Administration: Rapid bolus administration (eg, several minutes) may be associated with exaggerated hypotension, including shock and, rarely, cardiac arrest.
Ototoxicity: Ototoxicity has occurred in patients receiving vancomycin. It may be transient or permanent. It has been reported mostly in patients who have been excessive dose, who have an underlying hearing loss, or who are receiving concomitant therapy with another ototoxic agent, such as an aminoglycoside.
C. difficile-associated diarrhea: C. difficile-associated diarrhea has been reported with nearly all antibacterial agents, including vancomycin, and may range in severity from mild diarrhea to fatal colitis.
Neutropenia: Reversible neutropenia, usually starting 1 week or more after onset of therapy with vancomycin or after a total dosage of more than 25 g, has been reported in patients receiving vancomycin.
Tissue irritation: Vancomycin is irritating to tissue and must be given by a secure IV route of administration. Pain, tenderness, and necrosis occur with IM injection of vancomycin or with inadvertent extravasation. Thrombophlebitis may occur, the frequency and severity of which can be minimized by administering the drug slowly as a dilute solution (2.5 to 5 g/L) and by rotating the sites of venous access.
Hypersensitivity reactions: During or soon after the rapid infusion of vancomycin, patients may develop anaphylactoid reactions, including dyspnea, hypotension, pruritus, urticaria, or wheezing. Rapid infusion may also cause flushing of the upper body ("red neck") or pain and muscle spasm of the chest and back.
Renal function impairment: Use vancomycin with caution in patients with renal insufficiency because the risk of toxicity is appreciably increased by high, prolonged blood concentration.
Superinfection: Prolonged use of vancomycin may result in the overgrowth of non-susceptible organisms.