Version July 2025
Patients with preexisting moderate to severe renal impairment (CrCl ≤50 mL/minute) who were treated with telavancin for hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia had increased mortality observed versus vancomycin. Use of telavancin in patients with preexisting moderate to severe renal impairment (CrCl ≤50 mL/minute) should be considered only when the anticipated benefit to the patient outweighs the potential risk.
New-onset or worsening renal impairment has occurred. Monitor renal function in all patients.
May cause fetal harm. In animal reproduction studies, adverse developmental outcomes were observed in 3 animal species at clinically relevant doses. Verify pregnancy status in females of reproductive potential prior to initiating telavancin. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with telavancin and for 2 days after the final dose.
Note: Reserve for patients with or at risk for methicillin-resistant S. aureus (MRSA) infection who cannot receive preferred agents (Ref). In patients with CrCl ≤50 mL/minute, decreased efficacy and increased mortality were observed with skin and soft tissue infection and hospital-acquired/ventilator-associated pneumonia, respectively (Ref).
Bloodstream infection (alternative agent) (off-label use):
Pathogen-directed therapy for MRSA: IV: 10 mg/kg once daily (Ref). No maximum dose is recommended by the manufacturer; however, based on limited pharmacokinetic data in patients with obesity, up to 1 g/day may be safely used (Ref). Treat uncomplicated S. aureus bacteremia for ≥14 days from day of first negative blood culture, with longer courses warranted for endocarditis or metastatic sites of infection (Ref).
Pneumonia, hospital acquired or ventilator associated (alternative agent) :
Note: In patients with CrCl ≤50 mL/minute, increased mortality was observed compared to vancomycin.
As a component of empiric therapy or pathogen-directed therapy for MRSA: IV: 10 mg/kg every 24 hours. No maximum dose recommended by the manufacturer; however, based on limited pharmacokinetic data in patients with obesity, up to 1 g/day may be safely used (Ref). Duration of therapy varies based on disease severity and response to therapy; treatment is typically given for 7 days (Ref).
Skin and soft tissue infection (alternative agent):
Note: In patients with CrCl ≤50 mL/minute, decreased efficacy was observed compared to vancomycin.
IV: 10 mg/kg once daily (Ref). No maximum dose recommended by the manufacturer; however, based on limited pharmacokinetic data in patients with obesity, up to 1 g/day may be safely used (Ref). Total duration of therapy is ≥5 days (including oral step-down therapy); may extend up to 14 days depending on severity and clinical response (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Note: Contains solubilizer cyclodextrin (hydroxypropyl-beta-cyclodextrin) which may accumulate in patients with kidney dysfunction, although the clinical significance of this finding is uncertain (Ref). Kidney function may be estimated using the Cockcroft-Gault formula for dosage adjustment purposes.
Altered kidney function:
CrCl >50 mL/minute: IV: No dosage adjustment necessary (Ref).
CrCl ≤50 mL/minute: Note: In patients with CrCl ≤50 mL/minute, decreased efficacy and increased mortality were observed when telavancin was used to treat skin and soft tissue infection and hospital-acquired/ventilator-associated pneumonia, respectively. Additionally, worsening of kidney impairment has occurred with telavancin use. Only use in this population when benefits outweigh the risks. If necessary, the following dose adjustments are recommended, with close monitoring of SCr:
CrCl 30 to 50 mL/minute: IV: 7.5 mg/kg every 24 hours (Ref).
CrCl 10 to <30 mL/minute: IV: 10 mg/kg every 48 hours (Ref). Note: Not recommended in Canadian labeling.
CrCl <10 mL/minute: IV: No data available. If necessary, consider 5 mg/kg every 48 hours (Ref). Note: Not recommended in Canadian labeling.
Hemodialysis, intermittent (thrice weekly):
Note: In patients with CrCl ≤50 mL/minute, decreased efficacy and increased mortality were observed when telavancin was used to treat skin and soft tissue infection and hospital-acquired/ventilator-associated pneumonia, respectively. Only use in this population when benefits outweigh the risks.
Dialyzable (~30%): IV: 5 mg/kg every 48 hours; when scheduled dose falls on hemodialysis days, administer after hemodialysis (Ref). Note: Not recommended in Canadian labeling.
Peritoneal dialysis:
Note: In patients with CrCl ≤50 mL/minute, decreased efficacy and increased mortality were observed when telavancin was used to treat skin and soft tissue infection and hospital-acquired/ventilator-associated pneumonia, respectively. Additionally, worsening of kidney impairment has occurred with telavancin use, which may be an issue in patients with residual kidney function. Only use in this population when benefits outweigh the risks.
IV: No data available. If necessary, consider 5 mg/kg every 48 hours (Ref). Note: Not recommended in Canadian labeling.
CRRT:
Note: In patients with CrCl ≤50 mL/minute, decreased efficacy and increased mortality were observed when telavancin was used to treat skin and soft tissue infection and hospital-acquired/ventilator-associated pneumonia, respectively. Additionally, worsening of kidney impairment has occurred with telavancin use. Only use in this population when benefits outweigh the risks.
IV: No data available. If necessary, consider 10 mg/kg every 48 hours (Ref).
PIRRT:
Note: In patients with CrCl ≤50 mL/minute, decreased efficacy and increased mortality were observed when telavancin was used to treat skin and soft tissue infection and hospital-acquired/ventilator-associated pneumonia, respectively. Additionally, worsening of kidney impairment has occurred with telavancin use. Only use in this population when benefits outweigh the risks.
IV: No data available. If necessary, consider 10 mg/kg every 48 hours (Ref).
Mild-to-moderate hepatic impairment (Child-Pugh class A or B): No dosage adjustment necessary.
Severe hepatic impairment (Child-Pugh class C): No dosage adjustment provided in manufacturer's labeling (has not been studied).
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Central nervous system: Metallic taste (33%)
Gastrointestinal: Nausea (5% to 27%), vomiting (5% to 14%)
Renal: Increased serum creatinine (8% to 16%; ≥65 years of age: 11%; <65 years of age: 8%), foamy urine (13%)
1% to 10%:
Central nervous system: Dizziness (6%), infusion site pain (4%), rigors (4%)
Dermatologic: Pruritus (3% to 6%), skin rash (4%), localized erythema (3%)
Gastrointestinal: Diarrhea (7%), decreased appetite (3%), abdominal pain (2%)
Local: Infusion site reaction (3%)
Renal: Renal insufficiency (3%; ≥65 years of age: 9%; <65 years of age: 2%), acute renal failure (5%)
<1%, postmarketing, and/or case reports: Clostridioides difficile-associated diarrhea, flushing, hypersensitivity reaction (including anaphylaxis), nephrotoxicity, prolonged QT interval on ECG, transient flushing of upper body, urticaria
Hypersensitivity to telavancin or any component of the formulation; concomitant use of intravenous unfractionated heparin
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Concerns related to adverse effects:
• Anaphylaxis/hypersensitivity reactions: Serious hypersensitivity reactions, including anaphylaxis, have been reported after first or subsequent doses; some have been fatal. Discontinue if hypersensitivity or rash occurs. Telavancin is a semisynthetic derivative of vancomycin; cross-reactivity rates are unknown. Use with caution in patients with known vancomycin hypersensitivity.
• Cardiac conduction alteration: May prolong QTc interval; avoid use in patients with congenital long QT syndrome, known QTc prolongation, uncompensated heart failure, or severe left ventricular hypertrophy (were excluded from studies); use with caution in patients with concurrent administration of other medications known to prolong the QT interval. Clinical studies indicate mean maximal QTc prolongation of 12 to 15 msec at the end of 10 mg/kg infusion.
• Infusion reactions: Rapid IV administration may result in flushing, rash, urticaria, and/or pruritus; slowing or stopping the infusion may alleviate these symptoms.
• Nephrotoxicity: [US Boxed Warning]: New onset or worsening renal impairment has occurred. Monitor renal function prior to, during (at least every 48 to 72 hours; more frequently if indicated), and following therapy in all patients. Usual risk factors include concomitant nephrotoxic medications or baseline comorbidities associated with decreased renal function (eg baseline renal dysfunction, diabetes, hypertension, or heart failure). Contains solubilizer cyclodextrin (hydroxypropyl-beta-cyclodextrin) which may accumulate in patients with renal dysfunction, although the clinical significance of this finding is uncertain (Luke 2010).
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Renal impairment: [US Boxed Warning]: In clinical studies, patients with pre-existing moderate-to-severe renal impairment (CrCl ≤50 mL/minute) treated for hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP) had increased (all cause) mortality versus vancomycin. Use in HABP/VABP only when benefit outweighs risk. In patients with complicated skin and skin structure infections, efficacy may be reduced in patients with a baseline CrCl ≤50 mL/minute.
Special populations:
• Older adult: Lower doses are often required secondary to age-related decreases in renal function.
• Pregnancy: [US Boxed Warning]: Based on animal data, may cause fetal harm. Prior to initiating telavancin, verify pregnancy status in females of reproductive potential. Advise pregnant females of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with telavancin and for 2 days after the final dose.
Other warnings/precautions:
• Coagulation tests: May interfere with tests used to monitor coagulation (eg, prothrombin time, INR, activated partial thromboplastin time, activated clotting time, coagulation based factor Xa tests) when samples drawn ≤18 hours after drug administration. Blood samples should be collected as close to the next dose of telavancin as possible or a non-phospholipid dependent coagulation test (eg, bleeding time, factor Xa [chromogenic assay], platelet aggregation study, thrombin time) should be used. Consider selecting an alternative anticoagulant not requiring aPTT monitoring; concomitant use of telavancin with IV unfractionated heparin is contraindicated.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution Reconstituted, Intravenous:
Vibativ: 750 mg (1 ea)
Solution Reconstituted, Intravenous [preservative free]:
Vibativ: 750 mg (1 ea [DSC])
No
Solution (reconstituted) (Vibativ Intravenous)
750 mg (per each): $820.84
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IV: Administer IV over 60 minutes. Other medications should not be infused simultaneously through the same IV line. When the same intravenous line is used for sequential infusion of other medications, flush line with D5W, LR, or NS before and after infusing telavancin.
An infusion reaction (eg, hypotension, maculopapular rash appearing on the face, neck, trunk, and/or upper extremities) may occur if the infusion is too rapid; it is not an allergic reaction. If this should occur, discontinuing or slowing the infusion rate may eliminate these reactions.
An FDA-approved patient medication guide, which is available with the product information and at https://www.fda.gov/media/77801/download, must be dispensed with this medication.
Hospital-acquired and ventilator-associated bacterial pneumonia: Treatment of hospital-acquired and ventilator-associated bacterial pneumonia caused by susceptible isolates of Staphylococcus aureus when alternative treatments are not appropriate.
S kin and soft tissue infections: Treatment of complicated skin and soft tissue infections caused by susceptible gram-positive organisms including methicillin-susceptible or -resistant S. aureus, vancomycin-susceptible Enterococcus faecalis, and Streptococcus pyogenes, Streptococcus agalactiae, or Streptococcus anginosus group.
Bloodstream infection
Telavancin may be confused with telithromycin
Vibativ may be confused with Viactiv, Vibramycin, vigabatrin
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Anticoagulants: Telavancin may decrease therapeutic effects of Anticoagulants. Specifically, telavancin may artificially increase the results of laboratory tests commonly used to monitor anticoagulant effectiveness, which could lead to incorrect decisions to decrease anticoagulant doses. Risk C: Monitor
Bacillus clausii: Antibiotics may decrease therapeutic effects of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider Therapy Modification
BCG (Intravesical): Antibiotics may decrease therapeutic effects of BCG (Intravesical). Risk X: Avoid
BCG Vaccine (Immunization): Antibiotics may decrease therapeutic effects of BCG Vaccine (Immunization). Risk C: Monitor
Cholera Vaccine: Antibiotics may decrease therapeutic effects of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid
Fecal Microbiota (Live) (Oral): May decrease therapeutic effects of Antibiotics. Risk X: Avoid
Fecal Microbiota (Live) (Rectal): Antibiotics may decrease therapeutic effects of Fecal Microbiota (Live) (Rectal). Risk X: Avoid
Haloperidol: QT-prolonging Agents (Indeterminate Risk - Caution) may increase QTc-prolonging effects of Haloperidol. Risk C: Monitor
Heparin: Telavancin may decrease therapeutic effects of Heparin. Specifically, telavancin may artificially increase the results of laboratory tests commonly used to monitor IV heparin effectiveness, which could lead to incorrect decisions to decrease heparin doses. Risk X: Avoid
Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may decrease therapeutic effects of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor
Lactobacillus and Estriol: Antibiotics may decrease therapeutic effects of Lactobacillus and Estriol. Risk C: Monitor
Mycophenolate: Antibiotics may decrease active metabolite exposure of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor
QT-prolonging Agents (Highest Risk): QT-prolonging Agents (Indeterminate Risk - Caution) may increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
Sodium Picosulfate: Antibiotics may decrease therapeutic effects of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider Therapy Modification
Typhoid Vaccine: Antibiotics may decrease therapeutic effects of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider Therapy Modification
[US Boxed Warning]: Verify pregnancy status in females of reproductive potential prior to initiating telavancin. Advise females of reproductive potential to use effective contraception during treatment with telavancin and for 2 days after the final dose.
Telavancin crosses the placenta (Nanovskaya 2012). [US Boxed Warning]: Telavancin may cause fetal harm. In animal reproduction studies, adverse developmental outcomes were observed in 3 animal species at clinically relevant doses. Advise pregnant women of the potential risk to a fetus.
Data collection to monitor pregnancy and infant outcomes following exposure to telavancin is ongoing. Health care providers are encouraged to enroll females exposed to telavancin during pregnancy in the Vibativ Pregnancy Registry (1-877-484-2700). Pregnant females may also enroll themselves.
It is not known if telavancin is present in breast milk.
According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.
Renal function (prior to start, every 48 to 72 hours; more frequently if indicated, and following therapy). Evaluate pregnancy status prior to use in females of reproductive potential.
Exerts concentration-dependent bactericidal activity; inhibits bacterial cell wall synthesis by blocking polymerization and cross-linking of peptidoglycan by binding to D-Ala-D-Ala portion of cell wall. Unlike vancomycin, additional mechanism involves disruption of membrane potential and changes cell permeability due to presence of lipophilic side chain moiety.
Distribution: Vss: 0.13 L/kg
Protein binding: ~90%; primarily to albumin
Half-life elimination: 6.6 to 9.6 hours
Excretion: Urine (~76%); feces (<1%)
Altered kidney function: The mean AUC values were approximately 13%, 29%, and 118% higher for subjects with CrCl >50 to 80 mL/minute, CrCl 30 to 50 mL/minute, and CrCl ≤30 mL/minute, respectively when compared with subjects with healthy renal function.
Anti-infective considerations:
Parameters associated with efficacy: Concentration dependent; associated with free area under the curve (fAUC24)/minimum inhibitory concentration (MIC): Goal: fAUC24/MIC of > ~50 to 70 (Hegde 2004; Lepak 2017; MacGowan 2011).
Expected drug exposure in normal kidney function:
Adults: 10 mg/kg IV:
Cmax (peak): Single dose: 93.6 ± 14.2 mg/L.
Cmax (peak): Steady state: 108 ± 26 mg/L.
AUC0-24: Single dose: 666 ± 107 mg•hour/L.
AUC0-24: Steady state: 780 ± 125 mg•hour/L.
Postantibiotic effect: Bacterial killing continues after telavancin concentration falls below the MIC of targeted pathogen; generally, ~4 to 6 hours for S. aureus (Pace 2003).
