amikacin sulfate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
amikacin sulfate: clinical details
Prescribing considerations
- Assess renal function, hydration, previous aminoglycoside exposure, hearing or vestibular impairment, and concurrent toxic medicines.
- Ask about maternal or family hearing loss and known mitochondrial mutations.
- Liposomal inhaled amikacin should be initiated and managed by clinicians experienced in Mycobacterium avium complex lung disease and used with other active antibacterial agents.
Contraindications and cautions
- Hypersensitivity to amikacin, formulation excipients or another aminoglycoside.
- One selected injectable product contraindicates use in myasthenia gravis.
- A selected metabisulfite-containing injection is contraindicated in people with asthma and sulfite hypersensitivity.
- Liposomal inhaled amikacin is contraindicated with soya hypersensitivity, concurrent aminoglycoside treatment and severe renal impairment.
Monitoring
- For systemic treatment, monitor serum amikacin concentrations and renal function.
- Assess hearing and vestibular function, particularly with renal impairment, previous ear damage, mitochondrial risk or recurrent exposure.
- During inhaled treatment, monitor respiratory tolerance, underlying lung disease, hearing, balance, renal function and microbiological response.
Clinical pharmacology
Amikacin is a concentration-dependent bactericidal aminoglycoside that binds bacterial 30S ribosomes. It is eliminated mainly unchanged by glomerular filtration; impaired renal function increases accumulation risk. Liposomal nebulisation provides pulmonary delivery with lower systemic exposure than parenteral administration.
Formulation and product differences
- Parenteral products are for intramuscular injection or intravenous infusion and require systemic therapeutic-drug monitoring.
- The liposomal nebuliser dispersion is for oral inhalation only through the Lamira system and is not interchangeable with injectable amikacin.
- Excipients differ between injection products; check individual product information for metabisulfite, sodium and hypersensitivity implications.
amikacin sulfate preparations and strengths
Inhaled preparation
Route: Inhaled
Strengths: 590 mg
Injection
Route: Parenteral
Strengths: 250 mg/mL
amikacin sulfate interactions
Review prescribed, non-prescription and recent medicines because some combinations can increase toxicity.
Other aminoglycosides
Toxic effects may add together; concurrent use with liposomal inhaled amikacin is contraindicated regardless of route.
Cisplatin and other platinum compounds
May increase kidney toxicity and possibly hearing damage.
Amphotericin B, ciclosporin, tacrolimus, vancomycin or colistin
May add to kidney, hearing or neurological toxicity and generally requires avoidance or close monitoring.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.