Oritavancin
Glycopeptides
Glycopeptides
IV lipoglycopeptide with a half-life over a week: a single infusion treats skin infections by gram-positives, including MRSA.
Quick facts
- Group
- Glycopeptides
- Target
- D-Ala–D-Ala end of the peptidoglycan precursor and the bacterial membrane
- Used for
- Acute bacterial skin
- Key effects
- Nausea · Headache and dizziness · Tachycardia
- Monitor
- INR if on warfarin · Course of the wound
- ATC
- J01XA05
No doses: the clinician sets them by the current guideline.
Mechanism of action
No structure with oritavancin bound is available; the figure shows vancomycin, another glycopeptide, holding the same D-Ala-D-Ala peptide.
Oritavancin binds the D-Ala–D-Ala end of peptidoglycan units and halts wall synthesis, like vancomycin. Its lipid chain anchors it in the membrane and disrupts it, giving faster bactericidal action. Its inhibitory concentrations are lower than vancomycin's against many gram-positives, including MRSA.
- Anchors in the membrane with its lipid tail
- Binds the D-Ala–D-Ala end of the wall
- Blocks wall synthesis and disrupts the membrane
- Stays in the body for weeks after one infusion
Indications
- Acute bacterial skin and soft-tissue infections by susceptible gram-positives, including MRSA, with a single infusion
Adverse effects
Common
- Nausea, vomiting and diarrhoea
- Headache and dizziness
- Redness and swelling at the infusion site
- Tachycardia
Contraindications
- Allergy to oritavancin or other glycopeptides
Key interactions
- IV unfractionated heparin
- Usually stopped for at least 5 days after oritavancin.
- Warfarin
- Oritavancin has a minor effect on CYP metabolism; used only with close monitoring.
- Laboratory tests in the next 5 days
- Results may be altered; the laboratory is told.
What is monitored
- Signs of infusion reaction during the 3-hour infusion
- INR if on warfarin
- Course of the wound or abscess after the single dose
Administration and safety
- A single slow IV infusion of about 3 hours
- If flushing or itching appears, the infusion is slowed or stopped
- Name looks like dalbavancin: they are different products with different infusions
Nursing care
- Ask about heparin and warfarin before the infusion
- Watch for flushing, itching, hives or breathlessness during the infusion
- Record the dose date so the laboratory can be told in the next 5 days
- Teach to recognise signs of a new skin infection or severe diarrhoea
Pharmacokinetics
- Absorption
- IV only.
- Distribution
- Large volume of distribution.
- Elimination
- Very slow, renal and unchanged; no adjustment in mild to moderate kidney or liver impairment, and not removed by dialysis.
- Half-life
- Very long, in the order of 10 days or more.
Test yourself
Think of the answer, then tap the question to see it.
Which pharmacokinetic property lets one oritavancin infusion treat cellulitis?
Its very long half-life, over a week.
Which anticoagulant is usually stopped for at least 5 days after oritavancin?
Intravenous unfractionated heparin.
How is oritavancin like vancomycin, and how is it different?
Both bind the D-Ala–D-Ala of the wall; oritavancin also disrupts the membrane and lasts for weeks.
Connections
← Back to the class: Glycopeptides
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Oritavancin Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Complex of vancomycin with DI-acetyl-LYS-D-ALA-D-ALA (RCSB Protein Data Bank, 2026).
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Representative model, for educational purposes only.