Telavancin
Glycopeptides
GlycopeptidesPregnancy: contraindicated
It caused malformations in animals: a pregnancy test is done before starting and effective contraception is used.
IV lipoglycopeptide derived from vancomycin with a double action, wall and membrane, against gram-positives such as MRSA; kidney risk, long QT, teratogen.
Quick facts
- Group
- Glycopeptides
- Target
- D-Ala–D-Ala end of the peptidoglycan precursor and the bacterial membrane
- Used for
- Complicated skin · Hospital-acquired
- Key effects
- Taste disturbance · Nausea · Foamy urine
- Monitor
- Creatinine before and during treatment
- ATC
- J01XA03
No doses: the clinician sets them by the current guideline.
Mechanism of action
No structure with telavancin bound is available; the figure shows vancomycin, the glycopeptide it derives from, holding the same D-Ala-D-Ala peptide.
Like vancomycin, telavancin binds the D-Ala–D-Ala end of peptidoglycan units and halts wall synthesis. Its lipid chain anchors it to the membrane, which increases binding and also depolarises the membrane and makes it leaky. That second action makes it bactericidal faster than vancomycin.
- The lipid tail anchors it to the membrane
- Binds the D-Ala–D-Ala end and halts the wall
- Depolarises the membrane and makes it leaky
- The gram-positive bacterium dies quickly
Indications
- Complicated skin and soft-tissue infections by gram-positives, including MRSA
- Hospital-acquired and ventilator-associated S. aureus pneumonia when no other option exists Hospital-acquired and ventilator-associated pneumonia →
Adverse effects
Common
- Taste disturbance (metallic or soapy taste)
- Nausea, vomiting and loss of appetite
- Foamy urine
- Headache
Contraindications
- Allergy to telavancin or other glycopeptides
- Pregnancy (teratogenic in animals)
Key interactions
- QT-prolonging drugs
- Additive QT prolongation; the ECG is watched.
- NSAIDs (ibuprofen, naproxen) and other nephrotoxic drugs
- Reviewed before starting because of the added kidney risk.
What is monitored
- Creatinine before and during treatment
- ECG in people with long QT or heart disease
- Pregnancy test before starting in women who can become pregnant
Administration and safety
- Slow IV infusion to reduce infusion reactions
- Tell the laboratory the person is receiving telavancin before any test
Pregnancy and breastfeeding
It caused malformations in animals: a pregnancy test is done before starting and effective contraception is used.
Nursing care
- Measure creatinine and watch urine output
- Confirm a negative pregnancy test and explain contraception during treatment and the days after
- Watch for flushing, itching or breathlessness during the infusion
- Explain that a metallic taste and foamy urine are expected
Pharmacokinetics
- Absorption
- Not absorbed by mouth; IV only.
- Distribution
- Highly bound to plasma proteins.
- Elimination
- Mainly renal (mostly unchanged); needs adjustment in kidney failure.
- Half-life
- About 7 to 8 hours, allowing one infusion a day.
Test yourself
Think of the answer, then tap the question to see it.
What second action does telavancin add to that of vancomycin?
It anchors in the bacterial membrane, depolarises it and makes it leaky, which makes it bactericidal faster.
Which test is required before starting telavancin in a woman who can become pregnant?
A pregnancy test, because it was teratogenic in animals.
Which pneumonia patients did worse with telavancin in trials?
People with pre-existing kidney impairment, in whom higher mortality was seen.
Which expected but unpleasant effects are worth explaining to the patient?
A metallic or soapy taste, nausea and foamy urine.
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: Telavancin 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.