Significant Adverse Effects

Nephrotoxicity: These are usually reversible when the drug is discontinued. Reports of toxic nephropathy and acute renal failure have been received during postmarketing surveillance.
Ototoxicity: Toxic effects on the eighth cranial nerve can result in hearing loss, loss of balance, or both.

Significant Contraindications

Dehydration: Do not use in hypovolaemic animals or those with impaired glomerular filtration.
Pre-existing Renal Disease: Avoid use in Chronic Kidney Disease (CKD) and Acute Kidney Injury (AKI)
Allergy, hypersensitivity: Amikacin sulphate injection is contraindicated in patients with known allergy to amikacin or any formulation component.
Myasthenia gravis: Aminoglycosides may impair neuromuscular transmission and should not be given to patients with myasthenia gravis.

Anaesthetics: Potential for neuromuscular blockade.
Cephalosporins: Potential for additive nephrotoxicity and potential for synergistic effect with first or second-generation agents
Loop Diuretics (Furosemide, Torsemide): increased potential for nephrotoxic or ototoxic effects
Osmotic Diuretics (eg, mannitol): increased potential for nephrotoxic or ototoxic effects
NSAIDs: Increased risk of nephrotoxicity
Penicillins: Potential for a synergistic effect.

Pregnancy: Avoid use; potential for harm. In zebrafish, amikacin induced embryonic toxicity and reduced survival rate
Lactation: Amikacin is poorly excreted into milk.
Fertility: Amikacin administered subcutaneously to rats did not impair male or female fertility.
Carcinogenicity and mutagenicity: Long-term animal studies have not been performed to evaluate carcinogenic potential and mutagenicity.

Effects: There is a general risk for nephrotoxic, ototoxic and neurotoxic (neuromuscular blockage) reactions.
Clinical Response: Active fluid therapy to decontaminate through accelerated excretion. Consider dialysis.