Amikacin
AMIKIN
What it isAminoglycoside inhibiting the 30S ribosomal subunit; resistant Gram-negative and mycobacterial infection.
Why this oneResistance to many modifying enzymes preserves activity when other aminoglycosides fail; a liposomal inhaled form targets refractory MAC.
What limits itMonitor levels and kidney function: nephrotoxicity and often-irreversible ototoxicity are boxed risks; neuromuscular blockade can occur.
FDA-approved for
- gram-negative infections (~1976)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Refractory Mycobacterium avium complex (MAC) lung disease (as part of a combination regimen) | Adult | 590 mg inhaled QD | 590 mg inhaled QD | 590 mg QD |
Renal Undefined
Hepatic No adjustment needed (amikacin is not hepatically metabolized).
Instructions
- Oral inhalation only via the Lamira Nebulizer System.
- Shake vial 10–15 s and bring to room temperature before use.
- Consider pretreatment with a short-acting beta-2 agonist in hyperreactive airway disease.
- Do not double the dose for a missed dose.
Contraindications
- Known hypersensitivity to any aminoglycoside
Cautions
- Hypersensitivity pneumonitis
- Hemoptysis
- Bronchospasm
- Exacerbation of underlying pulmonary disease
- Anaphylaxis/hypersensitivity
- Ototoxicity (including with MT-RNR1 mitochondrial DNA variants)
- Nephrotoxicity
- Neuromuscular blockade
- Embryo-fetal toxicity (congenital deafness)
Adverse reactions
- Dysphonia
- Cough
- Bronchospasm
- Hemoptysis
- Musculoskeletal pain
- Upper airway irritation
- Ototoxicity
- Fatigue/asthenia
- Exacerbation of pulmonary disease
- Diarrhea
- Nausea
- Headache
Pregnancy No human data; systemic aminoglycosides may cause total, irreversible, bilateral congenital deafness.
Lactation No data for inhaled use; amikacin is present in human milk by other routes—systemic absorption after inhalation expected to be low.
⚠ BOXED WARNINGS
- Nephrotoxicity and ototoxicity
- Neuromuscular blockade
Cost, est. cash$20–$1,500/dose or month
Generic entry1984
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityNephrotoxicity and often irreversible ototoxicity require level and renal monitoring.
Mechanism of action: Amikacin ballicule
