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amikacin (Rx)Brand and Other Names:Amikin

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 50mg/mL
  • 250mg/mL
more...

General Dosing

15 mg/kg/day divided IV/IM q8-12hr 

Urinary Tract Infection

250 mg IV/IM q12hr

Extended Interval Dosing (q24 Hours)

First dose: 15 mg/kg IV based on lean body weight 

Subsequent doses: consult pharmacist

Hospital Acquired Pneumonia

20 mg/kg/day IV; may administer with antipseudomonal beta-lactam or carbapenem 

Renal Impairment/Elderly

CrCl >90 mL/min & <60 years old: q8hr

CrCl 60-90 mL/min OR >60 years old: q12hr

CrCl 25-60 mL/min: q24hr

CrCl 10-25 mL/min: q48hr

CrCl <10 mL/min: q72hr

Following dialysis in ESRD

Dosing Considerations

Monitor: peak, trough, renal & auditory function

Peak 15-40 mg/L, trough 5-10 mg/L

Mycobacterium Infections (Orphan)

Inhaled liposomal amikacin (Arikayce)

Orphan designation for treatment infections caused by nontuberculous mycobacteria

Sponsor

  • Insmed Incorporated; Princeton Corporate Plaza IV, Suite C; Monmouth Junction, NJ 08852-1919

Pseudomonas aeruginosa Lung Infections (Orphan)

Orphan designation for management of P aeruginosa lung infections in patients with cystic fibrosis

Sponsor

  • PlumeStars s.r.l.; Via Lago Scuro 11; 43124 Parma; Italy

Bronchopulmonary Pseudomonas aeruginosa (Orphan)

Inhaled liposomal amikacin (Arikayce)

Orphan designation for treatment of broncophulmonary P aeurginosa infections in cystic fibrosis

Administration: Inhalation NOTE: FDA imposed clinical hold on trials on August 1, 2011

Sponsor

  • Insemed Inc; 11 Deer Park Drive, Suite 117; Monmouth Junction, NJ 08852

Bronchiectasis (Orphan)

Inhaled liposomal amikacin (Arikayce)

Orphan designation for treatment of bronchiectasis in patients with P aeurginosa infections or other susceptible microbial pathogens (eg, NTM)

Administration: Inhalation NOTE: FDA imposed clinical hold on trials on August 1, 2011

Sponsor

  • Insemed Inc; 11 Deer Park Drive, Suite 117; Monmouth Junction, NJ 08852

Non-tuberculous Mycobacteria Infections (Orphan)

Encochleated amikacin product

Orphan designation for non-tuberculous mycobacteria (NTM) infections

Sponsor

  • Aquarius Biotechnologies, Inc; 1545 U.S. 206; Bedminster Township, New Jersey 07921

Dosage Forms & Strengths

injectable solution

  • 50mg/mL
  • 250mg/mL
more...

General Dosing

15-22.5 mg/kg/day IV/IM divided q8hr  

Neonates

Aged ≤7 days

  • ≤29 weeks gestational age: 18 mg/kg IV/IM q48hr 
  • 30-33 weeks gestational age: 18 mg/kg IV/IM q36hr
  • ≥34 weeks gestational age: 15 mg/kg IV/IM q24hr

Aged >7 days

  • 30-33 weeks gestational age: 15 mg/kg IV/IM q24hr 
  • ≥34 weeks gestational age: 15 mg/kg IV/IM q12-18hr

Aged 8-28 days old & <29 weeks gestational age

  • 15 mg/kg IV/IM q36hr 
  • Also use this dose for the following: significant asphyxia, indomethacin for PDA, poor cardiac output, or renal impairment

Neonates Aged >28 days old & <29 weeks gestational age

  • 15 mg/kg IV/IM q24hr 
  • Also use this dose for the following: significant asphyxia, indomethacin for PDA, poor cardiac output, or renal impairmen
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Interactions

Interaction Checker

amikacin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Neurotoxicity

            Nephrotoxicity (if trough >10 mg/L)

            Ototoxicity

            <1%

            Hypotension

            Headache

            Drug fever

            Rash

            Nausea

            Vomiting

            Eosinophilia

            Paresthesia

            Tremor

            Arthralgia

            Weakness

            Allergic reaction

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            Warnings

            Black Box Warnings

            Neurotoxicity, manifested as both bilateral auditory and vestibular ototoxicity, can occur in patients with preexisting renal damage and in patients with normal renal function treated at higher doses and/or for periods longer than those recommended. High-frequency deafness usually occurs first and can be detected only by audiometric testing

            Vertigo may occur and may be evidence of vestibular injury

            Aminoglycosides are potentially nephrotoxic

            Risk is greater in patients with impaired renal function and in those who receive high doses or prolonged therapy. Rarely, nephrotoxicity may not become apparent until the first few days after cessation of therapy

            Use with caution in premature infants and neonates because of renal immaturity and the resulting prolongation of serum half-life of the drug

            Neuromuscular blockade and respiratory paralysis have been reported following parenteral injection, topical instillation (as in orthopedic and abdominal irrigation or in local treatment of empyema), and oral use of aminoglycosides, especially when given soon after anesthesia or muscle relaxants

            If blockage occurs, calcium salts may reverse these phenomena, but mechanical respiratory assistance may be necessary

            Avoid concurrent or sequential use of neurotoxic and/or nephrotoxic drugs including other aminoglycosides (eg, amikacin, streptomycin, neomycin, kanamycin, gentamicin, paromomycin

            Cumulative listing of drugs to avoid from all aminoglycoside package inserts include amphotericin B, bacitracin, cephaloridine, cisplatin, colistin, polymyxin B, vancomycin, and viomycin

            Avoid potent diuretics (eg, ethacrynic acid, furosemide) because they increase risk of ototoxicity

            When administered intravenously, diuretics may enhance aminoglycoside toxicity by altering antibiotic concentrations in serum and tissue

            Contraindications

            Documented hypersensitivity

            Cautions

            Renal impairment

            Risk of neurotoxicity, ototoxicity, nephrotoxicity - risk of ototoxicity increase with concurrent loop diuretics

            Not intended for long-term therapy; caution in patients with renal failure (not on dialysis), hypocalcemia, myasthenia gravis, and conditions that depress neuromuscular transmission

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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: excretion in milk unknown/not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Half-Life: 2-3 hr (NFR)

            Peak Plasma Time: IM: 45-120 min

            Protein Binding: 0-11%

            Absorption: IM: May be delayed in bedridden patient

            Vd: 0.25-0.4 L/kg, primarily into extracellular fluid (highly hydrophilic); penetrates blood-brain barrier when meninges inflamed; crosses placenta, relative diffusion of antimicrobial agents from blood into CSF: good only with inflammation (exceeds usual MICs)

            Excretion: urine (94-98%)

            Dialyzable: HD: yes; PD: yes

            Mechanism of Action

            Irreversibly binds to 30S subunit of bacterial ribosomes; blocks recognition step in protein synthesis; causes growth inhibition. For gram-negative bacterial coverage of infections resistant to gentamicin and tobramycin

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            Administration

            IV Incompatibilities

            Additive: aminophylline in dextrose-containing diluents, amphotericin B, ampicillin, cefazolin, cefotaxime(?), ceftazidime, chloramphenicol, chlorothiazide, heparin, phenytoin, thiopental, vitamin B/C

            Syringe: heparin

            Y-site: allopurinol, amphotericin B cholesteryl sulfate, azithromycin, hetastarch, propofol

            IV Compatibilities

            Solution: compatible with most common solvents

            Additive (partial list): aminophylline (in LR, NS, Ringer's, Na-Lactate 1/6M), ascorbic acid, CaCl2, cefepime, ceftriaxone, ciprofloxacin, clindamycin, dexamethasone Na-phosphate(? may be conc-dep), diphenhydramine, fluconazole, furosemide, metronidazole, prochlorperazine, promethazine, NaHCO3, KCl (may not be in dextran6%/NS), succinylcholine, vancomycin

            Syringe: caffeine, clindamycin, doxapram

            Y-site (partial list): acyclovir, amiodarone, diltiazem, enalaprilat, fluconazole, furosemide, levofloxacin, linezolid, lorazepam, MgSO4, midazolam, milrinone, morphine, ondansetron, warfarin, zidovudine

            IV Preparation

            Dilute 500 mg to 100 or 200 mL sterile diluent (usu NS or D5W)

            IV/IM Administration

            IM: give undiluted to upper outer quadrant of buttocks

            IV: infuse over 30-60 min in adults and children and 1-2 hr in infants

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Select a class to view formulary status for similar drugs

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