KANAMYCIN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for KANAMYCIN (KANAMYCIN).
Aminoglycoside antibiotic that irreversibly binds to the 30S ribosomal subunit, causing misreading of mRNA and inhibiting protein synthesis.
| Metabolism | Not significantly metabolized; primarily excreted unchanged by glomerular filtration. |
| Excretion | Primarily renal excretion via glomerular filtration; approximately 80-90% of administered dose is excreted unchanged in urine within 24 hours. Biliary/fecal excretion is minimal (<1%). |
| Half-life | Terminal elimination half-life is 2-4 hours in patients with normal renal function (creatinine clearance >80 mL/min). In anuria, half-life may extend to 50-100 hours, necessitating dose adjustment based on renal function. |
| Protein binding | Very low, approximately 0-10%; primarily binds to albumin, but binding is negligible. |
| Volume of Distribution | 0.2-0.3 L/kg, indicating distribution predominantly into extracellular fluid. In neonates, Vd is larger (0.3-0.5 L/kg) due to higher extracellular water content. |
| Bioavailability | Oral: <1% (not absorbed); Intramuscular: ~100%; Intravenous: 100%. |
| Onset of Action | Intramuscular: 1-2 hours; Intravenous: rapid, within 30-60 minutes; Oral: negligible systemic absorption, onset not applicable for systemic effects. |
| Duration of Action | Approximately 6-12 hours with normal renal function; duration is prolonged in renal impairment. Peak serum levels are typically maintained for 2-4 hours post-dose. |
| Molecular Weight | 484.5 |
15 mg/kg/day IM or IV in divided doses every 12 hours. Maximum daily dose: 1.5 g.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 50-90 mL/min: administer every 12-24 hours; CrCl 10-50 mL/min: administer every 24-48 hours; CrCl <10 mL/min: administer every 48-72 hours. Monitor serum concentrations. |
| Liver impairment | No specific dosing adjustment required for hepatic impairment. |
| Pediatric use | 15-30 mg/kg/day IM or IV in divided doses every 8-12 hours. |
| Geriatric use | Reduce initial dose based on renal function; maintain same dosing interval as adults. Monitor renal function and serum concentrations closely. |
| 1st trimester | Avoid; based on animal data, potential for ototoxicity and nephrotoxicity; only use for life-threatening infections with no alternative. |
| 2nd trimester | Use only if clearly needed; no well-controlled human studies; may cause fetal harm. |
| 3rd trimester | Use only if clearly needed; risk of fetal ototoxicity and nephrotoxicity, especially during prolonged therapy. |
Clinical note
Comprehensive clinical and safety monograph for KANAMYCIN (KANAMYCIN).
| Placental transfer | Crosses the placenta; cord blood concentrations are lower than maternal serum levels, but sufficient to cause fetal ototoxicity. |
| Breastfeeding | Kanamycin is excreted into breast milk in small amounts; however, due to poor oral absorption, it is unlikely to cause adverse effects in the nursing infant. Use with caution, especially in infants with immature renal function. |
■ FDA Black Box Warning
Boxed warning for ototoxicity (cochlear and vestibular damage) and nephrotoxicity; risk increases with prolonged use, high doses, renal impairment, and concomitant use of other ototoxic/nephrotoxic drugs.
| Serious Effects |
Hypersensitivity to kanamycin or other aminoglycosidesMyasthenia gravisPre-existing hearing lossPrevious exposure to ototoxic drugs
| Precautions | Ototoxicity: may cause irreversible hearing loss and balance disturbances, Nephrotoxicity: monitor renal function; risk increases with dehydration or pre-existing renal disease, Neuromuscular blockade: may potentiate respiratory paralysis, especially with anesthesia or neuromuscular blocking agents, Monitor drug levels to avoid toxicity, Cross-allergy with other aminoglycosides |
| Food/Dietary | No specific food interactions. Maintain adequate hydration. Avoid excessive intake of caffeine or alcohol as they may increase gastrointestinal side effects. Consult healthcare provider before taking any dietary supplements. |
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| Lactation Rating | L2 (Probably Compatible) |
| Teratogenic Risk | First trimester: No evidence of teratogenicity in animal studies; human data limited. Second/third trimester: Avoid use due to potential fetal ototoxicity and nephrotoxicity; may cause aminoglycoside-induced fetal nephrotoxicity and ototoxicity if used repeatedly or in high doses. |
| Fetal Monitoring | Monitor maternal serum creatinine, BUN, and urine output for nephrotoxicity. Audiometry for hearing loss. Fetal monitoring for fetal distress if used near term. Therapeutic drug monitoring to maintain peak 15-30 mcg/mL and trough <5 mcg/mL. |
| Fertility Effects | No known direct adverse effects on fertility in humans. Animal studies show no reproductive impairment at therapeutic doses. |
| Clinical Pearls | Kanamycin is an aminoglycoside antibiotic with activity primarily against aerobic Gram-negative bacilli. Auditory and vestibular toxicity can occur even after short courses, especially in renal impairment. Concurrent use of loop diuretics (e.g., furosemide) increases ototoxicity risk. Therapeutic drug monitoring (peak 15-30 mcg/mL, trough <5 mcg/mL) is recommended for efficacy and safety. Administer intravenously over 30 min or intramuscularly. Adjust dose based on renal function (CrCl). Avoid prolonged use >7 days unless necessary. In patients with obesity, dose based on ideal body weight. |
| Patient Advice | Take this medication exactly as prescribed; do not skip doses or stop early. · Drink plenty of fluids unless otherwise directed by your doctor. · Report any hearing loss, ringing in the ears, dizziness, or balance problems immediately. · Inform your doctor if you experience muscle weakness, numbness, or tingling. · Tell your healthcare provider if you have kidney disease or are taking diuretics ('water pills'). · This medication can cause kidney damage; your doctor will monitor your kidney function. · If you are pregnant, think you may be pregnant, or are breastfeeding, consult your doctor. |