Atracurium
Severe
Database
Clinical effect not specified
Source: DDInter
Drug reference
Amikacin
Aminoglycoside · Antibiotic
Also known as Amikacin sulfate
START
Confirm gram-negative infection/susceptibility; baseline creatinine, audiogram if available; calculate IBW/ABW. Loading dose: 15 mg/kg IV (max 1.5 g).
TYPICAL MAX
15 mg/kg/day (1.5 g/day); cumulative max 15 g/course. Do not exceed peak >35 mcg/mL or trough >10 mcg/mL.
STOP IF
Rising creatinine (>0.5 mg/dL from baseline), evidence of ototoxicity (tinnitus, hearing loss), vestibular symptoms, severe hypersensitivity
WATCH
Renal function (daily creatinine), hearing (audiometry if course >7 days or pre-existing renal impairment), serum levels if conventional dosing (peak 30 min post-dose; trough pre-dose)
CDSCO approvedSchedule HJan AushadhiATC J01GB06
KDIGO 2024 + manufacturer label
- ONSET
- 11min · absorption onset
- PEAK
- 45min · 30-60 min post-infusion
- t½
- 2.5h · 2-3 h (normal); 30-70 h (ESRD)
- DURATION
- 1d · 24 h (once-daily dosing)
EXCRETION
94-98% renal unchanged within 24h; not metabolized
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
FDA PLLR: Aminoglycosides can cause fetal harm. Ototoxicity has been reported in fetuses exposed in utero. Use only if clearly needed and benefit outweighs risk. Avoid if possible, especially in first trimester.
FDA category + note
Top interactionssee all 12 →
- AtracuriumSevereDatabaseDDInter
- BacitracinSevereDatabaseDDInter
- Botulinum Toxin Type ASevereDatabaseDDInter
- Botulinum Toxin Type BSevereDatabaseDDInter
Available in India
1,746 branded formulations and 7 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Amikacin is a semisynthetic aminoglycoside antibiotic derived from kanamycin A. It exerts bactericidal activity by irreversibly binding to the 30S ribosomal subunit, causing misreading of mRNA and inhibition of bacterial protein synthesis. The 1-N-(L-4-amino-2-hydroxybutyryl) side chain confers resistance to most bacterial aminoglycoside-inactivating enzymes, making amikacin active against many gentamicin- and tobramycin-resistant gram-negative organisms.
Indications
Serious infections caused by susceptible gram-negative bacilli ( Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacteriaceae)Mycobacterium avium complex (MAC) infections (as part of combination therapy)Mycobacterial infections in combination regimens (M. chelonae, M. fortuitum)Nocardiosis (combination therapy)Empiric therapy for febrile neutropenia (in combination with beta-lactam)Hospital-acquired/ventilator-associated pneumonia (combination therapy)Intra-abdominal infections (combination with metronidazole and beta-lactam)Complicated urinary tract infections (resistant organisms)
Dosing
- Adult
- Conventional dosing: 15 mg/kg/day IV/IM divided q8-12h (max 1.5 g/day). Once-daily dosing (preferred): 15 mg/kg IV once daily (max 1.5 g/day). Extended interval: 15-20 mg/kg IV q24h. Dosing weight: use ideal body weight (IBW) if BMI ≤30; adjusted body weight if obese.
- Pediatric
- Conventional: 5-7.5 mg/kg IV/IM q8h (max 15 mg/kg/day). Once-daily (≥3 months): 15-22.5 mg/kg IV q24h. Neonates (≥34 weeks GA): 15 mg/kg IV q24-48h; <34 weeks: 15 mg/kg IV q48h.
- Renal adjustment
- CrCl >60: full dose q24h. CrCl 40-60: 7.5 mg/kg q24h (or full dose q36-48h). CrCl 20-39: 7.5 mg/kg q48h. CrCl <20: 3.75-7.5 mg/kg q48-72h. HD: supplemental dose post-dialysis (3.75-7.5 mg/kg). CRRT: 7.5 mg/kg q24-48h.
- Hepatic adjustment
- No dosage adjustment required; minimal hepatic metabolism.
- Geriatric
- Reduce dose and extend interval based on renal function. Monitor serum levels closely. Elderly at higher risk for nephrotoxicity and ototoxicity.
- Max dose
- 15 mg/kg/day; 1.5 g/day; maximum 15 g cumulative per course
Pharmacokinetics
Onset
Rapid bactericidal effect after IV administration; clinical response typically within 24-72 hours.
Peak effect
IV: immediate distribution; peak serum 30-60 min post-infusion. IM: peak at 1-2 hours.
Duration
Post-antibiotic effect (PAE) persists 2-8 hours against gram-negative bacilli.
Half-life
2-3 hours in normal renal function; 30-70 hours in end-stage renal disease (ESRD).
Bioavailability
IM: ~100%. Oral: negligible absorption (<1%). IV: 100% bioavailable.
Protein binding
Low: 0-11% (concentration-independent).
Metabolism
Not metabolized to any significant extent; excreted virtually unchanged.
Excretion
Primarily renal: 94-98% excreted unchanged in urine via glomerular filtration within 24 hours.
Contraindications
- Hypersensitivity to amikacin or other aminoglycosides
- Myasthenia gravis (may worsen neuromuscular blockade)
- Multiple myeloma (increased risk of nephrotoxicity)
- Relative: pre-existing severe renal impairment (dose reduction mandatory)
Side effects
Common
Nephrotoxicity (elevated creatinine/BUN, 1-10% — usually reversible)Ototoxicity — auditory (high-frequency hearing loss, tinnitus)Ototoxicity — vestibular (vertigo, ataxia, nystagmus)Injection site reactions (IM)Fever, rash (less common)
Serious
- Acute tubular necrosis (ATN) and acute kidney injury (AKI)
- Permanent bilateral sensorineural hearing loss (irreversible, dose/cumulative-related)
- Vestibular toxicity (permanent balance disorders)
- Neuromuscular blockade with respiratory paralysis (rare, especially with anesthesia/neuromuscular blockers)
- Anaphylaxis and severe hypersensitivity reactions
- Fetal harm when administered during pregnancy (ototoxicity risk to fetus)
Pregnancy & lactation
Pregnancy
FDA PLLR: Aminoglycosides can cause fetal harm. Ototoxicity has been reported in fetuses exposed in utero. Use only if clearly needed and benefit outweighs risk. Avoid if possible, especially in first trimester.
Lactation
Excreted in breast milk in low concentrations. Risk to nursing infant is low but theoretical (ototoxicity, nephrotoxicity). Consider discontinuing breastfeeding during treatment or monitor infant for adverse effects.
Drug interactions
Bacitracin
Severe
Database
Clinical effect not specified
Source: DDInter
Botulinum Toxin Type A
Severe
Database
Clinical effect not specified
Source: DDInter
Botulinum Toxin Type B
Severe
Database
Clinical effect not specified
Source: DDInter
Bumetanide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Capreomycin
Severe
Database
Clinical effect not specified
Source: DDInter
Cidofovir
Severe
Database
Clinical effect not specified
Source: DDInter
Cisatracurium
Severe
Database
Clinical effect not specified
Source: DDInter
Cisplatin
Severe
Database
Increased risk of acute kidney injury and ototoxicity
Avoid concomitant use. If unavoidable, monitor renal function and auditory function extremely closely. Consider alternative antibiotics if possible during cisplatin therapy.
Source: DDInter
Colistimethate
Severe
Database
Clinical effect not specified
Source: DDInter
Colistin
Severe
Database
Increased risk of acute kidney injury and respiratory depression/paralysis
Avoid concomitant use due to high risk of toxicity. If no other options, monitor renal function and respiratory status extremely closely. Be prepared for respiratory support.
Cyclosporine
Severe
Database
Increased risk of acute kidney injury and elevated cyclosporine levels due to impaired renal clearance.
Avoid concomitant use. If unavoidable, monitor renal function and cyclosporine trough levels very closely. Adjust cyclosporine dose as needed. Consider alternative antibiotics.
Source: DDInter
Related guidelines
Other Aminoglycoside drugs
Ask House about Amikacin
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-18 · House clinical team·Cockpit curated: 2026-05-18