Lower Cost Option for Prescribing Oral Vancomycin

Vancomycin is a treatment for C. Difficile colitis, but can it be obtained for less than $1000?

I had a patient, recently, who is uninsured who was treated for C. difficile colitis. I was saddened to hear that she was given a prescripiton for oral vancomycin capsules. If there is one way to sour a self-pay patient on modern medicine it is to prescribe off patent medications in an expensive formulation. I have to say I learned this trick a long time ago from a coleague. I regret I don't recall who told me, but it saves thousands of dollars.

Do I exagerate? No! Vancomycin capsules for a 10 day course of 250 mg four times a day cost upwards of $1000? So, how do you save money? Get a pharmacist to dispense the solution used for IV administration.

IV vancomycin has been available for years for about $15 for a 10 gram dose. That is just the amount needed for an oral course of therapy. Just have the pharmacist mix up the following:

Vancomycin HCl 10 g inj.1 vial
Saccharin Sodium0.4 g
Stevia0.4 g
Glycerin80 ml
Raspberry concentrate0.2 ml
Distilled waterqs 200 ml

This has a stability of 14 days if refrigerated. She has Crohn's disease and has recurrent C. diff which I found upon scoping her, today. This script will cost about $50-$80, saving her about $900 to $1000. Now she thinks I'm great. Next step may be a stool transplant (which might cure her Crohn's!).

I found this recipe for compounding Vancomycin at the American Society of Health-System Pharmacists web site. The internet is a wonderful place, and Google serves us well. The recent script I wrote left out the Stevia, and just ordered "flavor, prn", leaving that to the judgement of the pharmacist. Don't fear writing a compounding prescription. Pharmacists are our friends, and they like the chance to provide this service to our patients.

Stephen Holland, MD
Naperville Gastroenterology
Naperville, IL 60563

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