Use of Amikacin in neonatal and premature infants
Neonatal and premature infants are at an increased risk when using this medicine. The use of Amikacin may decrease the functioning of the kidney which may results in an increased time of staying (half-life) of medicine in the blood. Precaution should be taken in such patients when using Amikacin.
Patients using intravitreous (injection into the eye) of Amikacin
Patients using intravitreous (injection into the eye) of Amikacin are at an increased risk. Amikacin may cause visually disabling condition (macular infarction) which may lead to permanent loss of vision.
Patients having surgery
Patients having
surgery are at an increased risk when using this medicine. The use of Amikacin during surgery may cause irreversible
deafness, kidney failure, excessive growth of non-susceptible organisms and fatal. The large dose of Amikacin may cause defects of the neuromuscular junction (transient myasthenic
syndrome) in patients during surgery. In case of excessive growth of non-susceptible organisms in patients, suitable therapy should be started.
Drug-induced harmful effect to ear
Patients with abnormal functioning of the kidney, patients using Amikacin high doses or for more 5-7 days are at an increased risk when using this medicine. These patients may experience skin tingling, high-frequency
deafness,
vertigo, numbness, convulsions and muscle twitching. Amikacin should not be used or dose adjustment should be considered when symptoms of drug-induced harmful effects to ear appear.
Drug-induced harmful effects to the neuromuscular system
Patients taking Amikacin, anaesthetics, neuromuscular blocking agents such as decamethonium, tubocurarine, succinylcholine, atracurium, vecuronium or rocuronium and patients receiving massive transfusions of citrate-anticoagulated blood are at an increased risk. These patients are at an increased risk of neuromuscular blockade and complete or severe weakness of the muscles of respiration (respiratory
paralysis).
Calcium salts along with artificial respiration through ventilator are used in such patients.
Patients with muscle weakness
Patients with muscle weakness are at an increased risk when using this medicine. The use of Amikacin may induce harmful effects to the neuromuscular system which may reduce the activity of neuromuscular transmission. Such patients should not use this medicine.
Patients with a movement disorder (Parkinson's disease)
Patients with parkinsonism disease are at an increased risk when using this medicine. The use of Amikacin may potentiate the risk of muscle weakness in these patients. Precaution is required in such patients.
Allergic to Amikacin, aminoglycosides or have kidney damage or eighth nerve damage caused by using nephrotoxic or ototoxic drugs
Patients allergic to aminoglycosides or have kidney disease or eighth nerve damage caused by using nephrotoxic or ototoxic drugs such as dihydrostreptomycin, streptomycin, polymyxin B, gentamicin, cephaloridine, tobramycin, kanamycin, neomycin, colistin, or viomycin are at an increased risk when using this medicine. These patients are at an increased risk of harmful effects to the kidney. Precaution should be taken in these patients. If needed, this medicine should be used after the opinion of a doctor when therapeutic benefits outweigh the possible risks.
History of inner ear or hearing damage and reduced urine production
Patients with a history of inner ear or
hearing damage and reduced urine production are at an increased risk when using this medicine. The use of Amikacin in such patients may increase the risk of drug inducing harmful effects of ear and kidney. Patients should be well hydrated and kept under close clinical observation. A hearing ability test should be performed in these patients when Amikacin therapy is expected to last 7 days or more.
Amikacin at higher doses or for long-term
Patients taking Amikacin at higher doses or for long-term are at an increased risk. These patients are at an increased risk of kidney damage. Special precautions should be considered in such patients. Patients should be hydrated and should be monitored for the functioning of the kidney in starting of therapy and during the therapy. A dose reduction should be considered on the occurrence of symptoms of kidney failure such as the presence of albuminuria, red cells, white cells, or urinary casts, decreased urine specific gravity or
creatinine clearance, and increased blood urea nitrogen, blood creatinine, or reduced urination. Amikacin should not be used if there is an increase in nitrogen-containing compounds (azotemia) or continuous decrease in urinary output.
Abnormal functioning of kidneys
Patients having abnormal functioning of the kidney are at an increased risk when using this medicine. These patients are at an increased risk of drug inducing harmful effects to the kidney. Precautions should be taken in such patients. Patients should be hydrated and monitored for the eighth-cranial nerve function, Amikacin levels in the blood and for the functioning of the kidneys in starting or during the therapy. A dose reduction should be considered on the occurrence of symptoms of kidney failure such as the presence of albuminuria, red cells, white cells, or urinary casts, decreased urine specific gravity or
creatinine clearance, and increased blood urea nitrogen, blood creatinine, or reduced urination. Patients should stop using Amikacin on the occurrence of an increase in nitrogen-containing compounds (azotemia), continuous decrease in urinary output, symptoms of drug-induced kidney damage or harmful effects to ear such as
vertigo,
dizziness ringing or roaring in ear and loss of
hearing, and dose adjustment should also be considered. The hearing test should be performed in patients at high risk.
Taking other neurotoxic or nephrotoxic drugs
Patients using Amikacin with cisplatin, kanamycin, vancomycin, polymyxin B, paromomycin, viomycin, colistin, bacitracin, amphotericin B, cephaloridine or other aminoglycosides are at an increased risk when using this medicine. These patients may increase the risk of drug-induced kidney damage. The patients should not use both medicines together.