amikacin (Rx)

Brand and Other Names:Amikin (DSC)
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 50mg/mL
  • 250mg/mL

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  

Dosage Modifications

Renal impairment

  • CrCl >90 mL/min and aged <60 yr: q8hr
  • CrCl 60-90 mL/min OR aged ≥60 yr: q12hr
  • CrCl 25-60 mL/min: q24hr
  • CrCl 10-25 mL/min: q48hr
  • CrCl <10 mL/min: q72hr
  • Administer after dialysis in ESRD

Limitation of use

Drug has only been studied in patients with refractory Mycobacterium avium complex (MAC) lung disease defined as patients who did not achieve negative sputum cultures after a minimum of 6 consecutive months of a multidrug background regimen therapy; use is not recommended for patients with nonrefractory MAC lung disease

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

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

and amikacin

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      Serious - Use Alternative

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            Contraindicated (3)

            • amphotericin B deoxycholate

              amikacin and amphotericin B deoxycholate both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • cidofovir

              amikacin and cidofovir both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • neomycin PO

              amikacin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            Serious - Use Alternative (24)

            • atracurium

              amikacin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • bacitracin

              amikacin and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs

            • BCG vaccine live

              amikacin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

            • bumetanide

              bumetanide, amikacin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

            • cholera vaccine

              amikacin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

            • cisatracurium

              amikacin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • contrast media (iodinated)

              amikacin and contrast media (iodinated) both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • cyclosporine

              amikacin and cyclosporine both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • ethacrynic acid

              ethacrynic acid, amikacin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

            • furosemide

              furosemide, amikacin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

            • incobotulinumtoxinA

              amikacin increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • ioversol

              amikacin and ioversol both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • onabotulinumtoxinA

              amikacin increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • pancuronium

              amikacin increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • quinidine

              quinidine will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • rapacuronium

              amikacin increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • rimabotulinumtoxinB

              amikacin increases effects of rimabotulinumtoxinB by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • rocuronium

              amikacin increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • succinylcholine

              amikacin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • tacrolimus

              amikacin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • teicoplanin

              amikacin and teicoplanin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • torsemide

              torsemide, amikacin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

            • typhoid vaccine live

              amikacin decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

            • vecuronium

              amikacin increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            Monitor Closely (71)

            • abobotulinumtoxinA

              amikacin increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • acyclovir

              acyclovir and amikacin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • adefovir

              adefovir and amikacin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • amiodarone

              amiodarone will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • bazedoxifene/conjugated estrogens

              amikacin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • capreomycin

              amikacin and capreomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • carboplatin

              amikacin and carboplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • cephaloridine

              amikacin and cephaloridine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • cisplatin

              amikacin and cisplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • clarithromycin

              clarithromycin will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • clotrimazole

              clotrimazole will decrease the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • colistin

              amikacin and colistin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • conjugated estrogens

              amikacin will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • cyclosporine

              cyclosporine will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • deferasirox

              deferasirox, amikacin. Other (see comment). Use Caution/Monitor. Comment: Acute renal failure has been reported during treatment with deferasirox. Coadministration of deferasirox with other potentially nephrotoxic drugs, including aminoglycosides, may increase the risk of this toxicity. Monitor serum creatinine and/or creatinine clearance in patients who are receiving deferasirox and nephrotoxic drugs concomitantly.

            • dienogest/estradiol valerate

              amikacin will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

            • digoxin

              amikacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

            • dronedarone

              dronedarone will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              amikacin and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • erythromycin base

              erythromycin base will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • erythromycin lactobionate

              erythromycin lactobionate will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • erythromycin stearate

              erythromycin stearate will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • estradiol

              amikacin will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • estrogens conjugated synthetic

              amikacin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • estropipate

              amikacin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • felodipine

              felodipine will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • foscarnet

              amikacin and foscarnet both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • gentamicin

              amikacin and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • ibuprofen

              ibuprofen increases levels of amikacin by decreasing renal clearance. Use Caution/Monitor. Interaction mainly occurs in preterm infants.

            • ibuprofen IV

              ibuprofen IV increases levels of amikacin by decreasing renal clearance. Use Caution/Monitor. Interaction mainly occurs in preterm infants.

            • indinavir

              indinavir will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • ketoconazole

              ketoconazole will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • loratadine

              loratadine will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • magnesium supplement

              magnesium supplement, amikacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Each enhance the neuromuscular blocking effect of the other; may have negative respiratory effects.

            • mestranol

              amikacin will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • methoxyflurane

              amikacin and methoxyflurane both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • nefazodone

              nefazodone will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • nicardipine

              nicardipine will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • nifedipine

              nifedipine will decrease the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • nilotinib

              nilotinib will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • oxaliplatin

              amikacin and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • paromomycin

              amikacin and paromomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • pentamidine

              amikacin and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • peramivir

              amikacin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

            • phenobarbital

              phenobarbital will decrease the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • phenytoin

              phenytoin will decrease the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • polymyxin B

              amikacin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • prabotulinumtoxinA

              amikacin increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • quercetin

              quercetin will decrease the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • rifampin

              rifampin will decrease the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • ritonavir

              ritonavir will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • sirolimus

              sirolimus will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • sodium picosulfate/magnesium oxide/anhydrous citric acid

              amikacin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of amikacin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of amikacin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • St John's Wort

              St John's Wort will decrease the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • streptomycin

              amikacin and streptomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • streptozocin

              amikacin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • tacrolimus

              tacrolimus will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • tenofovir DF

              amikacin and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              amikacin increases levels of tenofovir DF by decreasing elimination. Use Caution/Monitor.

            • tobramycin

              amikacin and tobramycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • tobramycin inhaled

              tobramycin inhaled and amikacin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

            • tolvaptan

              tolvaptan will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • trazodone

              trazodone will decrease the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • trimagnesium citrate anhydrous

              amikacin, trimagnesium citrate anhydrous. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration of aminoglycosides with magnesium may increase risk of neuromuscular weakness and paralysis.

            • vancomycin

              amikacin and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • verapamil

              verapamil will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • voclosporin

              voclosporin, amikacin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • warfarin

              amikacin increases effects of warfarin by unknown mechanism. Use Caution/Monitor.

            Minor (61)

            • aceclofenac

              aceclofenac increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • acemetacin

              acemetacin increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • aspirin

              aspirin increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • aspirin rectal

              aspirin rectal increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • aztreonam

              aztreonam, amikacin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Pseudomonas spp. and Enterobacteriaceae.

            • balsalazide

              amikacin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • biotin

              amikacin will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • calcium acetate

              amikacin decreases levels of calcium acetate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • calcium carbonate

              amikacin decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • calcium chloride

              amikacin decreases levels of calcium chloride by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • calcium citrate

              amikacin decreases levels of calcium citrate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • calcium gluconate

              amikacin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • celecoxib

              celecoxib increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • clotrimazole

              clotrimazole decreases levels of amikacin by unknown mechanism. Minor/Significance Unknown.

            • cordyceps

              cordyceps decreases toxicity of amikacin by unspecified interaction mechanism. Minor/Significance Unknown.

            • cyanocobalamin

              amikacin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • diclofenac

              diclofenac increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • diflunisal

              diflunisal increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • entecavir

              amikacin, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

            • etodolac

              etodolac increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • fenoprofen

              fenoprofen increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • fluconazole

              fluconazole decreases levels of amikacin by unknown mechanism. Minor/Significance Unknown.

            • flurbiprofen

              flurbiprofen increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • indomethacin

              indomethacin increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • ketoconazole

              ketoconazole decreases levels of amikacin by unknown mechanism. Minor/Significance Unknown.

            • ketoprofen

              ketoprofen increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • ketorolac

              ketorolac increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • ketorolac intranasal

              ketorolac intranasal increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • lornoxicam

              lornoxicam increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • magnesium chloride

              amikacin decreases levels of magnesium chloride by increasing renal clearance. Minor/Significance Unknown.

            • magnesium citrate

              amikacin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

            • magnesium hydroxide

              amikacin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • magnesium oxide

              amikacin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

            • magnesium sulfate

              amikacin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

            • meclizine

              meclizine, amikacin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Ototoxicity of aminoglycoside may be masked.

            • meclofenamate

              meclofenamate increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • mefenamic acid

              mefenamic acid increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • meloxicam

              meloxicam increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • miconazole vaginal

              miconazole vaginal decreases levels of amikacin by unknown mechanism. Minor/Significance Unknown.

            • nabumetone

              nabumetone increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • naproxen

              naproxen increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • oxaprozin

              oxaprozin increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • pantothenic acid

              amikacin will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • parecoxib

              parecoxib increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • piperacillin

              piperacillin increases effects of amikacin by pharmacodynamic synergism. Minor/Significance Unknown.

            • piroxicam

              piroxicam increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • posaconazole

              posaconazole decreases levels of amikacin by unknown mechanism. Minor/Significance Unknown.

            • pyridoxine

              amikacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • pyridoxine (Antidote)

              amikacin will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • salicylates (non-asa)

              salicylates (non-asa) increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • salsalate

              salsalate increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • sulfasalazine

              sulfasalazine increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • sulindac

              sulindac increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • thiamine

              amikacin will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • ticarcillin

              ticarcillin decreases effects of amikacin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.

            • tolfenamic acid

              tolfenamic acid increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • tolmetin

              tolmetin increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • voriconazole

              voriconazole decreases levels of amikacin by unknown mechanism. Minor/Significance Unknown.

            • zoledronic acid

              amikacin, zoledronic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypocalcemia.

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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

            Postmarketing Reports

            Limitation of use

            Immune system disorders: Hypersensitivity, anaphylaxis

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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

            Caution in patients with renal impairment

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

            Serious and potentially life-threatening hypersensitivity reactions, including anaphylaxis, reported; before therapy instituted, evaluate for previous hypersensitivity reactions to aminoglycosides; if anaphylaxis or a hypersensitivity reaction occurs, discontinue therapy and institute appropriate supportive measures

            Hypersensitivity pneumonitis reported; if hypersensitivity pneumonitis occurs, discontinue therapy and manage patients as medically appropriate

            Higher frequency of hemoptysis and bronchospasm, reported with treatment; if these occur, manage patients as medically appropriate

            Aminoglycosides can cause nephrotoxicity; close monitoring of patients with known or suspected renal dysfunction may be needed when prescribing drug

            Higher frequency of ototoxicity reported with treatment; closely monitor patients with known or suspected auditory or vestibular dysfunction; if patients develop tinnitus this may be an early symptom of ototoxicity

            Aminoglycosides may aggravate muscle weakness because of a potential curare-like effect on neuromuscular function; if neuromuscular blockade occurs, it may be reversed by the administration of calcium salts, but mechanical assistance may be necessary

            Higher frequency of exacerbations of underlying pulmonary disease reported with treatment; treat patients as medically appropriate if this occurs

            Aminoglycosides can cause total, irreversible, bilateral congenital deafness in pediatric patients exposed in utero

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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.

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            Pharmacology

            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

            Absorption

            IM absorption: May be delayed in bedridden patient

            Peak plasma time, IM: 45-120 min

            Distribution

            Protein bound: 0-11%

            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)

            Elimination

            Half-Life: 2-3 hr (normal renal function)

            Excretion: urine (94-98%)

            Dialyzable: HD: yes; PD: yes

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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 (0.9% NaCl or D5W)

            IV/IM Administration

            IM: Administer undiluted to upper outer quadrant of buttocks

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

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            amikacin injection
            -
            1,000 mg/4 mL vial
            amikacin injection
            -
            500 mg/2 mL vial
            amikacin injection
            -
            500 mg/2 mL vial
            amikacin injection
            -
            1,000 mg/4 mL vial
            amikacin injection
            -
            500 mg/2 mL vial
            amikacin injection
            -
            1,000 mg/4 mL vial
            amikacin injection
            -
            1,000 mg/4 mL vial
            amikacin injection
            -
            1,000 mg/4 mL vial
            amikacin injection
            -
            500 mg/2 mL vial
            amikacin injection
            -
            1,000 mg/4 mL vial
            amikacin injection
            -
            500 mg/2 mL vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            amikacin injection

            AMIKACIN - INJECTION

            (A-mi-KAY-sin)

            COMMON BRAND NAME(S): Amikin

            WARNING: This medication can cause serious kidney problems and nerve damage, resulting in permanent hearing loss (including deafness or decreased hearing) and balance problems. The risk is increased if you are older, already have kidney disease, or if you have a severe loss of body water (dehydration). Your risk is also increased if you receive high doses, or with longer use of this medication.Tell your doctor right away if you notice ringing/roaring sounds in the ears, hearing loss, dizziness, or an unusual decrease in the amount of your urine.Careful monitoring by your doctor will reduce the risk of these side effects. Monitoring may include hearing, kidney, urine, and drug blood level tests.Avoid other medications that may increase your risk for these serious side effects if taken together with amikacin. See also Drug Interactions section.

            USES: This medication is used to prevent or treat a wide variety of bacterial infections. Amikacin belongs to a class of drugs known as aminoglycoside antibiotics. It works by stopping the growth of bacteria.

            HOW TO USE: This medication is given by injection into a vein or muscle as directed by your doctor. It is usually given every 8 hours or as directed by your doctor. The dosage is based on your medical condition, weight, and response to treatment. Laboratory tests (such as kidney function, levels of drug in the blood) may be performed to help find the best dose for your condition.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.Tell your doctor if your condition persists or worsens.

            SIDE EFFECTS: See also Warning section.Nausea, vomiting, stomach upset, or loss of appetite may occur. Pain/irritation/redness at the injection site may rarely occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: numbness/tingling, muscle twitching or weakness, seizure.This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before using amikacin, tell your doctor or pharmacist if you are allergic to it; or to other aminoglycoside antibiotics (such as gentamicin, tobramycin); or if you have any other allergies. This product may contain inactive ingredients (such as sulfites), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: cystic fibrosis, hearing problems (including deafness, decreased hearing), kidney problems, low blood minerals (including potassium, magnesium, calcium), myasthenia gravis, Parkinson's disease.Amikacin may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the effects of this drug, especially kidney damage.This medication is not recommended for use during pregnancy. Although there have been reports of harm in babies born to women using similar drugs, there have not been reports of harm in babies born to women using amikacin. Discuss the risks and benefits with your doctor.This drug passes into breast milk in small amounts. However, many doctors consider breastfeeding safe while using this medication. Consult your doctor before breastfeeding.

            DRUG INTERACTIONS: See also Warning section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Other medications that may affect the kidneys or hearing may increase the risk of kidney damage or hearing loss if taken with amikacin. Some examples include: amphotericin B, cidofovir, cisplatin, polymyxin B, tobramycin, cephalosporins such as cephaloridine, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, among others.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Laboratory and/or medical tests (such as kidney function, amikacin blood levels) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

            STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.