What it's for (Indications)
- Amikacin is indicated for serious infections due to amikacin-sensitive gram-negative organisms.
- Specifically, Amikacin Liposome Inhalation Suspension (ARIKAYCE) is indicated for refractory Mycobacterium avium complex (MAC) lung disease as part of a combination antibacterial regimen.
Dosage Information
| Type | Guideline |
|---|---|
| Standard | For Amikacin Liposome Inhalation Suspension (ARIKAYCE), the recommended dosage in adults is once daily oral inhalation of the contents of one 590 mg/8.4 mL ARIKAYCE vial. It is for oral inhalation use only and must be administered by nebulization solely with the Lamira® Nebulizer System. Pre-treatment with an inhaled bronchodilator (e.g., short-acting selective beta-2 agonists) should be considered, especially for patients with known hyperreactive airway disease or chronic obstructive pulmonary disease; patients should use their bronchodilator before ARIKAYCE. Dosage for other amikacin formulations (e.g., injectable) would follow different guidelines depending on the infection type, severity, renal function, and body weight, which are not detailed here. |
Safety & Warnings
Common Side Effects
- Patients using amikacin may experience ototoxicity (damages ear either temporarily or permanently) and nephrotoxicity (damages kidney either temporarily or permanently).
- Other reported adverse reactions include hypersensitivity pneumonitis, hemoptysis, bronchospasm, exacerbation of underlying pulmonary disease, anaphylaxis and other hypersensitivity reactions, neuromuscular blockade, dysphonia, cough, musculoskeletal pain, upper airway irritation, and fatigue/asthenia.
Serious Warnings
- Black Box Warning: WARNING: RISK OF INCREASED RESPIRATORY ADVERSE REACTIONS. Amikacin Liposome Inhalation Suspension (ARIKAYCE) has been associated with an increased risk of respiratory adverse reactions including hypersensitivity pneumonitis, hemoptysis, bronchospasm, and exacerbation of underlying pulmonary disease, which have led to hospitalizations in some cases.
- Amikacin should be used with extreme caution in patients with impaired renal (kidney) function; adequate hydration must be ensured, and patients should be closely monitored for signs of ototoxicity and nephrotoxicity.
- Amikacin is associated with an increased risk of respiratory adverse reactions, including hypersensitivity pneumonitis, hemoptysis, bronchospasm, and exacerbation of underlying pulmonary disease, which may require hospitalization.
- Anaphylaxis and other hypersensitivity reactions can occur.
- Neuromuscular blockade is a potential risk.
- This medicine should not be used in pregnancy or by breastfeeding mothers.
How it Works (Mechanism of Action)
Amikacin, a broad-spectrum aminoglycoside antibiotic, exerts its potent bactericidal effects primarily through the inhibition of bacterial protein synthesis. Its mechanism of action involves irreversible binding to the 30S ribosomal subunit of susceptible bacteria. This binding event critically interferes with the initiation complex formation and causes misreading of the messenger RNA (mRNA) template, leading to the incorporation of incorrect amino acids into the nascent polypeptide chain. The resulting production of truncated, non-functional, or aberrant proteins subsequently disrupts essential cellular processes and metabolism. Furthermore, the accumulation of these faulty proteins may contribute to increased bacterial cell membrane permeability, further compromising cell integrity and leading to bacterial death. This oxygen-dependent uptake mechanism largely explains its efficacy against aerobic Gram-negative bacilli and certain Gram-positive organisms, while limiting its activity against strict anaerobes.