Amikin (Amikacin Sulfate)
Also sold as: Amikin, Mikacin, Amicin, Biklin, Amikacin Injection
Pregnancy
Cat D
Lactation
Caution
Schedule
H
Forms
Injection 100mg/2mL, 250mg/mL, 500mg/2mL vials (IV/IM)
Indications
- Serious Gram-negative infections (MDR Pseudomonas, Klebsiella, E. coli, Acinetobacter)
- Septicaemia (empirical, in combination)
- Hospital-acquired pneumonia (HAP)
- Urinary tract infections (complicated, MDR organisms)
- MDR-TB (as part of regimen)
- Neonatal sepsis (second-line)
Adult Dosing
Serious infections
15-20 mg/kg/day IV/IM once daily (preferred) or divided every 8 hours
7-14 days
MDR-TB
15 mg/kg IM/IV once daily (max 1g)
Per TB regimen schedule
UTI (complicated)
500 mg IM/IV BD
7-10 days
Pediatric Dosing
Extended-interval dosing (once daily) preferred when possible. Therapeutic drug monitoring (TDM) mandatory in neonates and renal impairment.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 60 mL/min | 15 mg/kg every 24 hours |
| CrCl 40-60 mL/min | 7.5 mg/kg every 24 hours OR 15 mg/kg every 36 hours |
| CrCl 20-40 mL/min | 7.5 mg/kg every 36-48 hours |
| CrCl < 20 mL/min | Use with extreme caution; loading dose 7.5 mg/kg then guide by TDM |
| Hemodialysis | 5-7.5 mg/kg after each dialysis session — TDM guided |
Hepatic Adjustment
No hepatic adjustment (renally eliminated); hepatic failure increases toxicity risk if hepatorenal syndrome
Pregnancy & Lactation
Pregnancy: Category D
AVOID — crosses placenta; bilateral irreversible deafness reported in neonates of mothers treated during pregnancy (cochlear damage). Use only for life-threatening infections with no alternative.
Lactation: Caution
Very small amounts in breast milk; oral absorption minimal. Generally considered compatible with breastfeeding for short-term use.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Other nephrotoxic agents (vancomycin, amphotericin B, NSAIDs, contrast agents) | Additive nephrotoxicity — monitor creatinine closely | Major |
| Loop diuretics (furosemide) | Additive ototoxicity | Major |
| Neuromuscular blocking agents | Enhanced neuromuscular blockade — risk of respiratory depression | Major |
| Cephalosporins / Penicillins | Chemical inactivation if mixed in same IV line — administer separately | Moderate |
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Side Effects
Common
- Injection site pain
- Nausea
- Fever
- Rash
Serious / Discontinue If
- Nephrotoxicity (tubular damage — monitor creatinine, BUN)
- Ototoxicity — cochlear (high-frequency hearing loss, may be permanent) and vestibular (vertigo, tinnitus)
- Neuromuscular blockade (rare, with anaesthesia)
Contraindications
- Aminoglycoside hypersensitivity
- Myasthenia gravis
- Pregnancy (relative — only life-threatening indications)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Amikin 500mg | BMS (Pfizer) | Vial ₹95 |
| Mikacin 500mg | Cipla | Vial ₹85 |
| Amicin 500mg | Alkem | Vial ₹80 |
| Biklin 500mg | Samarth | Vial ₹78 |
Monitoring Required
- Therapeutic drug monitoring (TDM): Peak (30 min post-infusion): 20-35 mg/L; Trough (pre-dose): <5 mg/L
- Serum creatinine every 2-3 days
- Urine output and urinalysis daily
- Baseline and weekly audiometry for prolonged use
- Vestibular function (vertigo, nystagmus)
Patient Counseling Points
- Hospital-only IV/IM administration
- Blood tests will be done regularly to monitor kidneys
- Report any ringing in ears, dizziness, or decreased hearing immediately
- Ensure adequate hydration during therapy
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Clinically reviewed by: Dr. Sanjay Mehta, MD (Internal Medicine), Senior Consultant
Last reviewed: 2026-04-01
References
- BNF — Amikacin
- IDSA Aminoglycoside TDM Guidelines
- WHO MDR-TB Guidelines 2022
- IAP Neonatal Sepsis Guidelines