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Gentamicin should not be used concurrently with other potentially nephrotoxic or ototoxic drug substances unless considered essential by the physician. The potential nephrotoxicity of other aminoglycosides, vancomycin, ciclosporin, cisplatin, fludarabine and amphotericin may be increased in the presence of gentamicin and monitoring of renal function is therefore recommended.
Any potential nephrotoxicity of cephalosporins, and in particular cephaloridine, may also be increased in the presence of gentamicin. Consequently, if this combination is used monitoring of kidney function is advised.
Furosemide (frusemide) and piretanide may potentiate the ototoxicity of gentamicin, and etacrynic acid, which is ototoxic in its own right, should be avoided with gentamicin.
Aminoglycosides, including gentamicin, may induce neuromuscular blockade and respiratory paralysis and should therefore only be used with great caution in patients receiving curare-type muscle relaxants.
Aminoglycosides antagonise the effects of cholinergic agents such as neostigmine and pyridostigmine.
Indometacin has been reported to increase the plasma concentrations of aminoglycosides when given concomitantly.
Concurrent use with oral anticoagulants may increase the hypothrombinanaemic effect.
Concurrent use of bisphosphonates may increase the risk of hypocalcaemia.
Concurrent use of the Botulinum Toxin and gentamicin may increase the risk of toxicity due to enhanced neuromuscular block.
Bacteriostatic antibiotics may give an antagonistic interaction, but in some cases (e.g. with clindamycin and lincomycin) the disadvantage of antagonism may be outweighed by the addition of activity against anaerobic organisms. Synergistic action has been demonstrated with penicillin. However, if penicillins (such as ticarcillin) are used with gentamicin the drugs should not be physically mixed and patients with poor renal function should be monitored for effectiveness of the gentamicin. Cross-sensitivity with aminoglycosides may occur.
