Neonatal Intensive Care Drug Manual

1. Nephrotoxicity-

Associated with excessive accumulation of gentamicin. The initial symptoms may be due to renal tubular concentrating defect. These include excessive losses of sodium, calcium and magnesium. This may progress to proteinuria, increased urea, oliguria, increased serum creatinine. Renal impairment is usually reversible.

2. Ototoxicity.

Primarily vestibular but also auditory toxicity. Associated with excessive accumulation of gentamicin and duration of therapy. Effects often irreversible.

3. Neuromuscular blockade-

Muscular paralysis and respiratory failure may occur particularly when used with other neuromuscular blockers such as pancuronium.

4. Hypersensitivity-

Very rare − rash, urticaria, fever, laryngeal oedema, eosinophilia.

Nephrotoxicity and ototoxicity are more pronounced with addition of other nephrotoxic/ototoxic agents such as furosemide and vancomycin.

Y-Site: Amino acid solutions, amifostine, amiodarone, anidulafungin, atracurium, aztreonam, bivalirudin, calcium chloride, calcium gluconate, caspofungin, ciprofloxacin, cisatracurium, clindamycin, dexmedetomidine, digoxin, dobutamine, esmolol, fentanyl, fluconazole, foscarnet, granisetron, hydromorphone, labetalol, linezolid, magnesium sulfate, meropenem, methylprednisolone, metronidazole, midazolam, morphine sulfate, , pancuronium, pethidine, phenobarbital sodium, potassium chloride, remifentanil, rocuronium, suxamethonium, tigecycline, vancomycin, vecuronium, zidovudine.

Y-site: Azathioprine, azithromycin, chloramphenicol, dexamethasone, flucloxacillin, folic acid, frusemide, ganciclovir, heparin sodium, indomethacin, pentamidine, propofol, teicoplanin.

Note: Do not mix together with penicillins or cephalosporins.