Normally IM administration, but may be administered as slow IV inj over at least 3 min or short infusion if required. Adult 3-6 mg/kg/day as 1-2 single doses. In life-threatening infections, frequency may need to be increased to 6 hrly & dose may also be increased up to a total of 5 mg/kg in 24 hr. 160 mg once daily may be used in some cases. Childn & adolescent 3-6 mg/kg/day as 1-2 single doses. Infant after 1st mth of life 4.5-7.5 mg/kg/day as 1-2 single doses. Newborn 4-7 mg/kg/day as 1 single dose. Patient w/ CrCl >70 mL/min 80 mg 8 hrly, 30-70 mL/min 80 mg 12 hrly, 10-30 mL/min 80 mg daily, 5-10 mL/min 80 mg every 48 hr, <5 mL/min 80 mg after dialysis. Reduce to 60 mg if weighing <60 kg.
Do not administer as slow infusion or mix w/ other drugs before use. Serum conc monitoring is recommended, especially in elderly, newborns & patients w/ renal impairment. Avoid prolonged use, & whenever possible treatment should not exceed 7 days. Continuous monitoring of renal function, control of vestibular & cochlear functions, as well as hepatic & lab parameters is recommended before, during & after treatment. Determine serum levels to avoid peak conc >10 mg/L & troughs >2 mg/L for bd dose & >1 mg/L for once daily dose. Risk of ototoxicity & nephrotoxicity. Increased risk of ototoxicity in patients w/ mitochondrial mutations (particularly m.1555A>G mutation). Caution in significant obesity, & in parkinsonism & other conditions characterised by muscular weakness. Should only be used in pregnancy if considered essential.
Increased potential nephrotoxicity of other aminoglycosides, vancomycin, ciclosporin, cisplatin, fludarabine, amphotericin, & cephalosporins (particularly cephaloridine). Potentiated ototoxicity w/ furosemide, piretanide & etacrynic acid. Potential additive neuromuscular blockade & resp paralysis w/ curare-type muscle relaxants. Antagonised effect of cholinergic agents (eg, neostigmine & pyridostigmine). Increased plasma conc w/ indometacin. Concurrent use w/ oral anticoagulants may increase the hypothrombinanaemic effect. Concurrent use w/ bisphosphonates may increase the risk of hypocalcaemia. Concurrent use w/ botulinum toxin may increase the risk of toxicity due to enhanced neuromuscular block. Bacteriostatic antibiotics may give an antagonistic interaction, but in some cases (eg, clindamycin & lincomycin) the disadvantage of antagonism may be outweighed by the addition of activity against anaerobic organisms. Synergistic action w/ penicillin. Penicillins (eg, ticarcillin) & gentamicin should not be physically mixed. Cross-sensitivity w/ aminoglycosides may occur.
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