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Primary Sclerosing Cholangitis (PSC) - Online Support Group

Vanco timing of medication

Just wondering how people are taking vancomycin and how many hours apart between dosages?

(1) 3 times a day after meals.
(2) 3 times a day with/without food at exactly 8 hour intervals.

Has anyone noticed a difference between the above 2 approaches? like one working better than the other.

For my son, we have been giving after food and its like 7:30-8am breakfast, 12:30-1pm lunch, 7:30-8pm dinner. Not exactly 8 hours apart between dosages.

From my experience precise timing isn’t super critical. Timing with meals probably doesn’t matter with liquid vancomycin, but may with pills. The efficacy issue with certain generic pills is potentially related to their slower dissolution at certain pH when compared to other pills (Ani). This suggests that we may want pills dissolved higher up in the GI tract for improved effect. Food slows things way down in the stomach and can help give these pills extra time to dissolve.

From our experience with the IV formulation (Kabi brand, IV powder dissolved into water) timing did not have any impact on the resultant LFTs (ALT, AST, GGT AlkPhos).
For the three 500mg doses of liquid Vanco (or 1,500 mg/per day) our schedule was:

  • 8am after breakfast
  • 2pm after lunch
  • 9pm after dinner (late dinner as my daughter is a teenager:))

For the current two 500mg doses of liquid Vanco (or 1,000 mg per day) our schedule is:

  • 8am after breakfast
  • 9pm after dinner.

When comparing the absorption of the liquid Vanco into the upper part of the GI tract vs that of the pills, jtb’s remarks in his previous are important and make a lot of sense.

Daniela

Thank you both for the feedback and appreciate it. We are still using Ani capsules for now and potentially looking to switch to liquid vanco in near future, so this is good information for us.

My daughter has been taking Ani vanco capsules for a year and a half and it didnt seem to matter that the timing was exact. She never had stomach issues so she takes when she wakes up when she goes to bed. When she first started, and had to take four times a day, she would try to take one more with lunch and one with dinner too, but timing varied and it never made any difference. It also didnt matter if she took them with meals or without. Her blood tests were normalized after 5 weeks on vanco and have remained steady every since. My advice is not to drive yourself crazy with the exact timing. Good luck!

We have been using ANI 2x250mg 3 times a day after meals to a total of 1500mg per day for my 6 year old son during the past 3 and half months. After the first month we saw good improvements with AST/ALT/GGT/ALP around 71/81/198/541, the lowest ever we have seen in a year. But the next 2 months, these went up to 133/263/731/343 and 119/161/591/195 unfortunately although there have been some other improvements after switching to vanco.

He had abdomen distention earlier and that went away completely. He had some veins showing up from the chest towards the abdomen and those mostly went away too. He has more energy compared to earlier, and after a year of no change in growth, finally had a growth spurt last couple of months in height and grew couple of inches. Vitamin D and PT/INR are in control without any supplements and bilirubin has been under <= 0.3 mg/dL. Before this we were on urso/aza/prednisone from Feb of this year and the numbers were a lot higher last year when we were diagnosed incorrectly as wilson’s disease and were using different medication(s).

We are stumped for sure and doctor thinks because of kids fast metabolism the medicine may not have enough time in the stomach to do its work. Doc recommends us to switch to liquid vanco now and finally its approved from insurance today after a month of back & forth. We have to see if this makes any difference to LFT. At the back of our mind, we are wondering if the diagnosis of PSC (actually we were told its early stages of ASC after the MRCP in Feb 2019) is correct.