Amikacin is an aminoglycoside antibiotic given by injection, used to treat serious infections caused by Gram-negative bacteria (including Pseudomonas, E. coli and Klebsiella), mainly in hospital. It is effective but can damage the kidneys (nephrotoxicity) and the inner ear (ototoxicity), so close monitoring and blood level monitoring are required.
Also known as: Amikin
Combining Amikacin with Vancomycin increases the risk of nephrotoxicity and ototoxicity, with an additive effect on the kidney and the inner ear.
Vancomycin ("systemic exposure may result in acute kidney injury") and amikacin (an aminoglycoside with "ototoxicity and nephrotoxicity associated with their use", ototoxicity being "usually irreversible" and "greater in patients with renal damage") have overlapping toxicity that adds up in combination. The risk is particularly high in critically ill patients, pre-existing renal impairment, hypovolaemia, sepsis or prolonged therapy, and nephrotoxicity "may not become apparent until the first few days after cessation of therapy" (amikacin label). Monitor creatinine daily, vancomycin and amikacin levels, and otological symptoms (tinnitus, vertigo, hearing loss); adjust doses to creatinine clearance and reassess the need to keep both after 5–7 days.
Vancomycin + amikacin: additive renal and cochlear/vestibular toxicity. Monitor renal function, levels and hearing; adjust to creatinine clearance.
Vancomycin and Amikacin (aminoglycoside) are nephrotoxic and ototoxic; combined use adds renal and cochlear/vestibular toxicity, particularly with prior renal impairment or prolonged therapy.
Monitor renal function, serum levels of both drugs and signs of ototoxicity.
Worsening renal function, oliguria or auditory signs require prompt discontinuation and evaluation.
Avoid the combination; if needed, use the shortest course, hydrate and adjust doses to renal function.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890 ; approved Vancomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b01aaa02-8f1d-4b57-96a5-337503428af1 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Cefepime + amikacin: increased risk of nephrotoxicity and ototoxicity — monitor renal function.
The FDA cefepime label documents the aminoglycoside class in the interactions section ("Aminoglycosides: increased potential of nephrotoxicity and ototoxicity. Monitor renal function", 7.2). Amikacin is a broad-spectrum aminoglycoside used mainly against multidrug-resistant Gram-negatives, and the combination with cefepime is common in empirical regimens for severe infections (e.g., nosocomial sepsis, febrile neutropenia). The renal and auditory risk is additive and ototoxicity can be irreversible. Monitoring should include creatinine and urine output, watch for tinnitus, hearing loss and vertigo, and, when available, amikacin serum levels. In the elderly and renally impaired, extend the aminoglycoside interval and reassess the need for the combination daily.
Cefepime + amikacin: additive nephrotoxicity and ototoxicity (aminoglycoside) — monitor renal function and auditory symptoms.
The FDA cefepime label documents the class: "Aminoglycosides: increased potential of nephrotoxicity and ototoxicity. Monitor renal function" (7.2). Amikacin, a broad-spectrum aminoglycoside, is combined with cefepime in empirical regimens for severe infections — the renal and auditory risk is additive.
Monitor amikacin serum levels when applicable.
Rising creatinine, oliguria, tinnitus or hearing loss during the combination.
Monitor renal function and watch for ototoxicity during the combination.
DailyMed/FDA (NIH/NLM) — approved Cefepime label (WG CRITICAL CARE), section 7.2: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5fd857e5-591f-44ca-80cf-fd903660b03c ; approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Combining Amikacin with Furosemide increases the risk of ototoxicity and nephrotoxicity through an additive effect on the inner ear and the kidney.
Amikacin is an ototoxic aminoglycoside that destroys cochlear and vestibular hair cells. Furosemide, although not ototoxic on its own, significantly potentiates aminoglycoside ototoxicity — the proposed mechanism includes competition for tubular secretion (raising amikacin levels) and effect on cochlear microcirculation (hair cell ischaemia). Studies demonstrated that coadministration increases hearing loss incidence from 5-10% (monotherapy) to 15-30%. Hearing loss may be irreversible. If coadministration is unavoidable (e.g. pulmonary oedema in TB patient), monitor audiogram weekly and discontinue immediately if auditory deterioration occurs.
Amikacin + furosemide: additive ototoxicity. High risk of deafness. Avoid whenever possible.
Amikacin (aminoglycoside) and Furosemide (loop diuretic) are both ototoxic and nephrotoxic; co-administration potentiates vestibular/cochlear and renal toxicity, especially with renal impairment or dehydration.
Monitor renal function, urine output, electrolytes and ototoxic signs; serum amikacin levels during prolonged regimens.
Tinnitus, vertigo, hearing loss or worsening renal function require prompt discontinuation and evaluation.
Avoid the combination; if needed, minimize duration, ensure adequate hydration and adjust the amikacin dose to renal function.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890 ; approved Furosemide label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7cdcd001-ab4b-4210-a455-2e17a7bc4972 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Amikacin and streptomycin are both aminoglycosides with additive ototoxicity and nephrotoxicity. CONTRAINDICATED.
Amikacin and streptomycin are both aminoglycosides with the same mechanism of ototoxicity (cochlear and vestibular hair cell destruction) and nephrotoxicity (proximal tubular damage). Coadministration causes additive toxicity with very high risk of bilateral deafness and acute renal failure. There is no justifiable clinical scenario for combining two aminoglycosides — WHO and international guidelines explicitly prohibit this combination.
Amikacin + streptomycin: two aminoglycosides = additive toxicity. CONTRAINDICATED.
Both damage cochlear and vestibular hair cells by identical mechanism. The combination potentiates toxicity additively, with high risk of deafness and nephrotoxicity.
Audiogram, creatinine, electrolytes.
Bilateral deafness, acute renal failure.
CONTRAINDICATED. Never combine two aminoglycosides. Choose only one.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Capreomycin and amikacin are both ototoxic and nephrotoxic. Coadministration significantly increases the risk of auditory and renal toxicity.
Capreomycin and amikacin are both second-line injectable drugs with the same toxicity profile: ototoxicity (cochlear and vestibular) and tubular nephrotoxicity. Coadministration causes significant additive toxicity — studies in MDR-TB regimens demonstrated that combining two injectables increases hearing loss incidence to >20% and nephrotoxicity to >15%. WHO recommends using only one second-line injectable at a time. If switching between injectables is necessary, discontinue the first before starting the second (1-2 week washout period to allow elimination).
Capreomycin + amikacin: additive ototoxicity and nephrotoxicity. Always avoid.
Both cause damage to cochlear and vestibular hair cells. The combination potentiates ototoxicity and nephrotoxicity.
Audiogram, creatinine, electrolytes, vestibular.
Deafness, vestibulopathy, nephrotoxicity.
AVOID coadministration. If necessary, monitor audiogram and renal function weekly.
EMC-UK (MHRA) — approved Capreomycin SmPC: https://www.medicines.org.uk/emc/product/6852/smpc ; DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Amikacin is given intravenously or intramuscularly; food does not affect its pharmacokinetics.
May be administered regardless of meals.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
No relevant pharmacokinetic interaction, but alcohol can worsen ototoxicity/vestibular symptoms and dehydration.
Moderate alcohol intake during treatment.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Amikacin is eliminated renally; renal impairment increases the risk of nephrotoxicity and ototoxicity.
Adjust the dose and interval based on renal function and monitor serum levels and renal function.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Aminoglycosides are ototoxic; patients with pre-existing hearing loss or vestibular disease are at increased risk.
Monitor for ototoxic symptoms (tinnitus, vertigo, hearing loss) and consider audiometry in prolonged treatment.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Amikacin is not hepatically metabolised, but severe liver disease may affect elimination indirectly.
Monitor renal function and serum levels. No specific adjustment for liver disease required.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Aminoglycosides can cause fetal ototoxicity; use only if the benefit outweighs the risk.
Use only in severe infections when there is no alternative (e.g., multidrug-resistant tuberculosis).
Present in breast milk in small amounts; the ototoxicity risk to the infant is considered low, but use with caution.
No specific contraception required.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Bactericidal broad-spectrum aminoglycoside directed mainly at Gram-negatives (Pseudomonas, Escherichia coli, Klebsiella-Enterobacter-Serratia, Proteus, Acinetobacter), also active against staphylococci and many gentamicin- and tobramycin-resistant strains. Indicated for short-term treatment of serious infections (septicaemia, respiratory tract, bone and joints, CNS including meningitis, skin and soft tissue, intra-abdominal, burns, and complicated/recurrent urinary tract infections). The potential for ototoxicity, nephrotoxicity and neuromuscular blockade limits its use.
Binds to the prokaryotic ribosome, inhibiting protein synthesis in susceptible bacteria; bactericidal in vitro against Gram-positive and Gram-negative bacteria. Resists degradation by several aminoglycoside-inactivating enzymes that affect gentamicin, tobramycin and kanamycin. Combination with a beta-lactam is synergistic against many clinically significant Gram-negatives.
Rapidly absorbed after intramuscular administration: mean peak serum concentrations of about 12, 16 and 21 mcg/mL 1 hour after 250, 375 and 500 mg doses (3.7, 5 and 7.5 mg/kg); after a 500 mg IV infusion over 30 minutes the mean peak is 38 mcg/mL at the end of the infusion. Mean volume of distribution 24 L (28% of body weight); protein binding 0 to 11% (ultrafiltration). Remains mainly in the extracellular space.
Excreted essentially by glomerular filtration with no relevant metabolism: with normal renal function about 91.9% of an intramuscular dose is excreted unchanged in urine in the first 8 hours and 98.2% within 24 hours (84% in 9 h and about 94% within 24 h after IV infusion). In renal impairment excretion is much slower, prolonging half-life — adjust the dose.
Mean serum half-life slightly over 2 hours with normal renal function; mean serum clearance about 100 mL/min (renal clearance 94 mL/min). Prolonged in renal impairment (correlated inversely with postnatal age in neonates) and in heart failure. Therapeutic levels are found in bone, heart, gallbladder and lung, in addition to urine, bile and sputum.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
