Monitor creatinine at least 2-3 times/week. Discontinue if any signs of ototoxicity.

Extended interval dosing:

• Normal renal function: check 8-10 hour level and use Hartford nomogram to determine dosing interval
• CrCl <30: target Trough <1 ug/mL; target peak is 8-10 ug/mL

In critically ill patients, check peak level after the 1st dose to ensure peak target is obtained and renal function may change rapidly.

Cystic Fibrosis exacerbation

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 B
•  Cyclosporine
•  Cisplatin
•  NSAIDS
•  Contrast dye
•  Vancomycin

Increased ototoxicity

•  Furosemide

Neuromuscular blockade agents - Respiratory paralysis. Generally do not give IV push.

Restricted to Infectious Diseases and Pulmonary services (Cystic Fibrosis)

Ototoxicity may include both cochlear or vestibular toxicity

Formal audiology assessment if planning to use aminoglycoside for >7d or if symptoms develop. (annual for CF patients who receive IV, q5 years for nebulized tobramycin CF patients)

Inform patient of risk of ototoxicity and to report any symptoms