Amikacin (Epikacin) belongs to the aminoglycoside group of antibiotics used to treat a variety of susceptible gram-negative organisms. The usual susceptible gram-negative organisms include:
- Pseudomonas aeruginosa
- Escherichia Coli
- Proteus
- Providencia
- Klebsiella
- Enterobacter
- Serratia
- Acinetobacter
It is also used to treat Mycobacterium tuberculosis and Mycobacterium Avium Intracellulare Complex (MAC). Staphylococcus aureus and Nocardia are the only gram-positive bacteria strongly affected by amikacin.
Contraindication to Amikacin (Epikacin) Include:
- Patients who are allergic to Amikacin or any component thereof should not take the drug.
Boxed Warnings:
- Amikacin can cause severe neurotoxicity, including vestibular toxicity and permanent bilateral hearing ototoxicity in patients who are taking high-doses and long-term doses
- Audiometry can diagnose high-frequency deafness. Vertigo may be a sign of vestibular dysfunction. Ototoxicity is often irreversible. Other symptoms may include numbness, tingling sensations, seizures, and twitching.
- Nephrotoxicity is another serious adverse effect of the drug. Nephrotoxicity may occur in with preexisting renal disease and those on high doses of the medicine, especially for more than 14 days.
- Neuromuscular blockade may occur leading to weakness and paralysis. Patients with neurological diseases like myasthenia gravis and those on neuromuscular blocking agents may develop weakness following intravenous or topical administration (as in patients undergoing orthopedic procedures or after instillation of the medicine into empyema)
- Patients who have received a lot of transfusions can develop weakness. This can be treated with calcium chloride or calcium glutonate.
- Patients may also develop superimposed bacterial infections after prolonged therapy with amikacin.
Amikacin (Epikacin) Dose in Adults
- Amikacin has a low therapeutic index, it should, therefore, be prescribed according to the patient's total body weight, especially in underweight and non-obese individuals.
- Drug levels (peak and trough) should be monitored at periodic intervals in patients who are critically ill and those with severe infections including bones, joints and the heart.
- The maximum daily dose should not exceed 15 mg/kg or 1.5 grams per day in obese individuals. If higher doses are used, drug levels should be monitored periodically to avoid toxicity.
Usual dose of Amikacin (Epikacin):
Most people receive a dose of 5 to 7.5 mg/kg/dose intramuscularly or intravenously twice or three times each day. With comparable efficacy and less toxicity than the usual twice- or three-dosage regimens, a single daily dose of 15 to 20 mg/kg may also be administered.
Amikacin ( Epikacin) dose in specific situations:
- For infections of the cerebrospinal fluid shunt caused by gram-negative organisms that are sensitive:
- Intravenous dose: 5 mg/kg three times per day when combined with other antibiotics
- Intraventricular or intrathecal administration: 5 to 50 mg daily ( the usual intraventricular dose is 30 mg per day).
Some experts recommend adjusting amikacin dose based on CSF amikacin concentration, done at periodic intervals. The target CSF levels of amikacin should be 10 to 20 times that of the MIC of the organism.
When administered intrathecally via a drain, it should be clamped for 30 minutes to one hour for the drug to equilibrate with the CSF. (Intrathecal/ intraventricular amikacin should be administered to patients who fail intravenous medications).
- For Meningitis caused by susceptible gram-negative organisms:
- 5 mg/kg administered three times per day together with additional necessary medicines
- For Hospital-acquired or Ventilator-associated pneumonia:
- For seven days, administer 15–20 mg/kg intravenously once each day. Depending on the clinical situation, the length of the therapy may be extended. Amikacin should never be administered as a single therapy, too.
- Inhalational therapy in patients with exacerbation of cystic fibrosis:
- Monotherapy: 500 mg twice daily
- With concomitant intravenous amikacin or ceftazidime: 100 mg twice daily
- Mycobacterium Avium Complex infections:
- It should be given as an adjunct to ethambutol, rifamycin, and macrolide: 8 to 25 mg/kg two or three times weekly for the first three months ( maximum single dose for patients 50 years of age or greater: 500 mg)
- Mycobacterium fortuitum, M. abscessus, or M. Chelonae: 10 - 15 mg/kg daily along with high dose cefoxitin for at least two weeks.
Amikacin (Epikacin) Dose in Children
Usual dosing in severe Gram-negative infections:
- Intravenous/ Intramuscular:
- 15 -22.5 mg/kg/day in three divided doses, or
- 15 - 20 mg/kg/dose as a single daily dose
Note: Based on desired body weight, the dose should be determined. For children who are fat, the modified formula—IBW + 0.4—should be utilised (TBW - IBW). Based on the peak and trough values of the serum, the amikacin dose should be modified.
Amikacin dose in specific conditions:
Meningitis:
- Infants and children: 15–20 mg/kg/day administered intravenously in three separate doses
- Adolescents: three split doses of 15 mg/kg/day given intravenously
Ventriculitis and Ventriculoperitoneal shunt:
Intraventricular or intrathecal administration of 5 to 50 mg per day (normal dose: 30 mg per day).
Systemic use in Cystic fibrosis:
- Traditional dosing: 10 mg/kg/dose thrice daily intravenously or IM
- Extended-interval dosing (recommended by the CF Foundation): 30 mg/kg once daily
Inhalational use in cystic fibrosis as nebulization:
- Adolescents and children older than 3 years old should take 100 mg twice daily of IV amikacin and ceftazidime.
- Adolescents: 500 mg twice daily as monotherapy.
For the treatment of Endocarditis along with other appropriate antibiotics:
- 15 mg/kg/day in two or three divided doses
Complicated Intra-abdominal infections:
- Intravenously, in two or three split dosages, between 15 and 22.5 mg/kg/day
Mycobacterium Avium complex infections in HIV exposed/ Positive individuals:
- Infants and children: Combined with other treatments, 15–30 mg/kg/day given as a single dose each day or in two divided doses (maximum daily dose should not exceed 1500 mg)
- Teenagers: 15 mg/kg/dose given once daily in addition to other necessary antibiotics.
Peritonitis in patients with CAPD (continuous ambulatory peritoneal dialysis):
- Loading dose of 25 mg/liter of dialysate, a maintenance dose of 12 mg/liter.
Drug-resistant Tuberculosis:
- As part of a multi-drug treatment, 15–30 mg/kg once daily (up to 1000 mg/day is the maximum dose).
Amikacin (Epikacin) Dose in Renal Disease:
For Adults: Renal dose adjustment is based on a dose of 7.5 mg/kg/dose twice daily
- CrCl of >50 ml/min:
- Dose adjustment is not necessary
- CrCl of 10 - 50 ml/min:
- Administer the dose every 24 to 48 hours based on the serum levels
- CrCl of less than 10 ml/min:
- Administer the dose every 48 to 72 hours based on serum concentration
-
Intermittent Hemodialysis:
- 5 - 7.5 mg/kg every 48 to 72 hours. Follow serum levels.
- Re-dose, when pre-hemodialysis levels are less than 10 mg/l or post-hemodialysis serum concentrations are less than 6-8 mg/l.
- Intermittent Peritoneal Dialysis:
- 2 mg/kg/exchange once daily (allow dwell time of 6 hours or more)
- CAPD:
- Loading dose of 25 mg/l, a maintenance dose of 12 mg/l
- CVVH/ CVVHD/ CVVHDF:
- Loading dose of 10 mg/kg followed by a maintenance dose of 7.5 mg/kg every 24 to 48 hours
- For Severe Gram-Negative Infections:
- The Target Peak Concentration should be 15-30 mg/l. (The dose should be repeated if the serum concentration falls to less than 10 mg/L).
For Children, Renal adjustment of the dose is based on the dose of 5 - 7.5 mg/kg/dose every 8 hourly
- CrCl of > 50 ml/min/1.73m2:
- No adjustment in dose required
- CrCl of 30 - 50 ml/min/1.73m2:
- Give the dose every 12 to 18 hourly
- CrCl of 10 - 29 ml/min/1.73m2:
- Administer the dose every 18 to 24 hourly
- CrCl of < 10 ml/min/1.73m2:
- Administer the dose every 48 to 72 hourly
- Intermittent hemodialysis and peritoneal dialysis:
- 5 mg/kg/dose (re-dose based on the serum concentrations)
- CRRT:
- according to serum concentrations, 7.5 mg/kg/dose every 12 hours.
Amikacin (Epikacin) Dose in Liver Disease:
- The manufacturer's labelling makes no mention of dose modification.
How to Administer Amikacin (Epikacin)?
- Intramuscular:
- Administer deep in a large muscle
- Intravenous:
- Over a period of 30 to 60 minutes; for newborns, over a period of one to two hours
- Intrathecal/ Intraventricular:
- Dilute the dose in a preservative-free fluid (NS) to a total volume of 3 ml. When administering through a ventricular drain, clamp the drain for 30 to 60 minutes.
- Inhalation:
- Apply through a mask while using a normal jet nebulizer with an air compressor.
Pregnancy Risk Category: D
-
- Amikacin crosses into the placenta, and can cause congenital hearing loss.
- Amikacin passes into breast milk and may change the gut flora of the child.
- However, because of poor bioavailability, it may be used if indicated for serious infections in the mother.
Side Effects of Amikacin (Epikacin)
- Neurotoxicity
- Nephrotoxicity
- Auditory toxicity
- Vestibular toxicity
- Arthralgias
- Drug fever
- Shortness of breath
- Nausea
- Skin rash
- Tremors
- Vomiting
- Weakness
- Paraesthesia
- Hypotension
- Hypersensitivity reactions
- Headache
- Eosinophilia
Monitoring Parameters:
Monitor serum peak and trough concentrations, Urinalysis, Urea, creatinine, vitals signs, temperature, Input, and output record and hearing parameters.
Mechanism of action Amikacin (Epikacin):
- Amikacin binds to the 30S subunit of the ribosome inhibiting protein synthesis in susceptible bacteria. It is not absorbed orally, Intramuscular absorption is rapid.
- It penetrates the meninges poorly even when the meninges are inflamed.
- The volume of distribution is decreased in patients who are dehydrated and increased in patients with ascites, edema, fluid overload, and neonates.
Half-life elimination is 1 - 2 days. It is increased in neonates 1 - 3 days of ages (7 - 9 hours). Time to peak serum concentration is achieved in about 30 minutes after intravenous infusion over 30 minutes, and 60 minutes after intramuscular injection. 94 - 98% of the drug is excreted unchanged via urine.
Amikacin Brands in Pakistan:
AMIKA (PRIX PHARMACEUTICA)
Injection : 100 mg :
2 ml injection : Rs. 126.00
Injection : 250 mg :
2 ml injection : Rs. 225.00
Injection :500 mg :
2 ml injection : Rs. 400.00
Injection : 1 g :
4 ml injection : Rs. 585.00
AMIKACIN (ZAFA PHARMACEUTICAL LABORATORIES (PVT) LTD)
Injection : 100 mg :
one vial : Rs. 30.00
Injection : 250 mg :
one vial : Rs. 55.00
Injection :500 mg :
one vial : Rs. 100.00
Injection : 1 g :
one vial : Rs. 150.00
BIKIL (SIZA INTERNATIONAL (PVT) LTD)
Injection : 250 mg :
one injection : Rs. 60.00
Injection :500 mg :
one injection : Rs. 120.00
Injection : 1 g :
one injection : Rs. 249.00
AIKA (LINZ PHARMACEUTICALS (PVT) LTD)
Injection : 25 mg :
1 injection: Rs. 100.00
Injection : 50 mg :
1 injection : Rs. 125.00
AMECIN (NOBLE PHARMA)
Injection : 25 mg :
1 ml injection : Rs. 33.00
Injection : 100 mg :
2 ml injection : Rs. 60.00
AMKAY (BOSCH PHARMACEUTICALS (PVT) LTD)
injection : 250 mg :
1 Amp*2 ml injection : Rs. 90.00
Injection : 500 mg :
2 ml injection : Rs. 150.00
Injection : 100 mg :
5 injections pack : Rs. 250.00
Injection : 50 mg :
5s*1ml injection : Rs. 130.00
Injection :25 mg :
5s*2ml injection : Rs. 105.00
GRASIL (SAMI PHARMACEUTICALS (PVT) LTD)
injection : 250 mg :
2 ml injection : Rs. 125.00
Injection : 500 mg :
2 ml injection : Rs. 185.00
Injection : 100 mg :
2 ml injections : Rs. 80.00
Injection : 50 mg :
1 ml injection : Rs. 24.00
Injection :25 mg :
1 ml injection : Rs. 23.00
MINK (MASS PHARMA (PRIVATE) LIMITED)
injection : 250 mg :
2 ml injection : Rs. 66.00
Injection : 500 mg :
2 ml injection : Rs. 112.00
Injection : 100 mg :
2 ml injections : Rs. 41.00
Injection : 50 mg :
1 ml inection : Rs. 25.00
Injection :25 mg :
1 ml injection : Rs. 20.00
AMISUL (OPHTH-PHARMA (PVT) LTD)
injection : 250 mg :
2 ml injection : Rs. 125.00
Injection : 50 mg :
2 ml injection : Rs. 50.00
EKACIN (ENGLISH PHARMACEUTICALS INDUSTRIES)
injection : 250 mg :
2 ml injection : Rs. 66.00
Injection : 500 mg :
2 ml injection : Rs. 125.00
Injection : 100 mg :
2 ml injections : Rs. 41.00
Injection : 50 mg :
1 injection : Rs. 25.00
IPRACIN (IPRAM INTERNATIONAL)
injection : 250 mg :
2 ml injection : Rs. 66.00
Injection : 500 mg :
2 ml injection : Rs. 125.00
Injection : 100 mg :
2 ml injections : Rs. 41.00
Injection : 50 mg :
1 ml injection : Rs. 25.00
KAMIN (GLOBAL PHARMACEUTICALS)
Injection : 500 mg :
2 ml injection : Rs. 162.00
Injection : 100 mg :
2 ml injections : Rs. 55.00
Injection : 50 mg :
1 ml injection : Rs. 140.00
KIMDON (SAYDON PHARMACEUTICAL INDUSTRIES (PVT) LTD)
injection : 250 mg :
2 ml injection : Rs. 66.00
Injection : 500 mg :
2 ml injection : Rs. 125.00
Injection : 100 mg :
2 ml injections : Rs. 41.00
Injection : 50 mg :
1 ml injection : Rs. 25.00
KIMSAY (SAYDON PHARMACEUTICAL INDUSTRIES (PVT) LTD)
injection : 250 mg :
2 ml injection : Rs. 66.00
Injection : 100 mg :
2 ml injections : Rs. 41.00
Injection : 50 mg :
1 ml injection : Rs. 25.00
SUPRACIL (MEDICEENA PHARMA (PVT) LTD)
injection : 250 mg :
5 ml*5 injection : Rs. 325.00
Injection : 100 mg :
2 ml*10 injections : Rs. 350.00
Injection : 50 mg :
10 ml injection : Rs. 125.00
1 ml*10 injections : Rs. 280.00
VITAMIKA (NIMRALL LABORATORIES)
Injection : 50 mg :
1 injection : Rs. 41.00
AMICIN (STAR LABORATORIES (PVT) LTD)
Injection : 100 mg :
1 injection pack : Rs. 40.00
Injection : 250 mg :
1 injection pack : Rs. 66.00
Injection : 500 mg :
1 injection pack : Rs. 120.00
AMIFATE (CANDID PHARMACEUTICALS)
Injection : 100 mg :
2 ml injection pack : Rs. 41.00
Injection : 250 mg :
2 ml injection pack : Rs. 66.00
Injection : 500 mg :
2 ml injection pack : Rs. 125.00
AMIKANEU (NEUTRO PHARMA (PVT) LTD)
Injection : 100 mg :
2 ml injection pack : Rs. 41.00
Injection : 250 mg :
2 ml injection pack : Rs. 66.00
Injection : 500 mg :
2 ml injection pack : Rs. 125.00
AMIKARAN (ORTA LABS (PVT) LTD)
Injection : 100 mg :
1 ml vial injection pack : Rs. 41.00
Injection : 250 mg :
1 ml vial injection pack : Rs. 66.00
AMIKAREX (REX PHARMACEUTICALS PAKISTAN)
Injection : 100 mg :
2 ml injection pack : Rs. 41.00
Injection : 250 mg :
2 ml injection pack : Rs. 66.00
Injection : 500 mg :
2 ml injection pack : Rs. 125.00
AMIKIN (GLAXOSMITHKLINE)
Injection : 100 mg :
2 ml injection pack : Rs. 168.00
Injection : 250 mg :
2 ml injection pack : Rs. 295.00
Injection : 500 mg :
2 ml injection pack : Rs. 533.00
AMIKOSIDE (P.D.H. PHARMACEUTICALS (PVT) LTD)
Injection : 100 mg :
2 ml injection pack : Rs. 40.00
Injection : 250 mg :
2 ml injection pack : Rs. 70.00
Injection : 500 mg :
2 ml injection pack : Rs. 125.00
AMINOCIN (MACQUINS INTERNATIONAL)
Injection : 100 mg :
2 ml injection pack : Rs. 175.00
Injection : 250 mg :
2 ml injection pack : Rs. 65.00
Injection : 500 mg :
2 ml injection pack : Rs. 125.00
AMIZIN (AKSON PHARMACEUTICALS (PVT) LTD)
Injection : 100 mg :
2 ml injection pack : Rs. 41.00
Injection : 250 mg :
2 ml injection pack : Rs. 66.00
Injection : 500 mg :
2 ml injection pack : Rs. 125.00
AMKEEN (DRUGS INN PAKISTAN)
Injection : 100 mg :
1 vial injection pack : Rs. 108.00
Injection : 500 mg :
1 vial injection pack : Rs. 331.00
BAKACIN (GLOBAL PHARMACEUTICALS)
Injection : 100 mg :
1 injection pack : Rs. 41.00
Injection : 500 mg :
1 injection pack : Rs. 125.00
BLOKASIN (POLYFINE CHEMPHARMA (PVT) LTD)
Injection : 100 mg :
1 injection pack : Rs. 35.00
CIMIKAN (TRIGON PHARMACEUTICALS PAKISTAN (PVT) LTD)
Injection : 100 mg :
1 injection pack : Rs. 41.00
DUNKIN (AMROS PHARMACEUTICALS)
Injection : 100 mg :
2 ml injection pack : Rs. 41.00
Injection : 1 g/4ml :
4 ml vial injection pack : Rs. 208.00
Injection : 500 mg :
2 ml injection pack : Rs. 125.00
ENRIST (FIGS PHARMACEUTICALS)
Injection : 100 mg :
2 amp injection pack : Rs. 41.00
Injection : 250 mg :
2 amp injection pack : Rs. 66.00
Injection : 500 mg :
2 amp injection pack : Rs. 125.00
KOVEX (S.J. & G. FAZUL ELLAHIE (PVT) LTD)
Injection : 100 mg :
2 ml injection pack : Rs. 41.00
Injection : 250 mg :
2 ml injection pack : Rs. 66.00
Injection : 500 mg :
2 ml injection pack : Rs. 125.00
MICRORID (MEDICRAFT PHARMACEUTICALS (PVT) LTD)
Injection : 100 mg :
2 ml injection pack : Rs. 41.00
Injection : 250 mg :
2 ml injection pack : Rs. 66.00
Injection : 500 mg :
2 ml injection pack : Rs. 125.00
MIKACIN (GLOBAL PHARMACEUTICALS)
Injection : 100 mg :
2 ml injection pack : Rs. 41.00
Injection : 500 mg :
2 ml injection pack : Rs. 125.00
NEGRAMIN (REKO PHARMACAL (PVT) LTD)
Injection : 100 mg :
2 ml injection pack : Rs. 60.00
Injection : 500 mg :
2 ml injection pack : Rs. 125.00
ORLOBIN (R.Y. INTERNATIONAL)
Injection : 100 mg :
1 injection pack : Rs. 134.00
Injection : 500 mg :
1 injection pack : Rs. 299.00
SEFKIN (SAFFRON PHARMACEUTICAL COMPANY)
Injection : 100 mg :
2 ml injection pack : Rs. 60.00
Injection : 250 mg :
2 ml injection pack : Rs. 100.00
Injection : 500 mg :
2 ml injection pack : Rs. 150.00
ZOMACIN (STANDPHARM PAKISTAN (PVT) LTD)
Injection : 100 mg :
2 ml injection pack : Rs. 39.00
Injection : 250 mg :
2 ml injection pack : Rs. 69.00
Injection : 500 mg :
2 ml injection pack : Rs. 115.00
MIFATE (SWISS PHARMACEUTICALS (PVT)LTD)
Injection : 100 mg :
Inj IM/IV Vial : Rs. 40.02
Injection : 250 mg :
Inj IM/IV Vial : Rs. 66.00
Injection : 500 mg :
Inj IM/IV Vial : Rs. 125.00
International Brands of Amikacin (Epikacin):
- Acemycin
- Agnicin
- Akacin
- Akicin
- Akim
- Alostil
- Amicare
- Amicasil
- Amicilon
- Amicin
- Amikabiot
- Amikacin Fresenius
- Amikacina
- Amikacina Normon
- Amikafur
- Amikagram
- Amikan
- Amikaxing
- Amikayect
- Amikin
- Amikin
- Amiklin
- Amikozit
- Amiktam
- Amiosin
- Amitax
- Amiwok
- Amukin
- Apalin
- Biclin
- Biklin
- Biodacyna
- Biokacin
- Briclin
- Briklin
- Chemacin
- Cinamak
- Cinmik
- Epikacin
- Eukacin
- Gamikal
- Glukamin
- Glybotic
- Indobact
- Kacin
- Kacinth-A
- Kamicin
- Kamin
- Kamina
- Karmikin
- Kormakin
- Lanomycin
- Likacin
- Likacin Gel
- Lisobac
- Lukadin
- Miacin
- Mikaciland
- Mikacin
- Mikaject
- Mikasin
- Mikin
- Oprad
- Orlobin
- Psudonil
- Ramickin
- Riklinak
- Savox
- Selaxa
- Selemycin
- Sikacin
- Simikan
- Tybikin
- Uzix
- Verdix
- Vetomikacin
- Yectamid
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