufacturer, telavancin should be used with caution when prescribing other agents also known to prolong the QT interval. However, according to the manufacturer of asenapine, the drug should be avoided in combination with other agents also known to prolong the QT interval.
    Aspirin, ASA: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Butalbital; Caffeine: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Butalbital; Caffeine; Codeine: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Caffeine: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Caffeine; Dihydrocodeine: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Caffeine; Orphenadrine: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Carisoprodol: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Carisoprodol; Codeine: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Dipyridamole: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Omeprazole: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Oxycodone: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Aspirin, ASA; Pravastatin: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Atomoxetine: (Moderate) Use caution if telavancin is administered with atomoxetine as concurrent use may increase the risk of QT prolongation. Telavancin has been associated with QT prolongation. QT prolongation has occurred during therapeutic use o atomoxetine and following overdose.
    Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Azithromycin: (Major) Avoid coadministration of azithromycin with telavancin due to the increased risk of QT prolongation. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. QT prolongation and torsade de pointes (TdP) have been spontaneously reported during azithromycin postmarketing surveillance. Telavancin has been associated with QT prolongation.
    Bacitracin: (Minor) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as systemic bacitracin may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Bedaquiline: (Major) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering bedaquiline with telavancin. Both drugs have been reported to prolong the QT interval. Prior to initiating bedaquiline, obtain serum electrolyte concentrations and a baseline ECG. An ECG should also be performed at least 2, 12, and 24 weeks after starting bedaquiline therapy.
    Benazepril: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: (Moderate) Concomitant use of metronidazole and telavancin may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP.
    Bismuth Subsalicylate: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Bismuth Subsalicylate; Metronidazole; Tetracycline: (Moderate) Concomitant use of metronidazole and telavancin may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Bivalirudin: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Bumetanide: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as loop diuretics may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Bupivacaine; Meloxicam: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Buprenorphine: (Major) Buprenorphine has been associated with QT prolongation and has a possible risk of torsade de pointes (TdP). FDA-approved labeling for some buprenorphine products recommend avoiding use with Class 1A and Class III antiarrhythmic medications while other labels recommend avoiding use with any drug that has the potential to prolong the QT interval, such as telavancin. Coadministration may further increase the risk of QT prolongation and TdP.
    Buprenorphine; Naloxone: (Major) Buprenorphine has been associated with QT prolongation and has a possible risk of torsade de pointes (TdP). FDA-approved labeling for some buprenorphine products recommend avoiding use with Class 1A and Class III antiarrhythmic medications while other labels recommend avoiding use with any drug that has the potential to prolong the QT interval, such as telavancin. Coadministration may further increase the risk of QT prolongation and TdP.
    Cabotegravir; Rilpivirine: (Moderate) Caution is advised when administering rilpivirine with telavancin as concurrent use may increase the risk of QT prolongation. Supratherapeutic doses of rilpivirine (75 to 300 mg/day) have caused QT prolongation. Telavancin has also been associated with QT prolongation.
    Captopril: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Celecoxib: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Celecoxib; Tramadol: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Ceritinib: (Major) Avoid coadministration of ceritinib with telavancin if possible due to the risk of QT prolongation. If concomitant use is unavoidable, periodically monitor ECGs and electrolytes; an interruption of ceritinib therapy, dose reduction, or discontinuation of therapy may be necessary if QT prolongation occurs. Ceritinib causes concentration-dependent prolongation of the QT interval. Telavancin is also associated with QT prolongation.
    Chloroquine: (Major) Avoid coadministration of chloroquine with telavancin due to the increased risk of QT prolongation. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Chloroquine is associated with an increased risk of QT prolongation and torsade de pointes (TdP); the risk of QT prolongation is increased with higher chloroquine doses. Telavancin has also been associated with QT prolongation.
    Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Chlorpromazine: (Major) Concurrent use of chlorpromazine and telavancin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Telavancin has been associated with QT prolongation. Phenothiazines have also been associated with a risk of QT prolongation and/or TdP. This risk is generally higher at elevated drugs concentrations of phenothiazines. Chlorpromazine is specifically associated with an established risk of QT prolongation and TdP; case reports have included patients receiving therapeutic doses of chlorpromazine.
    Choline Salicylate; Magnesium Salicylate: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Cidofovir: (Contraindicated) The administration of cidofovir with other potentially nephrotoxic drugs such as telavancin is contraindicated. Discontinue telavancin at least 7 days prior to beginning cidofovir.
    Ciprofloxacin: (Moderate) Due to an increased risk for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with ciprofloxacin. Telavancin has been associated with QT prolongation. Rare cases of QT prolongation and TdP have been reported with ciprofloxacin during postmarketing surveillance
    Cisapride: (Contraindicated) Telavancin has been associated with QT prolongation. Because of the potential for torsade de pointes (TdP), use of cisapride with telavancin is contraindicated.
    Cisplatin: (Moderate) Closely monitor renal function if concomitant use with cisplatin and telavancin is necessary. Both drugs can cause nephrotoxicity, which may be additive when used together.
    Citalopram: (Major) Concurrent use of citalopram and telavancin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). If concurrent therapy is considered essential, ECG monitoring is recommended. Citalopram causes dose-dependent QT interval prolongation. Telavancin has also been associated with QT prolongation.
    Clarithromycin: (Major) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering clarithromycin with telavancin. Both telavancin and clarithromycin are associated with QT prolongation, while clarithromycin is also associated with an established risk for TdP.
    Class IA Antiarrhythmics: (Major) Class IA antiarrhythmics (disopyramide, procainamide, quinidine) should be used cautiously with telavancin. Class IA antiarrhythmics are associated with QT prolongation and torsades de pointes (TdP) and telavancin has been associated with QT prolongation.
    Clindamycin: (Moderate) Concomitant use of telavancin and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Clofazimine: (Major) Monitor ECGs for QT prolongation when clofazimine is administered with telavancin. QT prolongation and torsade de pointes have been reported in patients receiving clofazimine in combination with QT prolonging medications. Telavancin has been associated with QT prolongation.
    Clozapine: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with clozapine. Telavancin has been associated with QT prolongation, while treatment with clozapine has been associated with QT prolongation, TdP, cardiac arrest, and sudden death.
    Codeine; Phenylephrine; Promethazine: (Moderate) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with promehtazine. Both promethazine and telavancin have been associated with QT prolongation.
    Codeine; Promethazine: (Moderate) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with promehtazine. Both promethazine and telavancin have been associated with QT prolongation.
    Colistin: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs, such as colistimethate sodium, may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Crizotinib: (Major) Avoid coadministration of crizotinib with telavancin due to the risk of QT prolongation. If concomitant use is unavoidable, monitor ECGs for QT prolongation and monitor electrolytes. An interruption of therapy, dose reduction, or discontinuation of therapy may be necessary for crizotinib if QT prolongation occurs. Crizotinib has been associated with concentration-dependent QT prolongation. Telavancin has also been associated with QT prolongation.
    Cyclosporine: (Minor) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as cyclosporine may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Dabigatran: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Danaparoid: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Dasatinib: (Moderate) Monitor for evidence of QT prolongation during concurrent use of dasatinib and telavancin. In vitro studies have shown that dasatinib has the potential to prolong the QT interval. Telavancin has been associated with QT prolongation.
    Degarelix: (Moderate) Consider whether the benefits of androgen deprivation therapy outweigh the potential risks in patients receiving telavancin as concurrent use may increase the risk of QT prolongation. Androgen deprivation therapy (i.e., degarelix) may prolong the QT/QTc interval. Telavancin has been associated with QT prolongation.
    Desirudin: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Deutetrabenazine: (Moderate) Use caution if telavancin is administered with deutetrabenazine. Telavancin has been associated with QT prolongation. Deutetrabenazine may prolong the QT interval, but the degree of QT prolongation is not clinically significant when deutetrabenazine is administered within the recommended dosage range. Telavancin has been associated with QT prolongation.
    Diclofenac: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Diclofenac; Misoprostol: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Diflunisal: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Diphenhydramine; Ibuprofen: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Diphenhydramine; Naproxen: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Dofetilide: (Major) Coadministration of dofetilide and telavancin is not recommended as concurrent use may increase the risk of QT prolongation. Dofetilide, a Class III antiarrhythmic agent, is associated with a well-established risk of QT prolongation and torsade de pointes (TdP). Telavancin has been associated with QT prolongation.
    Dolasetron: (Moderate) Administer dolasetron with caution in combination with telavancin as concurrent use may increase the risk of QT prolongation. Telavancin has been associated with QT prolongation. Dolasetron has been associated with a dose-dependent prolongation in the QT, PR, and QRS intervals on an electrocardiogram.
    Dolutegravir; Rilpivirine: (Moderate) Caution is advised when administering rilpivirine with telavancin as concurrent use may increase the risk of QT prolongation. Supratherapeutic doses of rilpivirine (75 to 300 mg/day) have caused QT prolongation. Telavancin has also been associated with QT prolongation.
    Donepezil: (Moderate) Use donepezil with caution in combination with telavancin as concurrent use may increase the risk of QT prolongation. Case reports indicate that QT prolongation and torsade de pointes (TdP) can occur during donepezil therapy. Telavancin has been associated with QT prolongation.
    Donepezil; Memantine: (Moderate) Use donepezil with caution in combination with telavancin as concurrent use may increase the risk of QT prolongation. Case reports indicate that QT prolongation and torsade de pointes (TdP) can occur during donepezil therapy. Telavancin has been associated with QT prolongation.
    Dronedarone: (Contraindicated) Concurrent use of dronedarone and telavancin is contraindicated. Telavancin has been associated with QT prolongation. Dronedarone administration is associated with a dose-related increase in the QTc interval. The increase in QTc is approximately 10 milliseconds at doses of 400 mg twice daily (the FDA-approved dose) and up to 25 milliseconds at doses of 1600 mg twice daily. Although there are no studies examining the effects of dronedarone in patients receiving other QT prolonging drugs, coadministration of such drugs may result in additive QT prolongation.
    Droperidol: (Major) Droperidol should be administered with extreme caution to patients receiving other agents that may prolong the QT interval. Droperidol administration is associated with an established risk for QT prolongation and torsades de pointes (TdP). Any drug known to have potential to prolong the QT interval should not be coadministered with droperidol. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with droperidol include telavancin.
    Efavirenz: (Moderate) Consider alternatives to efavirenz when coadministering with telavancin. QTc prolongation has been observed with the use of efavirenz. Telavancin has been associated with QT prolongation.
    Efavirenz; Emtricitabine; Tenofovir: (Moderate) Consider alternatives to efavirenz when coadministering with telavancin. QTc prolongation has been observed with the use of efavirenz. Telavancin has been associated with QT prolongation.
    Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: (Moderate) Consider alternatives to efavirenz when coadministering with telavancin. QTc prolongation has been observed with the use of efavirenz. Telavancin has been associated with QT prolongation.
    Eliglustat: (Moderate) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with eliglustat. Telavancin has been associated with QT prolongation. Eliglustat is predicted to cause PR, QRS, and/or QT prolongation at significantly elevated plasma concentrations.
    Emtricitabine; Rilpivirine; Tenofovir alafenamide: (Moderate) Caution is advised when administering rilpivirine with telavancin as concurrent use may increase the risk of QT prolongation. Supratherapeutic doses of rilpivirine (75 to 300 mg/day) have caused QT prolongation. Telavancin has also been associated with QT prolongation.
    Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate: (Moderate) Caution is advised when administering rilpivirine with telavancin as concurrent use may increase the risk of QT prolongation. Supratherapeutic doses of rilpivirine (75 to 300 mg/day) have caused QT prolongation. Telavancin has also been associated with QT prolongation.
    Enalapril, Enalaprilat: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Enalapril; Felodipine: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Encorafenib: (Major) Avoid coadministration of encorafenib and telavancin due to the potential for additive QT prolongation. If concurrent use cannot be avoided, monitor ECGs for QT prolongation and monitor electrolytes; correct hypokalemia and hypomagnesemia prior to treatment. Encorafenib is associated with dose-dependent prolongation of the QT interval. Telavancin has been associated with QT prolongation.
    Entrectinib: (Major) Avoid coadministration of entrectinib with telavancin due to the risk of QT prolongation. Both entrectinib and telavancin have been associated with QT prolongation.
    Eribulin: (Major) Eribulin has been associated with QT prolongation. If eribulin and another drug that prolongs the QT interval, such as telavancin, must be coadministered, ECG monitoring is recommended; closely monitor the patient for QT interval prolongation.
    Erythromycin: (Major) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with erythromycin. Both telavancin and erythromycin have been associated with QT prolongation, while erythromycin is also associated with cases of TdP.
    Erythromycin; Sulfisoxazole: (Major) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with erythromycin. Both telavancin and erythromycin have been associated with QT prolongation, while erythromycin is also associated with cases of TdP.
    Escitalopram: (Moderate) Use escitalopram with caution in combination with telavancin as concurrent use may increase the risk of QT prolongation. Escitalopram has been associated with a risk of QT prolongation and torsade de pointes (TdP). Telavancin has been associated with QT prolongation.
    Ethacrynic Acid: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as loop diuretics may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Etodolac: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Ezogabine: (Moderate) Use caution if telavancin is administered with ezogabine as concurrent use may increase the risk of QT prolongation. Telavancin and ezogabine have been associated with QT prolongation.
    Famotidine; Ibuprofen: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Fenoprofen: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Fingolimod: (Moderate) Exercise caution when administering fingolimod concomitantly with telavancin. Telavancin has been associated with QT prolongation. Fingolimod initiation results in decreased heart rate and may prolong the QT interval. Fingolimod has not been studied in patients treated with drugs that prolong the QT interval, but drugs that prolong the QT interval have been associated with cases of TdP in patients with bradycardia.
    Flecainide: (Major) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with flecainide. Telavancin has been associated with QT prolongation. Flecainide is a Class IC antiarrhythmic and is also associated with a possible risk for QT prolongation and/or TdP; flecainide increases the QT interval, but largely due to prolongation of the QRS interval. Although causality for TdP has not been established for flecainide, patients receiving concurrent drugs which have the potential for QT prolongation may have an increased risk of developing proarrhythmias.
    Fluconazole: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with fluconazole. Telavancin has been associated with QT prolongation. Fluconazole has also been associated with QT prolongation and rare cases of TdP.
    Fluoxetine: (Moderate) Use caution if telavancin is administered with fluoxetine as concurrent use may increase the risk of QT prolongation. Coadministration may increase the risk for QT prolongation and torsade de pointes (TdP). QT prolongation and TdP have been reported in patients treated with fluoxetine. Telavancin has also been associated with QT prolongation.
    Fluphenazine: (Minor) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with fluphenazine. Telavancin has been associated with QT prolongation. Fluphenazine, a phenothiazine, is also associated with a possible risk for QT prolongation.
    Flurbiprofen: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Fluvoxamine: (Moderate) There may be an increased risk for QT prolongation and torsade de pointes (TdP) during concurrent use of fluvoxamine and telavancin. Telavancin has been associated with QT prolongation. Cases of QT prolongation and TdP have been reported during postmarketing use of fluvoxamine.
    Fondaparinux: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Foscarnet: (Major) When possible, avoid concurrent use of foscarnet with other drugs known to prolong the QT interval, such as telavancin. Foscarnet has been associated with postmarketing reports of both QT prolongation and torsade de pointes (TdP). Telavancin has also been associated with QT prolongation. If these drugs are administered together, obtain an electrocardiogram and electrolyte concentrations before and periodically during treatment. Also, concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as foscarnet may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Fosinopril: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Fostemsavir: (Moderate) Use caution if telavancin is administered with fostemsavir due to the potential for QT prolongation. Telavancin has been associated with QT prolongation. Supratherapeutic doses of fostemsavir (2,400 mg twice daily, four times the recommended daily dose) have been shown to cause QT prolongation. Fostemsavir causes dose-dependent QT prolongation.
    Furosemide: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as loop diuretics may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Ganciclovir: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as ganciclovir may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Gemifloxacin: (Moderate) Due to an increased risk for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with gemifloxacin. Telavancin has been associated with QT prolongation. Gemifloxacin may also prolong the QT interval in some patients, with the maximal change in the QTc interval occurring approximately 5 to 10 hours following oral administration. The likelihood of QTc prolongation may increase with increasing dose of gemifloxacin; therefore, the recommended dose should not be exceeded especially in patients with renal or hepatic impairment where the Cmax and AUC are slightly higher.
    Gemtuzumab Ozogamicin: (Moderate) Use gemtuzumab ozogamicin and telavancin together with caution due to the potential for additive QT interval prolongation and risk of torsade de pointes (TdP). If these agents are used together, obtain an ECG and serum electrolytes prior to the start of gemtuzumab and as needed during treatment. Although QT interval prolongation has not been reported with gemtuzumab, it has been reported with other drugs that contain calicheamicin. Telavancin has been associated with QT prolongation.
    Gentamicin: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs (e.g., systemic aminoglycosides) may lead to additive nephrotoxicity. Televancin is closely related to vancomycin. In one clinical study, vancomycin coadministration, high aminoglycoside trough levels, and heart failure independently predicted acute kidney injury during aminoglycoside treatment. Closely monitor renal function and adjust telavancin doses based on creatinine clearance/renal function, and aminoglycoside doses based on renal function and serum aminoglycoside concentrations as clinically indicated.
    Gilteritinib: (Moderate) Use caution and monitor for additive QT prolongation if concurrent use of gilteritinib and telavancin is necessary. Both drugs have been associated with QT prolongation.
    Glasdegib: (Major) Avoid coadministration of glasdegib with telavancin due to the potential for additive QT prolongation. If coadministration cannot be avoided, monitor patients for increased risk of QT prolongation with increased frequency of ECG monitoring. Glasdegib therapy may result in QT prolongation and ventricular arrhythmias including ventricular fibrillation and ventricular tachycardia. Telavancin has also been associated with QT prolongation.
    Goserelin: (Moderate) Consider whether the benefits of androgen deprivation therapy (i.e., goserelin) outweigh the potential risks of QT prolongation in patients receiving telavancin as concurrent use may increase the risk of QT prolongation. Androgen deprivation therapy may prolong the QT/QTc interval and telavancin has also been associated with QT prolongation.
    Granisetron: (Moderate) Use granisetron with caution in combination with telavancin due to increased risk for QT prolongation. Both granisetron and telavancin have been associated with QT prolongation.
    Halogenated Anesthetics: (Major) Telavancin has been associated with QT prolongation. According to the manufacturer, telavancin should be used with caution when prescribing other agents also known to prolong the QT interval (e.g., halogenated anesthetics).
    Haloperidol: (Moderate) Caution is advisable when combining haloperidol concurrently with telavancin as concurrent use may increase the risk of QT prolongation. QT prolongation and torsade de pointes (TdP) have been observed during haloperidol treatment. Excessive doses (particularly in the overdose setting) or IV administration of haloperidol may be associated with a higher risk of QT prolongation. Telavancin has also been associated with QT prolongation.
    Heparin: (Contraindicated) Concomitant use of intravenous unfractionated heparin infusions and telavancin is contraindicated as the activated partial thromboplastin time (aPTT) test results are expected to be artificially prolonged for 0 to 18 hours after telavancin administration. Although telavancin does not increase bleeding risk and has no effect on platelet aggregation, it does interfere with some coagulation tests by binding to and preventing activation of coagulation by phospholipid reagents commonly used in laboratory tests. For patients who require aPTT monitoring while being treated with telavancin, a nonphospholipid dependent coagulation test, such as a Factor Xa (chromogenic) assay, or an alternative anticoagulant not requiring aPTT monitoring may be considered.
    Histrelin: (Moderate) Consider whether the benefits of androgen deprivation therapy (i.e., histrelin) outweigh the potential risks of QT prolongation in patients receiving telavancin as concurrent use may increase the risk of QT prolongation. Androgen deprivation therapy may prolong the QT/QTc interval and telavancin has been associated with QT prolongation.
    Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Hydrocodone; Ibuprofen: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Hydroxychloroquine: (Major) Avoid coadministration of hydroxychloroquine and telavancin. Hydroxychloroquine increases the QT interval and should not be administered with other drugs known to prolong the QT interval. Ventricular arrhythmias and torsade de pointes have been reported with the use of hydroxychloroquine. Telavancin has been associated with QT prolongation.
    Hydroxyzine: (Moderate) Caution is recommended if hydroxyzine is administered with telavancin due to the potential for additive QT prolongation and risk of torsade de pointes (TdP). Postmarketing data indicate that hydroxyzine causes QT prolongation and TdP. Telavancin has been associated with QT prolongation.
    Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Ibuprofen: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Ibuprofen; Oxycodone: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Ibuprofen; Pseudoephedrine: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Ibutilide: (Major) Ibutilide administration can cause QT prolongation and torsades de pointes (TdP); proarrhythmic events should be anticipated. The potential for proarrhythmic events with ibutilide increases with the coadministration of other drugs that prolong the QT interval. Telavancin has been associated with QT prolongation. Use caution and close monitoring during concurrent administration.
    Iloperidone: (Major) Iloperidone has been associated with QT prolongation; however, torsade de pointes (TdP) has not been reported. According to the manufacturer, since iloperidone may prolong the QT interval, it should be avoided in combination with other agents also known to have this effect, such as telavancin.
    Indomethacin: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Inotuzumab Ozogamicin: (Major) Avoid coadministration of inotuzumab ozogamicin with telavancin due to the potential for additive QT prolongation and risk of torsade de pointes (TdP). If coadministration is unavoidable, obtain an ECG and serum electrolytes prior to the start of treatment, after treatment initiation, and periodically during treatment. Both inotuzumab and telavancin have been associated with QT interval prolongation.
    Itraconazole: (Moderate) Use itraconazole with caution in combination with telavancin as concurrent use may increase the risk of QT prolongation. Itraconazole and telavancin have been associated with prolongation of the QT interval.
    Ivosidenib: (Major) Avoid coadministration of ivosidenib with telavancin due to an increased risk of QT prolongation. If concomitant use is unavoidable, monitor ECGs for QTc prolongation and monitor electrolytes; correct any electrolyte abnormalities as clinically appropriate. An interruption of therapy and dose reduction of ivosidenib may be necessary if QT prolongation occurs. Prolongation of the QTc interval and ventricular arrhythmias have been reported in patients treated with ivosidenib. Telavancin has been associated with QT prolongation.
    Kanamycin: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs (e.g., systemic aminoglycosides) may lead to additive nephrotoxicity. Televancin is closely related to vancomycin. In one clinical study, vancomycin coadministration, high aminoglycoside trough levels, and heart failure independently predicted acute kidney injury during aminoglycoside treatment. Closely monitor renal function and adjust telavancin doses based on creatinine clearance/renal function, and aminoglycoside doses based on renal function and serum aminoglycoside concentrations as clinically indicated.
    Ketoconazole: (Moderate) Use ketoconazole with caution in combination with telavancin. Ketoconazole and telavancin have both been associated with prolongation of the QT interval.
    Ketoprofen: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Ketorolac: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Lansoprazole; Amoxicillin; Clarithromycin: (Major) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering clarithromycin with telavancin. Both telavancin and clarithromycin are associated with QT prolongation, while clarithromycin is also associated with an established risk for TdP.
    Lansoprazole; Naproxen: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Lapatinib: (Moderate) Monitor ECGs for QT prolongation and monitor electrolytes if coadministration of lapatinib with telavancin is necessary; correct electrolyte abnormalities prior to treatment. Telavancin has been associated with QT prolongation. Lapatinib has also been associated with concentration-dependent QT prolongation; ventricular arrhythmias and torsade de pointes (TdP) have been reported in postmarketing experience with lapatinib.
    Lefamulin: (Major) Avoid coadministration of lefamulin with telavancin as concurrent use may increase the risk of QT prolongation. If coadministration cannot be avoided, monitor ECG during treatment. Lefamulin has a concentration dependent QTc prolongation effect. The pharmacodynamic interaction potential to prolong the QT interval of the electrocardiogram between lefamulin and other drugs that effect cardiac conduction is unknown. Telavancin has been associated with QT prolongation.
    Lenvatinib: (Major) Avoid coadministration of lenvatinib with telavancin due to the risk of QT prolongation. Prolongation of the QT interval has been reported with lenvatinib therapy. Telavancin also has been associated with QT prolongation.
    Lepirudin: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Leuprolide: (Moderate) Consider whether the benefits of androgen deprivation therapy (i.e., leuprolide) outweigh the potential risks of QT prolongation in patients receiving telavancin as concurrent use may increase the risk of QT prolongation. Telavancin has been associated with QT prolongation. Androgen deprivation therapy may also prolong the QT/QTc interval.
    Leuprolide; Norethindrone: (Moderate) Consider whether the benefits of androgen deprivation therapy (i.e., leuprolide) outweigh the potential risks of QT prolongation in patients receiving telavancin as concurrent use may increase the risk of QT prolongation. Telavancin has been associated with QT prolongation. Androgen deprivation therapy may also prolong the QT/QTc interval.
    Levofloxacin: (Moderate) Use caution if telavancin is administered with levofloxacin. Telavancin has been associated with QT prolongation. Levofloxacin has been associated with a risk of QT prolongation and torsade de pointes (TdP). Although extremely rare, TdP has been reported during postmarketing surveillance of levofloxacin.
    Levoketoconazole: (Moderate) Use ketoconazole with caution in combination with telavancin. Ketoconazole and telavancin have both been associated with prolongation of the QT interval.
    Lisinopril: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Lithium: (Moderate) Lithium should be used cautiously and with close monitoring with telavancin. Both lithium and telavancin have been associated with QT prolongation.
    Lofexidine: (Major) Monitor ECG if lofexidine is coadministered with telavancin due to the potential for additive QT prolongation. Lofexidine prolongs the QT interval. In addition, there are postmarketing reports of torsade de pointes. Telavancin has been associated with QT prolongation.
    Loop diuretics: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as loop diuretics may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Loperamide: (Moderate) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with loperamide. Telavancin has been associated with QT prolongation. At high doses, loperamide has been associated with serious cardiac toxicities, including syncope, ventricular tachycardia, QT prolongation, TdP, and cardiac arrest.
    Loperamide; Simethicone: (Moderate) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with loperamide. Telavancin has been associated with QT prolongation. At high doses, loperamide has been associated with serious cardiac toxicities, including syncope, ventricular tachycardia, QT prolongation, TdP, and cardiac arrest.
    Lopinavir; Ritonavir: (Major) Avoid coadministration of lopinavir with telavancin due to the potential for additive QT prolongation. If use together is necessary, obtain a baseline ECG to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances. Both drugs have been associated with QT prolongation.
    Low Molecular Weight Heparins: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Macimorelin: (Major) Avoid concurrent administration of macimorelin with drugs that prolong the QT interval, such as telavancin. Use of these drugs together may increase the risk of developing torsade de pointes-type ventricular tachycardia. Sufficient washout time of drugs that are known to prolong the QT interval prior to administration of macimorelin is recommended. Treatment with macimorelin has been associated with an increase in the corrected QT (QTc) interval. Telavancin has been associated with QT prolongation.
    Magnesium Salicylate: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Maprotiline: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with maprotiline. Telavancin has been associated with QT prolongation. Maprotiline has also been reported to prolong the QT interval, particularly in overdose or with higher-dose prescription therapy (elevated serum concentrations). Cases of long QT syndrome and TdP tachycardia have been described with maprotiline use, but rarely occur when the drug is used alone in normal prescribed doses and in the absence of other known risk factors for QT prolongation. Limited data are available regarding the safety of maprotiline in combination with other QT-prolonging drugs.
    Meclofenamate Sodium: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Mefenamic Acid: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Mefloquine: (Moderate) Mefloquine should be used with caution in patients receiving telavancin as concurrent use may increase the risk of QT prolongation. Telavancin has been associated with QT prolongation. There is also evidence that the use of halofantrine after mefloquine causes a significant lengthening of the QTc interval. Mefloquine alone has not been reported to cause QT prolongation. However, due to the lack of clinical data, mefloquine should be used with caution in patients receiving drugs that prolong the QT interval.
    Meloxicam: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Meperidine; Promethazine: (Moderate) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with promehtazine. Both promethazine and telavancin have been associated with QT prolongation.
    Methadone: (Major) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with methadone. The need to coadminister these drugs should be done with careful assessment of treatment risks versus benefits. Telavancin has been associated with QT prolongation. Methadone is considered to be associated with an increased risk for QT prolongation and TdP, especially at higher doses (> 200 mg/day but averaging approximately 400 mg/day in adult patients). Laboratory studies, both in vivo and in vitro, have demonstrated that methadone inhibits cardiac potassium channels and prolongs the QT interval. Most cases involve patients being treated for pain with large, multiple daily doses of methadone, although cases have been reported in patients receiving doses commonly used for maintenance treatment of opioid addiction.
    Metronidazole: (Moderate) Concomitant use of metronidazole and telavancin may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP.
    Midostaurin: (Major) The concomitant use of midostaurin and telavancin may lead to additive QT interval prolongation. If these drugs are used together, consider electrocardiogram monitoring. In clinical trials, QT prolongation has been reported in patients who received midostaurin as single-agent therapy or in combination with cytarabine and daunorubicin and in patients who received telavancin.
    Mifepristone: (Major) Due to a possible risk for QT prolongation and torsade de pointes (TdP), mifepristone and telavancin should be used together cautiously. Mifepristone has been associated with dose-dependent prolongation of the QT interval. There is no experience with high exposure or concomitant use with other QT prolonging drugs. To minimize the risk of QT prolongation, the lowest effective dose should always be used. Telavancin has been associated with QT prolongation.
    Mirtazapine: (Moderate) Coadminister mirtazapine and telavancin with caution as concurrent use may lead to increased risks for QT prolongation and torsade de pointes (TdP). Telavancin has been associated with QT prolongation. Mirtazapine has ben associated with dose-dependent prolongation of the QT interval. TdP has been reported postmarketing, primarily in overdose or in patients with other risk factors for QT prolongation.
    Mobocertinib: (Major) Concomitant use of mobocertinib and telavancin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary.
    Moexipril: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Moxifloxacin: (Major) Concurrent use of telavancin and moxifloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Telavancin has been associated with QT prolongation. Moxifloxacin has also been associated with prolongation of the QT interval. Additionally, post-marketing surveillance has identified very rare cases of ventricular arrhythmias including TdP, usually in patients with severe underlying proarrhythmic conditions. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin, therefore the recommended dose or infusion rate should not be exceeded.
    Nabumetone: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Naproxen: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Naproxen; Esomeprazole: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Naproxen; Pseudoephedrine: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Nilotinib: (Major) Avoid the concomitant use of nilotinib and telavancin; significant prolongation of the QT interval may occur. Sudden death and QT prolongation have occurred in patients who received nilotinib therapy. Telavancin has been associated with QT prolongation.
    Nonsteroidal antiinflammatory drugs: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Norfloxacin: (Moderate) Due to an increased risk for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with norfloxacin. Telavancin has been associated with QT prolongation. Quinolones have also been associated with QT prolongation and TdP. For norfloxacin specifically, extremely rare cases of TdP were reported during post-marketing surveillance. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory.
    Octreotide: (Moderate) Use octreotide with caution in combination with telavancin. Telavancin has been associated with QT prolongation. Arrhythmias, sinus bradycardia, and conduction disturbances have occurred during octreotide therapy. Since bradycardia is a risk factor for development of torsade de pointes (TdP), the potential occurrence of bradycardia during octreotide administration could theoretically increase the risk of TdP in patients receiving drugs that prolong the QT interval.
    Ofloxacin: (Moderate) Use caution if telavancin is administered with ofloxacin as concurrent use may increase the risk of QT prolongation. Telavancin has been associated with QT prolongation. Quinolones have been associated with a risk of QT prolongation and torsade de pointes (TdP). Although extremely rare, TdP has been reported during postmarketing surveillance of ofloxacin. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory.
    Olanzapine: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with olanzapine. Telavancin has been associated with QT prolongation. Limited data, including some case reports, suggest that olanzapine also may be associated with a significant prolongation of the QTc interval in rare instances.
    Olanzapine; Fluoxetine: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with olanzapine. Telavancin has been associated with QT prolongation. Limited data, including some case reports, suggest that olanzapine also may be associated with a significant prolongation of the QTc interval in rare instances. (Moderate) Use caution if telavancin is administered with fluoxetine as concurrent use may increase the risk of QT prolongation. Coadministration may increase the risk for QT prolongation and torsade de pointes (TdP). QT prolongation and TdP have been reported in patients treated with fluoxetine. Telavancin has also been associated with QT prolongation.
    Olanzapine; Samidorphan: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with olanzapine. Telavancin has been associated with QT prolongation. Limited data, including some case reports, suggest that olanzapine also may be associated with a significant prolongation of the QTc interval in rare instances.
    Ondansetron: (Major) Monitor ECG for evidence of QT prolongation if coadministration of ondansetron and telavancin is necessary. Telavancin has been associated with QT prolongation. Ondansetron has been associated with a dose-related increase in the QT interval and postmarketing reports of torsade de pointes (TdP).
    Oral Contraceptives: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in 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 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 concentrations of OCs. 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 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.
    Osilodrostat: (Moderate) Monitor ECGs in patients receiving osilodrostat with telavancin as concurrent use may increase the risk of QT prolongation. Osilodrostat is associated with dose-dependent QT prolongation. Telavancin has been associated with QT prolongation.
    Osimertinib: (Major) Avoid coadministration of telavancin with osimertinib if possible due to the risk of QT prolongation and torsade de pointes (TdP). If concomitant use is unavoidable, periodically monitor ECGs for QT prolongation and monitor electrolytes; an interruption of osimertinib therapy with dose reduction or discontinuation of therapy may be necessary if QT prolongation occurs. Concentration-dependent QTc prolongation occurred during clinical trials of osimertinib. Telavancin has also been associated with QT prolongation.
    Oxaliplatin: (Major) Monitor electrolytes and ECGs for QT prolongation if coadministration of telavancin with oxaliplatin is necessary; correct electrolyte abnormalities prior to administration of oxaliplatin. Telavancin has been associated with QT prolongation. QT prolongation and ventricular arrhythmias including fatal torsade de pointes have also been reported with oxaliplatin use in postmarketing experience.
    Oxaprozin: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Ozanimod: (Major) In general, do not initiate ozanimod in patients taking telavancin due to the risk of additive bradycardia, QT prolongation, and torsade de pointes (TdP). If treatment initiation is considered, seek advice from a cardiologist. Ozanimod initiation may result in a transient decrease in heart rate and atrioventricular conduction delays. Ozanimod has not been studied in patients taking concurrent QT prolonging drugs; however, QT prolonging drugs have been associated with TdP in patients with bradycardia. Telavancin has been associated with QT prolongation.
    Pacritinib: (Major) Concomitant use of pacritinib and telavancin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary.
    Paliperidone: (Major) Paliperidone has been associated with QT prolongation; torsade de pointes and ventricular fibrillation have been reported in the setting of overdose. According to the manufacturer, since paliperidone may prolong the QT interval, it should be avoided in combination with other agents also known to have this effect, such as telavancin. However, if coadministration is necessary and the patient has known risk factors for cardiac disease or arrhythmias, close monitoring is essential.
    Pamidronate: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as pamidronate may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Panobinostat: (Major) QT prolongation has been reported with panobinostat therapy in patients with multiple myeloma in a clinical trial; use of panobinostat with other agents that prolong the QT interval is not recommended. Obtain an electrocardiogram at baseline and periodically during treatment. Hold panobinostat if the QTcF increases to >= 480 milliseconds during therapy; permanently discontinue if QT prolongation does not resolve. Drugs with a possible risk for QT prolongation and torsade de pointes that should be used cautiously and with close monitoring with panobinostat include telavancin.
    Paromomycin: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs (e.g., systemic aminoglycosides) may lead to additive nephrotoxicity. Televancin is closely related to vancomycin. In one clinical study, vancomycin coadministration, high aminoglycoside trough levels, and heart failure independently predicted acute kidney injury during aminoglycoside treatment. Closely monitor renal function and adjust telavancin doses based on creatinine clearance/renal function, and aminoglycoside doses based on renal function and serum aminoglycoside concentrations as clinically indicated.
    Pasireotide: (Moderate) Use caution when using pasireotide in combination with telavancin as concurrent use may increase the risk of QT prolongation. QT prolongation has occurred with pasireotide at therapeutic and supra-therapeutic doses. Telavancin has been associated with QT prolongation.
    Pazopanib: (Major) Concurrent use of pazopanib and telavancin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). If these drugs must be coadministered, closely monitor the patient for QT interval prolongation. Both pazopanib and telavancin have been reported to prolong the QT interval.
    Pentamidine: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as intravenous pentamidine may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance. In addition, both telavancin and pentamidine have been associated with QT prolongation. Caution is recommended when prescribing these drugs together.
    Pentosan: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Perindopril: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Perindopril; Amlodipine: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Perphenazine: (Minor) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with perphenazine. Telavancin has been associated with QT prolongation. Perphenazine, a phenothiazine, is associated with a possible risk for QT prolongation.
    Perphenazine; Amitriptyline: (Minor) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with perphenazine. Telavancin has been associated with QT prolongation. Perphenazine, a phenothiazine, is associated with a possible risk for QT prolongation.
    Pimavanserin: (Major) Pimavanserin may cause QT prolongation and should generally be avoided in patients receiving other medications known to prolong the QT interval, such as telavancin. Coadministration may increase the risk for QT prolongation.
    Pimozide: (Contraindicated) Pimozide is associated with a well-established risk of QT prolongation and torsade de pointes (TdP). Because of the potential for TdP, use of telavancin with pimozide is contraindicated.
    Piroxicam: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Pitolisant: (Major) Avoid coadministration of pitolisant with telavancin as concurrent use may increase the risk of QT prolongation. Pitolisant prolongs the QT interval. Telavancin has been associated with QT prolongation.
    Plazomicin: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs (e.g., systemic aminoglycosides) may lead to additive nephrotoxicity. Televancin is closely related to vancomycin. In one clinical study, vancomycin coadministration, high aminoglycoside trough levels, and heart failure independently predicted acute kidney injury during aminoglycoside treatment. Closely monitor renal function and adjust telavancin doses based on creatinine clearance/renal function, and aminoglycoside doses based on renal function and serum aminoglycoside concentrations as clinically indicated.
    Polymyxin B: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as polymyxin B may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Ponesimod: (Major) In general, do not initiate ponesimod in patients taking telavancin due to the risk of additive bradycardia, QT prolongation, and torsade de pointes (TdP). If treatment initiation is considered, seek advice from a cardiologist. Ponesimod initiation may result in a transient decrease in heart rate and atrioventricular conduction delays. Ponesimod has not been studied in patients taking concurrent QT prolonging drugs; however, QT prolonging drugs have been associated with TdP in patients with bradycardia. Telavancin has been associated with QT prolongation.
    Posaconazole: (Moderate) Use posaconazole with caution in combination with telavancin as concurrent use may increase the risk of QT prolongation. Posaconazole has been associated with prolongation of the QT interval as well as rare cases of torsade de pointes. Telavancin has also been associated with QT prolongation.
    Primaquine: (Moderate) Exercise caution when administering primaquine in combination with telavancin as concurrent use may increase the risk of QT prolongation. Primaquine is associated with QT prolongation. Telavancin has been associated with QT prolongation.
    Prochlorperazine: (Minor) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with prochlorperazine. Both telavancin and prochlorperazine have been associated with QT prolongation.
    Promethazine: (Moderate) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with promehtazine. Both promethazine and telavancin have been associated with QT prolongation.
    Promethazine; Dextromethorphan: (Moderate) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with promehtazine. Both promethazine and telavancin have been associated with QT prolongation.
    Promethazine; Phenylephrine: (Moderate) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with promehtazine. Both promethazine and telavancin have been associated with QT prolongation.
    Propafenone: (Major) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with propafenone. Telavancin has been associated with QT prolongation. Propafenone, a Class IC antiarrhythmic, also increases the QT interval, but largely due to prolongation of the QRS interval.
    Quetiapine: (Major) Concurrent use of quetiapine and telavancin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Telavancin has been associated with QT prolongation. Limited data, including some case reports, suggest that quetiapine may also be associated with a significant prolongation of the QTc interval in rare instances.
    Quinapril: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Quinine: (Major) Concurrent use of quinine and telavancin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Quinine has been associated with prolongation of the QT interval and rare cases of TdP. Telavancin has also been associated with QT prolongation.
    Ramipril: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Ranolazine: (Moderate) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with ranolazine. Telavancin has been associated with QT prolongation. Ranolazine is associated with dose- and plasma concentration-related increases in the QTc interval.
    Relugolix: (Moderate) Use caution if telavancin is administered with relugolix. Telavancin has been associated with QT prolongation. Androgen deprivation therapy (i.e., relugolix) may also prolong the QT/QTc interval.
    Relugolix; Estradiol; Norethindrone acetate: (Moderate) Use caution if telavancin is administered with relugolix. Telavancin has been associated with QT prolongation. Androgen deprivation therapy (i.e., relugolix) may also prolong the QT/QTc interval.
    Ribociclib: (Major) Avoid coadministration of ribociclib with telavancin due to an increased risk for QT prolongation. Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. Telavancin has also been associated with QT prolongation. Concomitant use may increase the risk for QT prolongation.
    Ribociclib; Letrozole: (Major) Avoid coadministration of ribociclib with telavancin due to an increased risk for QT prolongation. Ribociclib has been shown to prolong the QT interval in a concentration-dependent manner. Telavancin has also been associated with QT prolongation. Concomitant use may increase the risk for QT prolongation.
    Rilpivirine: (Moderate) Caution is advised when administering rilpivirine with telavancin as concurrent use may increase the risk of QT prolongation. Supratherapeutic doses of rilpivirine (75 to 300 mg/day) have caused QT prolongation. Telavancin has also been associated with QT prolongation.
    Risperidone: (Moderate) Use risperidone and telavancin together with caution due to the potential for additive QT prolongation and risk of torsade de pointes (TdP). Risperidone has been associated with a possible risk for QT prolongation and/or TdP, primarily in the overdose setting. Telavancin has also been associated with QT prolongation.
    Rivaroxaban: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose.
    Rofecoxib: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Romidepsin: (Moderate) Consider monitoring electrolytes and ECGs at baseline and periodically during treatment if romidepsin is administered with telavancin as concurrent use may increase the risk of QT prolongation. Romidepsin has been reported to prolong the QT interval. Telavancin has also been asociated with QT prolongation.
    Salicylates: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Salsalate: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as salicylates may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Saquinavir: (Major) Saquinavir boosted with ritonavir increases the QT interval in a dose-dependent fashion, which may increase the risk for serious arrhythmias such as torsade de pointes (TdP). Avoid administering saquinavir boosted with ritonavir concurrently with other drugs that may prolong the QT interval, such as telavancin. If no acceptable alternative therapy is available, perform a baseline ECG prior to initiation of concomitant therapy and carefully follow monitoring recommendations.
    Selpercatinib: (Major) Monitor ECGs more frequently for QT prolongation if coadministration of selpercatinib with telavancin is necessary due to the risk of additive QT prolongation. Concentration-dependent QT prolongation has been observed with selpercatinib therapy. Telavancin has been associated with QT prolongation.
    Sertraline: (Moderate) Use caution and monitor patients for QT prolongation when administering telavancin with sertraline. Telavancin has been associated with QT prolongation. Sertraline's FDA-approved labeling recommends avoiding concomitant use with drugs known to prolong the QTc interval; however, the risk of sertraline-induced QT prolongation is generally considered to be low in clinical practice. Its effect on QTc interval is minimal (typically less than 5 msec), and the drug has been used safely in patients with cardiac disease (e.g., recent myocardial infarction, unstable angina, chronic heart failure).
    Siponimod: (Major) In general, do not initiate treatment with siponimod in patients receiving telavancin due to the potential for QT prolongation. Consult a cardiologist regarding appropriate monitoring if siponimod use is required. Siponimod therapy prolonged the QT interval at recommended doses in a clinical study. Telavancin has been associated with QT prolongation.
    Sodium picosulfate; Magnesium oxide; Anhydrous citric acid: (Major) Prior or concomitant use of antibiotics with sodium picosulfate; magnesium oxide; anhydrous citric acid may reduce efficacy of the bowel preparation as conversion of sodium picosulfate to its active metabolite bis-(p-hydroxy-phenyl)-pyridyl-2-methane (BHPM) is mediated by colonic bacteria. If possible, avoid coadministration. Certain antibiotics (i.e., tetracyclines and quinolones) may chelate with the magnesium in sodium picosulfate; magnesium oxide; anhydrous citric acid solution. Therefore, these antibiotics should be taken at least 2 hours before and not less than 6 hours after the administration of sodium picosulfate; magnesium oxide; anhydrous citric acid solution.
    Solifenacin: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering solifenacin with telavancin. Solifenacin has been associated with dose-dependent prolongation of the QT interval; TdP has been reported during post-marketing use, although causality was not determined. Telavancin has also been associated with QT prolongation.
    Sorafenib: (Major) Avoid coadministration of sorafenib with telavancin due to the risk of additive QT prolongation. If concomitant use is unavoidable, monitor electrocardiograms and correct electrolyte abnormalities. An interruption or discontinuation of sorafenib therapy may be necessary if QT prolongation occurs. Both drugs are associated with QTc prolongation.
    Sotalol: (Major) Sotalol administration is associated with QT prolongation and torsades de pointes (TdP). Proarrhythmic events should be anticipated after initiation of therapy and after each upward dosage adjustment. Telavancin has been associated with QT prolongation. Use caution and close monitoring during concurrent administration.
    Streptomycin: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs (e.g., systemic aminoglycosides) may lead to additive nephrotoxicity. Televancin is closely related to vancomycin. In one clinical study, vancomycin coadministration, high aminoglycoside trough levels, and heart failure independently predicted acute kidney injury during aminoglycoside treatment. Closely monitor renal function and adjust telavancin doses based on creatinine clearance/renal function, and aminoglycoside doses based on renal function and serum aminoglycoside concentrations as clinically indicated.
    Streptozocin: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as streptozocin may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Sulindac: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Sumatriptan; Naproxen: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Sunitinib: (Moderate) Monitor for evidence of QT prolongation if sunitinib is administered with telavancin. Telavancin has been associated with QT prolongation. Sunitinib can prolong the QT interval.
    Tacrolimus: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as tacrolimus may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance. In addition, telavancin has been associated with QT prolongation. According to the manufacturer, telavancin should be used with caution when prescribing other agents known to prolong the QT interval such as tacrolimus.
    Tamoxifen: (Moderate) Caution is advised with the concomitant use of tamoxifen and telavancin due to an increased risk of QT prolongation. Tamoxifen has been reported to prolong the QT interval, usually in overdose or when used in high doses. Rare case reports of QT prolongation have also been described when tamoxifen is used at lower doses. Telavancin has also been associated with QT prolongation.
    Telithromycin: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with telithromycin. Both telithromycin and telavancin are associated with QT prolongation; telithromycin is also associated with cases of TdP.
    Tetrabenazine: (Major) Tetrabenazine causes a small increase in the corrected QT interval (QTc). The manufacturer recommends avoiding concurrent use of tetrabenazine with other drugs known to prolong QTc such as telavancin.
    Thioridazine: (Contraindicated) Thioridazine is associated with a well-established risk of QT prolongation and torsades de pointes (TdP). Thioridazine is considered contraindicated for use along with telavancin which, when combined with thioridazine, may prolong the QT interval and increase the risk of TdP, and/or cause orthostatic hypotension.
    Tobramycin: (Major) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs (e.g., systemic aminoglycosides) may lead to additive nephrotoxicity. Televancin is closely related to vancomycin. In one clinical study, vancomycin coadministration, high aminoglycoside trough levels, and heart failure independently predicted acute kidney injury during aminoglycoside treatment. Closely monitor renal function and adjust telavancin doses based on creatinine clearance/renal function, and aminoglycoside doses based on renal function and serum aminoglycoside concentrations as clinically indicated.
    Tolmetin: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Tolterodine: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering tolterodine with telavancin. Tolterodine has been associated with dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers. Telavancin has also been associated with QT prolongation.
    Toremifene: (Major) Avoid coadministration of telavancin with toremifene if possible due to the risk of additive QT prolongation. If concomitant use is unavoidable, closely monitor ECGs for QT prolongation and monitor electrolytes; correct hypokalemia or hypomagnesemia prior to administration of toremifene. Toremifene has been shown to prolong the QTc interval in a dose- and concentration-related manner. Telavancin has also been associated with QT prolongation.
    Torsemide: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as loop diuretics may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Trandolapril: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Trandolapril; Verapamil: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as Angiotensin-converting enzyme inhibitors (ACE inhibitors) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Trazodone: (Major) Telavancin has been associated with QT prolongation and should be avoided in combination with trazodone. Trazodone can prolong the QT/QTc interval at therapeutic doses. In addition, there are post-marketing reports of torsade de pointes (TdP). Therefore, the manufacturer recommends avoiding trazodone in patients receiving other drugs that increase the QT interval.
    Triclabendazole: (Moderate) Monitor ECGs in patients receiving triclabendazole with telavancin as concurrent use may increase the risk of QT prolongation. Transient prolongation of the mean QTc interval was noted on the ECG recordings in dogs administered triclabendazole. Telavancin has been associated with QT prolongation.
    Trifluoperazine: (Minor) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with trifluoperazine. Telavancin has been associated with QT prolongation. Trifluoperazine, a phenothiazine, is associated with a possible risk for QT prolongation.
    Triptorelin: (Moderate) Consider whether the benefits of androgen deprivation therapy (i.e., triptorelin) outweigh the potential risks of QT prolongation in patients receiving telavancin as concurrent use may increase the risk of QT prolongation. Telavancin has been associated with QT prolongation. Androgen deprivation therapy may also prolong the QT/QTc interval.
    Valdecoxib: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.
    Vandetanib: (Major) Avoid coadministration of vandetanib with telavancin due to an increased risk of QT prolongation and torsade de pointes (TdP). If concomitant use is unavoidable, monitor ECGs for QT prolongation and monitor electrolytes; correct hypocalcemia, hypomagnesemia, and/or hypomagnesemia prior to vandetanib administration. An interruption of vandetanib therapy or dose reduction may be necessary for QT prolongation. Vandetanib can prolong the QT interval in a concentration-dependent manner; TdP and sudden death have been reported in patients receiving vandetanib. Telavancin has also been associated with QT prolongation.
    Vardenafil: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with vardenafil. Telavancin has been associated with QT prolongation. Therapeutic (10 mg) and supratherapeutic (80 mg) doses of vardenafil also produces an increase in QTc interval (e.g., 4 to 6 msec calculated by individual QT correction).
    Vemurafenib: (Major) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with vemurafenib. If these drugs must be coadministered, ECG monitoring is recommended; closely monitor the patient for QT interval prolongation. Both telavancin and vemurafenib have been associated with QT prolongation.
    Venlafaxine: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering telavancin with venlafaxine. Telavancin has been associated with QT prolongation. Venlafaxine is associated with a possible risk of QT prolongation and TdP has been reported with post-marketing use.
    Voclosporin: (Moderate) Concomitant use of voclosporin and telavancin may increase the risk of QT prolongation and additive nephrotoxicity. Consider interventions to minimize the risk of progression to torsades de pointes (TdP), such as ECG monitoring and correcting electrolyte abnormalities, particularly in patients with additional risk factors for TdP. Additionally, monitor for renal toxicity if concomitant use is required. Voclosporin has been associated with QT prolongation at supratherapeutic doses. Telavancin has been associated with QT prolongation.
    Voriconazole: (Moderate) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering voriconazole with telavancin. Voriconazole has been associated with prolongation of the QT interval and rare cases of arrhythmias, including TdP. Telavancin has also been associated with QT prolongation.
    Vorinostat: (Moderate) Due to increased risk of QT interval prolongation and torsade de pointes (TdP), use caution if telavancin is administered with vorinostat. Both telavancin and vorinostat have been associated with QT prolongation.
    Warfarin: (Moderate) Telavancin has no effect on coagulation or platelet aggregation; however, caution is advised when administering telavancin concurrently with other anticoagulants as telavancin may interfere with laboratory tests used in monitoring these medications. The coagulation tests affected by telavancin include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), activated clotting time, and coagulation-based factor Xa tests. When measured shortly after completion of a telavancin infusion, the results of these tests are increased; however, the effects of telavancin on these tests dissipate over time as plasma concentrations of telavancin decrease. Therefore, when administering telavancin in conjunction with anticoagulants ensure that blood samples for these coagulation tests are collected as close as possible to the patient's next telavancin dose. Additionally, the concomitant use of warfarin with many antibiotics may result in an increased INR thereby potentiating the risk for bleeding. Inhibition of vitamin K synthesis due to alterations in the intestinal flora may be a mechanism; however, concurrent infection is also a potential risk factor for elevated INR. Monitor patients for signs and symptoms of bleeding. Additionally, increased monitoring of the INR, especially during initiation and upon discontinuation of the antibiotic, may be necessary.
    Ziprasidone: (Major) Concomitant use of ziprasidone and telavancin should be avoided due to the potential for additive QT prolongation. Clinical trial data indicate that ziprasidone causes QT prolongation; there are postmarketing reports of torsade de pointes (TdP) in patients with multiple confounding factors. Telavancin has been associated with QT prolongation.
    Zoledronic Acid: (Moderate) Concurrent or sequential use of telavancin with other potentially nephrotoxic drugs such as zoledronic acid may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance.

    PREGNANCY AND LACTATION

    Pregnancy

    Based on findings in animal reproduction studies, telavancin may cause fetal harm. Advise pregnant women of the potential risk to the fetus. There are no available data on telavancin use in human pregnancy to evaluate for drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. In embryo-fetal developmental studies in animals, telavancin demonstrated the potential to cause limb and skeletal malformations when given intravenously during organogenesis at doses providing 1- to 2-fold the human exposure at the maximum recommended clinical dose. Malformations observed at less than 1% included brachymelia, syndactyly, adactyly, and polydactyly. Additional findings included flexed front paw and absent ulna, deformed digits and front leg, decreased fetal body weights, and increased number of stillborn rat pups. There is a pregnancy exposure registry that monitors outcomes in pregnant patients exposed to telavancin; information about the registry can be obtained at www.clinicaltrials.gov or by calling 1-855-633-8479.[36615]

    Telavancin may be associated with reproductive risk. Verify pregnancy status with pregnancy testing in females of childbearing age before administering telavancin. Additionally, discuss contraception requirements with the patient. Advise females of childbearing potential to use effective contraception during telavancin therapy and for 2 days after the final dose. Based on findings in animals, telavancin may cause male infertility. The effects on fertility, including histopathological changes in the seminiferous tubules and epididymides of the testis, were reversible at the end of a 4-week recovery period in rats.[36615]

    MECHANISM OF ACTION

    Telavancin is a lipoglycopeptide antibiotic with bactericidal activity against many gram-positive bacteria; telavancin is ineffective against gram-negative bacteria. There are 2 mechanisms by which telavancin exerts its antibacterial activity. First, telavancin, like other glycopeptides, inhibits bacterial cell wall synthesis by binding to the D-Ala-D-Ala terminal of immature, unlinked glycan strands. By binding to these strands, telavancin blocks their interaction with the enzymes transglycosylase and transpeptidase. As a result, peptidoglycan polymerization and cross-linking of the peptidoglycan strands into the bacterial cell wall is prevented. The other mechanism involves incorporation of the lipophilic decylaminoethyl side chain into the bacterial cell membrane. This interaction disrupts the cell membrane integrity by causing depolarization and increasing the permeability of the membrane. Telavancin exerts concentration-dependent, bactericidal activity; therefore, the antibacterial activity of telavancin is best predicted by the ratio of area under the concentration-time curve to minimal inhibitory concentration (AUC:MIC). In addition, in vitro data suggest that telavancin exhibits a post-antibiotic effect of 1 to 6 hours for most gram-positive bacteria.[36615] [36625] [36626]
     
    The susceptibility interpretive criteria for telavancin are delineated by pathogen. The MICs for beta-hemolytic streptococci and Staphylococcus aureus (including MRSA) are defined as susceptible at 0.12 mcg/mL or less. The MICs for Streptococcus viridans group are defined as susceptible at 0.06 mcg/mL or less. The MICs for Enterococcus faecalis (vancomycin-susceptible) are defined as susceptible at 0.25 mcg/mL or less.[63320] [63321]

    PHARMACOKINETICS

    Telavancin is administered by intravenous infusion. While in circulation, the drug is 93% bound to human plasma proteins, primarily to albumin. The volume of distribution at steady state is 0.1—0.13 L/kg. The drug distributes into the pulmonary epithelial lining fluid and alveolar macrophages, with concentrations exceeding the minimum inhibitory concentration (MIC90) for Staphylococcus aureus for at least 24 hours after dosing. Telavancin does not undergo hepatic metabolism and thus is not expected to be altered by inducers or inhibitors of CYP 1A2, 2C9, 2C19, 2D6, 3A4, 3A5, or 4A11. According to the manufacturer, it is metabolized to 3 hydroxylated metabolites; however, the exact mechanism for metabolism is unknown. The elimination half-life in adults is 8—9 hours after the administration of doses of 7.5—15 mg/kg/day. It is primarily eliminated by the kidneys with approximately 76% of the dose excreted in the urine and < 1% excreted in feces.
     
    Affected cytochrome P450 isoenzymes and drug transporters:  CYP3A4, CYP3A5
    Telavancin is not an inhibitor of CYP 1A2, 2C9, 2C19, or 2D6. It does inhibit CYP3A4 and CYP3A5, although not to an extent likely to alter the pharmacokinetic parameters of medications metabolized by these enzymes.

    Intravenous Route

    Telavancin displays linear pharmacokinetics after IV administration of both single and multiple doses. In a pharmacokinetic study involving healthy adults, the maximum plasma concentrations resulting from 7 daily IV doses of 7.5, 12.5, and 15 mg/kg were 96.7, 151, and 203 mcg/ml respectively. Steady state plasma concentrations are achieved by days 3 to 4.