Concomitant administration of vancomycin and anesthetic agents may enhance anaphylactoid reactions including erythema, histamine-like flushing, hypotension, wheezing, dyspnea, urticaria or pruritus. However, such reactions may be minimized by the administration of vancomycin as a 60-minute infusion prior to anaesthetic induction.
Concurrent or sequential systemic or topical use of other potentially neurotoxic or nephrotoxic drugs, such as amphotericin B, aminoglycosides, bacitracin, polymyxin B, colistin, viomycin, cisplatin, Nedaplatin when indicated, requires careful monitoring.
Change in INR: In patients who received antibiotics including vancomycin with anticoagulant concurrently, increased anticoagulant effect has been reported.
Infectious disease (including inflammatory process), age and general condition of patients are the risky factors. Although drug interaction between vancomycin and warfarin has not been established through clinical trials, INR monitoring should be instituted, Dosage of anticoagulant should be adjusted if necessary. (Some kind of antibiotics, in particular fluoroquinolone, macrolide, cycline, co-trimoxazole and some cephalosporin it is necessary.)
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