Following IM administration of a single dose of amikacin of 7.5 mg/kg in adults with normal renal function,
peak plasma amikacin concentrations of 17-25 micrograms/mL are attained within 45 minutes to 2 hours.
Following IV infusion of the same dose given over 1 hour peak plasma concentrations of the drug average
38 micrograms/mL immediately following the infusion, 5.5 micrograms/mL at 4 hours, and 1.3
micrograms/mL at 8 hours.
Following administration of usual dosages of amikacin, amikacin has been found in bone, heart,
gallbladder, and lung tissue. Amikacin is also distributed into bile, sputum, bronchial secretions, and
interstitial, pleural, and synovial fluids.
The plasma elimination half-life of amikacin is usually 2-3 hours in adults with normal renal function and is
reported to range from 30-86 hours in adults with severe renal impairment.
In adults with normal renal function, 94-98% of a single IM or IV dose of amikacin is excreted unchanged
by glomerular filtration within 24 hours. The drug may be completely recovered within approximately 10-
20 days in patients with normal renal function. Terminal elimination half-lives of greater than 100 hours
have been reported in adults with normal renal function following repeated IM or IV administration of the
In patients with impaired renal function, the clearance of amikacin is decreased; the more severe the
impairment, the slower the clearance. Therefore, the interval between doses should be adjusted
according to the degree of renal impairment. Endogenous creatinine clearance rate and serum creatinine
which have high correlation with serum half-life of amikacin, may be used as a guide for this purpose (see
Dosage and Administration - Impaired Renal Function).
Use in Pregnancy
Category D. Gentamicin and other aminoglycosides cross the placenta. There is evidence of selective
uptake of gentamicin by the foetal kidney resulting in damage (probably reversible) to immature nephrons.
Eighth cranial nerve damage has also been reported following in-utero exposure to some of the
aminoglycosides. Because of the chemical similarity, all aminoglycosides must be considered potentially
nephrotoxic and ototoxic to the foetus. It should also be noted that therapeutic blood levels in the mother
do not equate with safety for the foetus.
Use in Lactation
It is not known whether amikacin is excreted in breast milk. Since the possible harmful effect on the infant
is not known, it is recommended that if nursing mothers must be given amikacin, the infants should not be
breast fed during therapy.
Interactions with Other Drugs
Potent diuretics: If possible, do not give amikacin in conjunction with ethacrynic acid, frusemide or other potent diuretics
which may themselves cause ototoxicity or enhance aminoglycoside toxicity by altering antibiotic
concentrations in serum and tissue.
Other neurotoxic and/or nephrotoxic agents: If possible, avoid concurrent or sequential use of other neurotoxic and/or nephrotoxic antibiotics, including
other aminoglycosides, polymyxin B, colistin, cisplatin, vancomycin, amphotericin B, clindamycin and