Amikacin sulfate is available as a 250-mg/mL solution in 2- and 4-mL single-dose vials.3952 Each mL contains the equivalent of amikacin 250 mg as the sulfate with sodium metabisulfite 0.66%, sodium citrate dihydrate 2.5%, and sulfuric acid to adjust pH.3952
pH
Osmolality
The osmolality of amikacin sulfate 500 mg was calculated for the following dilutions:1054
| Osmolality (mOsm/kg) | ||
|---|---|---|
| Diluent | 50 mL | 100 mL |
| Dextrose 5% | 353 | 319 |
| Sodium chloride 0.9% | 383 | 349 |
Sodium Content
The sodium content of amikacin sulfate 50 mg/mL is 0.064 mEq/mL; for the 250-mg/mL concentration, the sodium content is 0.319 mEq/mL.291
Amikacin sulfate is administered by intramuscular injection or intermittent intravenous infusion.3952 For intravenous infusion in adults, 500 mg of amikacin may be diluted in 100 to 200 mL of compatible infusion solution and administered over 30 to 60 minutes.3952 For pediatric patients, the dose should be diluted in sufficient volume for infusion over 1 to 2 hours in infants or 30 to 60 minutes in older children.3952
Intact vials should be stored at controlled room temperature.3952
Amikacin sulfate injection is a clear, colorless to pale yellow or light straw-colored solution.3952 It was reported that aqueous solutions of amikacin sulfate in amikacin concentrations of 37.5 to 250 mg/mL retained greater than 90% for up to 36 months at 25°C, 12 months at 37°C, and 3 months at 56°C.291 Aqueous solutions of amikacin sulfate are subject to color darkening because of air oxidation. However, this change in color has no effect on potency.291
Syringes
Amikacin sulfate (Bristol) prepared at an amikacin concentration of 750 mg/4 mL in sodium chloride 0.9% was stable, showing about a 2% loss when stored in polypropylene syringes (Becton Dickinson) for 48 hours at 23°C under fluorescent light.1159
Sorption
Amikacin sulfate was shown not to exhibit sorption to polyvinyl chloride (PVC) bags or sets and multilayer bags composed of polyethylene, polyamide, and polypropylene.2269
Central Venous Catheter
Amikacin sulfate (Apothecon) prepared at an amikacin concentration of 1 mg/mL in dextrose 5% was found to be compatible with the ARROWg+ard Blue Plus (Arrow International) chlorhexidine-bearing triple-lumen central catheter. Delivery of the amikacin sulfate ranged from 92 to 98% of the initial concentration among the 3 lumens. Furthermore, chlorhexidine delivered from the catheter remained at trace amounts with no substantial increase due to the delivery of the drug through the catheter.2335
Drugs in Syringe Compatibility
Y-Site Injection Compatibility (1:1 Mixture)
Additional Compatibility Information
ß-Lactam Antibiotics
In common with other aminoglycoside antibiotics, amikacin activity may be impaired by ß-lactam antibiotics. This inactivation is dependent on concentration, temperature, and time of exposure. However, amikacin appears to be less affected by the ß-lactam antibiotics than other aminoglycosides such as gentamicin and tobramycin.68; 574; 575; 654; 740; 816; 824; 973; 1052
The clinical significance of these interactions appears to be primarily confined to patients with renal failure.218; 334; 361; 364; 616; 816; 847 Literature reports of greatly reduced aminoglycoside levels in such patients have appeared frequently.363; 365; 366; 367; 614; 615; 962 In addition, the interaction may be clinically important if assays for aminoglycoside levels in serum are sufficiently delayed.576; 618; 814; 824; 847; 1052
Most authors believe that in vitro mixing of penicillins with aminoglycoside antibiotics should be avoided but that clinical use of the drugs in combination can be of great value. It is generally recommended that the drugs be given separately in such combined therapy.157; 218; 222; 224; 361; 364; 368; 369; 370
Peritoneal Dialysis Solutions
Amikacin base (Bristol) 10 and 50 mg/L in peritoneal dialysis concentrate with 50% dextrose (McGaw) retained about 70% of initial activity in 7 hours and about 40 to 50% in 24 hours at room temperature.1044
Amikacin sulfate (Bristol) at an amikacin concentration of 25 mcg/mL combined separately with the cephalosporins cefazolin sodium (Lilly) and cefoxitin (MSD) at a concentration of 125 mcg/mL in peritoneal dialysis solution (Dianeal 1.5%) exhibited enhanced rates of lethality to Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa compared to any of the drugs alone.1623
For a list of references cited in the text of this monograph, search the monograph titled References.