Hospital Formulary Status Yes (PO solid, PO soln compounded from IV)
In-Hospital Cost will be updated
PharmaCare Formulary Status Yes (PO solid)
Special Authority Yes (125mg, 250mg PO solid) (See below under Restricted Use Criteria)
PharmaCare Coverage 125mg PO - $5.5944/cap 250mg PO - $11.1888/cap
Outpatient Cost 125mg PO - $5.62-9.56/cap 250mg PO - $11.25-11.83/cap
Only indication is in the therapy of C. difficile infection, particularly recurrent or severe disease
Possibility of accumulation in severe renal dysfunction.
Consider checking a vancomycin level in dialysis patients.
Special Authority Status: Yes (125mg PO solid, 250mg PO solid)
Special Authority Category: Limited Coverage Drugs
Special Authority Criteria: For the treatment of symptomatic C. Difficile Infection, when:
*Vancomycin capsules are a full benefit for patients registered with the Palliative program
Special Authority Approval Period: Initial: up to 14 days. Second or further recurrence: up to 14 days
Special Authority Practitioner Exemptions: None
Special Authority Special Notes:
Hypokalemia (PO)
Gastrointestinal (PO)
Other
Antimicrobial class: Glycopeptide
Pregnancy category: B
No oral absorption. May increase vancomycin resistant enterococci colonization in the gut.
Average serum half life: 0.0 hr
Urine penetration: None
Lung penetration: None
CSF penetration: None
Biliary penetration: None