Atracurium
Severe
Database
Clinical effect not specified
Source: DDInter
Drug reference
Netilmicin
Aminoglycoside antibiotic · Antibiotic
Also known as Netilmicin sulfate
START
Extended-interval: 4–6 mg/kg IV/IM once daily; adjust by levels
TYPICAL MAX
7.5 mg/kg/day (traditional dosing)
STOP IF
New vertigo/hearing loss or rising creatinine
WATCH
Audiometry/vestibular, renal function, peak/trough levels
CDSCO approvedSchedule HATC J01GB07
KDIGO 2024 + manufacturer label
- ONSET
- 6min · infusion start
- PEAK
- 30min · end infusion
- t½
- 2.5h · t½
- DURATION
- 1d · once-daily
EXCRETION
Renal — glomerular filtration, unchanged
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Avoid — documented fetal ototoxicity (aminoglycoside class).
FDA category + note
Top interactionssee all 12 →
- AtracuriumSevereDatabaseDDInter
- BacitracinSevereDatabaseDDInter
- Botulinum Toxin Type ASevereDatabaseDDInter
- Botulinum Toxin Type BSevereDatabaseDDInter
Mechanism
Binds the 30S ribosomal subunit, causing misreading of mRNA and inhibiting bacterial protein synthesis; bactericidal, concentration-dependent, active against Gram-negative aerobes and some Gram-positives (with β-lactam synergy).
Indications
Septicaemia / serious systemic infectionsHospital-acquired Gram-negative respiratory / urinary tract infectionsEndocarditis (synergy with penicillin)Burns / surgical infections
Dosing
- Adult
- Standard: 4–6 mg/kg IV/IM once daily (extended-interval) OR 1.5–2 mg/kg IV/IM every 8–12 h (traditional). Adjust by levels.
- Pediatric
- Neonates / infants per gestational age (specialist).
- Renal adjustment
- Extend interval / reduce dose; level-guided (CrCl-dependent).
- Hepatic adjustment
- No specific adjustment.
- Geriatric
- Lower mg/kg; higher oto/nephrotoxicity risk.
- Max dose
- 7.5 mg/kg/day (traditional) or 6 mg/kg/day (extended-interval)
Pharmacokinetics
Onset
Bactericidal levels within 1 h
Peak effect
End of infusion / 1 h post-IM
Duration
~8–24 h per interval
Half-life
~2–3 h (markedly prolonged in renal failure)
Bioavailability
IV/IM 100%
Protein binding
<10%
Metabolism
Not metabolised
Excretion
Renal — glomerular filtration, unchanged
Contraindications
- Aminoglycoside hypersensitivity
- Myasthenia gravis
- Pre-existing severe vestibular / auditory damage
- Pregnancy (ototoxicity)
Side effects
Common
Nephrotoxicity (rise in creatinine)Vestibular disturbanceTinnitusInjection-site reactions
Serious
- Irreversible ototoxicity (cochlear and vestibular)
- Severe nephrotoxicity (less than gentamicin)
- Neuromuscular blockade / apnoea
- Anaphylaxis
Pregnancy & lactation
Pregnancy
Avoid — documented fetal ototoxicity (aminoglycoside class).
Lactation
Poor oral absorption by infant; generally considered compatible.
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
Additive oto/nephrotoxicity
Avoid concurrent use
Source: Kimi deep-research + Cla
Colistimethate
Severe
Database
Clinical effect not specified
Source: DDInter
Deferasirox
Severe
Database
Clinical effect not specified
Source: DDInter
Diatrizoate
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Other Aminoglycoside antibiotic drugs
Ask House about Netilmicin
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20