20 to 50     : Give 1–2 mg/kg then dose according to serum levels
10 to 20     : Give 1 mg/kg then dose according to serum levels
<10           : Give 1 mg/kg then dose according to serum levels
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                : Dialysed. Dose as in GFR <10 mL/min
HD                     : Dialysed. Dose as in GFR <10 mL/min
HDF/high flux   : Dialysed. Dose as in GFR <10 mL/min
CAV/VVHD      : Dialysed. 1.5–2 mg/kg every 24 hours and monitor levels1
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs Botulinum toxin: neuromuscular block enhanced – risk of toxicity
Ciclosporin: increased risk of nephrotoxicity Cytotoxics: increased risk of nephrotoxicity and possibly of ototoxicity with platinum compounds
Diuretics: increased risk of ototoxicity with loop diuretics Muscle relaxants: enhanced effect of non-depolarising muscle relaxants and suxamethonium Parasympathomimetics: antagonism of effect of neostigmine and pyridostigmine
Tacrolimus: increased risk of nephrotoxicity
ADMINISTRATION
Reconstition
Add to 50–100 mL sodium chloride 0.9% or glucose 5% for
IV infusion
Route
IV, IM, IP, nebulised
Rate of Administration
20–60 minutes
Comments
Plasma concentrations should be measured frequently; trough ≤2 mg/L, peak 60 minutes post dose ≤10 mg/L; avoid prolonged peaks above 12 mg/L
OTHER INFORMATION
25–70% can be removed by haemodialysis Used via nebuliser for chronic pulmonary Pseudomonas aeruginosa infection in cystic fibrosis: 300 mg every 12 hours for 28 days, repeat after 28 days Can be used for peritonitis at doses of 6 mg/L intraperitoneally