Clinical evidence,mechanism, importance and management
Vancomycin is both potentially nephrotoxic and ototoxic,and its manufacturers therefore suggest that it should be used with particular care, or avoided in patients with renal impairment or deafness (See reference number 1). They also advise avoidance of other drugs that have nephrotoxic potential, because effects could be additive. They list amphotericin B,aminoglycosides, bacitracin, colistin, polymyxin B, viomycin and cisplatin. They also list etacrynic acid and furosemide as potentially aggravating ototoxicity.
The monograph Aminoglycosides + Vancomycin interaction,outlines some of evidence that additive nephrotoxicity can occur with aminoglycosides, but there seems to be no direct evidence about other drugs. Even so, general warning issued by manufacturers to monitor carefully is a reasonable precaution.
1. Vancomycin hydrochloride. Mayne Pharma plc. UK Summary of product characteristics,December 2003.