Is Vancomycin safe?
Decades of use, known kidney risk
Given by vein, it can injure the kidneys. The risk is higher at high blood levels, with long courses, or alongside other drugs that harm the kidneys. So doctors monitor blood levels. A fast infusion causes vancomycin flushing syndrome, once called red man syndrome. This histamine reaction brings flushing and low blood pressure. The label also warns of hearing damage (tinnitus, hearing loss or vertigo). It can be permanent. It is more likely in older patients, at higher doses and alongside other drugs that harm hearing. 2
The body absorbs almost none of the oral drug, so side effects are uncommon. Some may be absorbed in patients with inflamed bowel or kidney failure. Nausea, abdominal pain and low blood potassium were the most common adverse reactions in the oral trials. Either route can favor vancomycin-resistant enterococci in the gut. In the Fowler trial, clinically significant kidney dysfunction occurred in 26.3 percent of standard-therapy patients. In the daptomycin arm it occurred in 11.0 percent. Only the standard-therapy arm received gentamicin at the start. Gentamicin is itself toxic to the kidneys. 123
Kidney injury with intravenous use, which is why doctors check blood levels. Infusion reactions if given too fast. Selection of vancomycin-resistant bacteria. Oral use is largely free of effects in the body. 23
More on Vancomycin
Citations
- Fowler 2006, NEJM: Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus pubmed.ncbi.nlm.nih.gov
- FDA 2026: Vancomycin Injection prescribing information (NDA 050671), intravenous use accessdata.fda.gov
- FDA 2021: Vancocin (vancomycin hydrochloride) capsules prescribing information, oral use accessdata.fda.gov
Reference information only, not medical advice. Drawn from the Vancomycin article, fact-checked against the cited sources. No dosing anywhere on this site.