Monitor creatinine at least 3 times/week. Discontinue if any signs of ototoxicity.

Nephrotoxicity (non-oliguric)

•  Avoid concomitant nephrotoxins
•  Less common with once daily dosing
•  Greater toxicity with longer duration and supratherapeutic trough levels

Vestibulocochlear toxicity

• Irreversible
• Require audiology testing if prolonged use

Can exacerbate neuromuscular blockade

•  Contraindicated in patients with myasthenia gravis

Increased nephrotoxicity

•  Amphotericin
•  Vancomycin
•  Cyclosporin
•  NSAIDs
•  Contrast

Increased ototoxicity

•  Loop diuretics (e.g. furosemide)

Non-depolarizing muscle relaxants may be potentiated

Formal audiology assessment if planning to use aminoglycoside for >7d or if symptoms develop.

Inform patient of risk of ototoxicity and to report any symptoms.