kanamycin (Discontinued)

Brand and Other Names:Kantrex
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Dosing & Uses

AdultPediatric

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

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Interactions

Interaction Checker

and kanamycin

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (3)

                • 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.

                Minor (1)

                • 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.

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                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

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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, 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

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                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.

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                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.

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                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

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                Images

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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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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.