Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 75mg/2mL
- 500mg/2mL
- 1g/3mL
Susceptible Infections
IV Administration: 5-7.5 mg/kg/dose divided q8-12hr; not to exceed 15 mg/kg/day divided q6-12hr; administer slowly
IM Administration: 5-7.5 mg/kg/dose divided q8-12hr; not to exceed 15 mg/kg/day IM divided q12hr at equally divided intervals; continuously high blood levels are desired; daily dose of 15 mg/kg may be given divided q6-8hr
Aerosol: 250 mg q6-12hr by nebulization
Renal Impairment
CrCl 50-80 mL/min: give 60-90% of usual dose or give q8-12hr
CrCl 10-50 mL/min: give 30-70% of usual dose or give q12hr
CrCl <10 mL/min: give 20-30% of usual dose or give q24-48hr
Monitor
Peak (15-30 mg/L)
Trough (5-10 mg/L)
See adult dosing
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (1)
- microbiota oral
kanamycin decreases effects of microbiota oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Microbiota oral contains bacterial spores. Antibacterial agents may decrease efficacy if coadministered. Complete antibiotic regimens 2-4 days before initiating microbiota oral. .
Monitor Closely (5)
- levoketoconazole
levoketoconazole will increase the level or effect of kanamycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of kanamycin 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 kanamycin 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.
- voclosporin
voclosporin, kanamycin. 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
kanamycin increases effects of warfarin by anticoagulation. Use Caution/Monitor.
Minor (2)
- entecavir
kanamycin, 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.
- levoketoconazole
levoketoconazole decreases levels of kanamycin by unknown mechanism. Minor/Significance Unknown.
Adverse Effects
Frequency Not Defined
Agranulocytosis
Anorexia
Diarrhea
Dyspnea
Edema
Elevated BUN
Enterocolitis
Headache
Incr salivation
Muscle cramps
Muscle weakness
Nausea
Nephrotoxicity
Neurotoxicity
Ototoxicity
Pruritus
Pseudotumor cerebri
Rash
Tinnitus
Thrombocytopenia
Tremor
Vertigo
Weakness
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 antimicrobials#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 antimicrobials#aminoglycosides (eg, amikacin, streptomycin, neomycin, kanamycin, gentamicin, puromomycin
Cumulative listing of drugs to avoid from all aminoglycoside package inserts includes 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
Auditory toxicity more common with kanamycin than with streptomycin and capreomycin; monthly audiometry is recommended while patients are being treated with this drug; vestibular toxicity is rare; renal toxicity occurs at a frequency similar to that of capreomycin; regular monitoring of serum creatinine recommended
Renal impairment
Myasthenia gravis
Vestibular/cochlear implant
Nephrotoxic agents
Pregnancy & Lactation
Pregnancy Category: D
Lactation: usually compatible
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.Pharmacology
Metabolism: unknown
Excretion: urine
Mechanism of Action
Bactericidal
Aminoglycoside contain 1 or 2 amino sugars linked to an aminocyclitol nucleus. Nucleus is 2-deoxystreptamine. Bactericidal and believed to inhibit protein synthesis by binding to 30 S ribosomal subunit.
Administration
IV Incompatibilities
Do not mix with other drugs
IV Preparation
For adults, IV infusions are prepared by adding 500 mg of kanamycin to 100-200 mL of usual IV infusion fluid such as NS or D5W or by adding 1 g of the drug to 200-400 mL of diluent
IV/IM Administration
Administer by deep IM injection, or IV infusion
May administer by intraperitoneal instillation, irrigation, or inhalation
Infuse over 30-60 min
Storage
Store <40°C, preferably between 15-30°C
Protect from freezing
