What to avoid while on vancomycin?

October 6, 2025 •

4 min read

Nearly 16% of patients treated with vancomycin may develop kidney toxicity, a risk significantly heightened by concurrent medication use. To ensure safe and effective treatment, it is critical to understand what to avoid while on vancomycin, including specific drugs, substances, and certain administration practices.

Quick Summary

Prevent complications with vancomycin therapy by avoiding specific nephrotoxic and ototoxic drugs, alcohol, and rapid IV infusion. Understand key interactions and precautions for safe treatment.

Key Points

Avoid Nephrotoxic Drugs: Never combine vancomycin with other kidney-damaging medications like aminoglycosides (e.g., gentamicin) or NSAIDs without strict medical supervision.
Exercise Caution with Ototoxic Drugs: If you have pre-existing hearing issues, be extra cautious with other medications that can damage hearing and report any tinnitus or hearing changes.
Limit Alcohol: While not directly counteracting the antibiotic, alcohol can worsen vancomycin side effects like dizziness and should be avoided during treatment.
Ensure Slow IV Infusion: Rapid intravenous administration of vancomycin can trigger 'Red Man Syndrome' due to histamine release; this is prevented by slow infusion over at least 60 minutes.
Disclose All Supplements: Always inform your doctor about any over-the-counter medications, vitamins, or herbal supplements, as some can interfere with vancomycin's action.
Monitor Oral Vancomycin Timing: When taking oral vancomycin for C. difficile, avoid taking bile acid sequestrants (like cholestyramine) or probiotics within a few hours to prevent absorption issues.
Prioritize Hydration: Staying well-hydrated is crucial, as it helps support kidney function during vancomycin therapy and minimizes the risk of renal complications.

Vancomycin is a powerful antibiotic used to treat serious bacterial infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). While highly effective, vancomycin carries a risk of toxicity, especially to the kidneys (nephrotoxicity) and ears (ototoxicity). A patient's safety largely depends on avoiding potentially harmful interactions with other medications and substances.

Medications to Avoid or Use with Caution

Certain drug combinations can significantly increase the risk of adverse effects when taken with vancomycin. These include other drugs that also affect the kidneys or hearing, as well as certain classes of drugs that interact with the antibiotic's metabolism.

Nephrotoxic (Kidney-Damaging) Drugs

Vancomycin is cleared by the kidneys, so combining it with other drugs that can harm renal function can dangerously increase the risk of kidney damage. A heightened risk of vancomycin-associated acute kidney injury (AKI) has been well-documented.

Common nephrotoxic drugs to avoid include:

Aminoglycosides: Antibiotics such as gentamicin, tobramycin, and amikacin, when used alongside vancomycin, are known to increase the risk of both kidney damage and hearing loss.
Loop Diuretics: Medications like furosemide (Lasix) and torsemide, used to treat fluid retention, can increase the risk of kidney damage due to dehydration and electrolyte imbalances.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter and prescription NSAIDs such as ibuprofen and naproxen should be avoided, as they can also be hard on the kidneys.
Immunosuppressants: Drugs like cyclosporine and tacrolimus, used to prevent organ transplant rejection, can significantly increase the risk of nephrotoxicity.
Piperacillin/Tazobactam: This combination antibiotic has been shown in some studies to increase the risk of acute kidney injury when co-administered with vancomycin, though the mechanism is still being studied.

Ototoxic (Hearing-Damaging) Drugs

Vancomycin can be toxic to the auditory nerve, causing potential hearing loss or ringing in the ears (tinnitus). The risk is highest for patients with pre-existing hearing loss or when other ototoxic drugs are used concurrently.

These include:

Aminoglycosides: As mentioned above, this class of antibiotics carries a risk of hearing damage in addition to kidney damage.
Chemotherapy Agents: Some chemotherapy drugs, like cisplatin, are also known to be ototoxic and can amplify the risk when combined with vancomycin.

Lifestyle and Substance Restrictions

Alcohol

Consuming alcohol while on vancomycin will not stop the antibiotic from working but can significantly worsen its side effects. Vancomycin can cause nausea, dizziness, and drowsiness. Combining it with alcohol can intensify these effects, prolonging recovery and potentially leading to dangerous impairment. It is best to avoid alcohol entirely during your course of treatment.

Rapid Intravenous (IV) Infusion

For patients receiving vancomycin intravenously, it is crucial to ensure the infusion is administered slowly. Rapid infusion can trigger a reaction known as Vancomycin Infusion Reaction (VIR), previously called Red Man Syndrome. This is a non-allergic reaction caused by a histamine release and can result in:

Flushing of the face, neck, and upper body
Itching and skin rash
Chest pain and muscle spasms
Sudden drop in blood pressure (hypotension)

VIR is prevented by administering the IV infusion over at least 60 minutes. If a reaction occurs, the infusion should be stopped, and antihistamines may be given.

Herbal and Over-the-Counter Supplements

Always inform your doctor about any supplements you take. Oral vancomycin's efficacy can be decreased by substances that bind to it in the gut. For instance, bile acid sequestrants like cholestyramine and colestipol should not be taken within 3-4 hours of an oral vancomycin dose. Similarly, probiotics may need to be taken at a different time. Some herbal supplements, like Ginkgo biloba, can increase bleeding risk when taken with medications like vancomycin and anticoagulants.

A Comparison of High-Risk Interactions


Interaction Type	Associated Substances	Potential Risks
Nephrotoxic (Kidney-Damaging)	Aminoglycosides (gentamicin, tobramycin), NSAIDs (ibuprofen, naproxen), Loop Diuretics (furosemide), Immunosuppressants (cyclosporine)	Acute kidney injury, permanent kidney damage, elevated vancomycin levels leading to further toxicity
Ototoxic (Hearing-Damaging)	Aminoglycosides, Cisplatin (chemotherapy)	Tinnitus, varying degrees of hearing loss, which can be permanent
Oral Formulation Absorption	Bile Acid Sequestrants (cholestyramine), Probiotics	Reduced vancomycin efficacy for treating C. difficile colitis
Histamine Release (IV Only)	Rapid Infusion Rate	Flushing, itching, rash, hypotension, chest and back pain (Vancomycin Infusion Reaction)
Exacerbated Side Effects	Alcohol	Worsened dizziness, drowsiness, and stomach upset; delayed recovery from illness
Bleeding Risk (Theoretical)	Anticoagulants (warfarin), Ginkgo biloba	Increased risk of bleeding

Conclusion: Prioritize Open Communication

Managing a vancomycin course effectively requires more than just taking the medication as prescribed. It demands a clear understanding of potential risks and a proactive approach to managing your health. Given the significant risk of nephrotoxicity, particularly when combined with other agents, healthcare providers must employ vigilance and caution. By avoiding certain drugs, limiting alcohol, and ensuring proper administration, patients can minimize the risk of serious complications. The most important step is maintaining open and transparent communication with your healthcare provider about all medications, supplements, and pre-existing conditions. Always follow your doctor's instructions precisely and report any unusual symptoms immediately.

For more detailed information on minimizing the risks associated with vancomycin, consult authoritative medical resources like those from the National Institutes of Health.

Frequently Asked Questions

While alcohol does not directly make vancomycin ineffective, it can worsen common side effects like dizziness, drowsiness, and stomach upset. For this reason, and to support your body's recovery from infection, it is best to avoid alcohol until your course of vancomycin is complete.

You should strictly avoid other nephrotoxic (kidney-damaging) drugs such as aminoglycoside antibiotics (e.g., gentamicin), NSAIDs (e.g., ibuprofen), and certain chemotherapy agents. Always consult your doctor before taking any new medication, including over-the-counter drugs, while on vancomycin.

Red Man Syndrome, or more accurately Vancomycin Infusion Reaction (VIR), is a reaction caused by rapid intravenous infusion of vancomycin. It is not a true allergy but a histamine release that causes flushing, itching, and a drop in blood pressure. To avoid it, healthcare providers ensure the vancomycin infusion is administered slowly over at least 60 minutes.

Yes, vancomycin can be ototoxic (harmful to the ears), potentially causing temporary or permanent hearing loss or tinnitus (ringing in the ears). This risk increases with higher doses, prolonged treatment, or when taken with other ototoxic medications.

For most patients, oral vancomycin does not interact with food and can be taken with or without it. However, if taking oral vancomycin for C. difficile, avoid taking bile acid sequestrants (like cholestyramine) within a few hours, as they can interfere with absorption.

Oral vancomycin is poorly absorbed into the bloodstream and primarily treats intestinal infections like C. difficile. IV vancomycin is used for systemic infections, carries higher risks of nephrotoxicity and ototoxicity, and requires slow infusion to prevent reactions. Specific oral interactions, like those with bile acid sequestrants, do not apply to the IV form.

To protect your kidneys, ensure you are well-hydrated, avoid other kidney-damaging medications (NSAIDs, aminoglycosides), and follow all dosing instructions precisely. Your doctor will likely monitor your kidney function regularly throughout treatment.

Yes, absolutely. Always tell your doctor about any herbal, vitamin, or over-the-counter supplements you use. Some, like bile acid sequestrants or certain herbs, can interact with vancomycin.