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Patients treated with aminoglycosides must be carefully observed clinically because of the potential toxicity associated with the use of these drugs. Netilmicin has the potential as a strong neuromuscular blocker. The possibility of phenomena occurring in humans should be considered if aminoglycosides are given to patients receiving neuromuscular blocking agents such as succinylcholine, tubocurarine or decamethonium or receiving massive blood transfusions containing citric anticoagulants. As with other aminoglycosides, injection of Netilmicin sulfate is potentially nephrotoxic. This risk is greater in patients with impaired kidney function, patients who receive high doses or long-term therapy and elderly patients.
Neurotoxicity is manifested by ototoxicity, both vestibular dysfunction and hearing, can occur especially in patients with history of renal impairment and patients who are treated with larger doses or longer than recommended.
Aminoglycoside-induced ototoxicity is usually irreversible.
Renal function and eighth cranial nerve should be monitored, especially in patients who are known or suspected of having impaired kidney function at the start of therapy or during therapy. Urine should be examined for an increase in protein excretion, weight loss and presence of cells or cast.
Creatinine serum concentration or blood urea nitrogen must be determined periodically. The dose of Netilmicin needs to be reduced or discontinued if it is proven to be ototoxicity or nephrotoxicity. Aminoglycoside concentrations in serum need to be monitored if possible, to ensure adequate levels and avoid toxic levels. Avoid concomitant use with potentially neurotoxic or nephrotoxic drugs such as: Cephaloridine, Amphotericin B, Streptomycin, Kanamycin, Acyclovir, Gentamicin, Tobramycin, Amikacin, Neomycin, Vancomycin, Bacitracin, Polymyxin B, Colistin, Promomycin, Viomycin or Cisplatin. Also avoid combination with strong diuretics such as ethacrynic acid or furosemide, because it causes ototoxicity.
Use carefully in patients with a history of hypersensitivity or serious toxic reactions to other aminoglycosides, because cross-sensitivity of drugs in same class has been reported.
Aminoglycosides should be used cautiously in patients with neuromuscular disorders such as myasthenia gravis and infant botulism, because these muscles exacerbate muscle weakness due to their effects which have potential such as curare on the neuromuscular junction. Elderly patients may have decreased kidney function which cannot be proven in routine screening tests such as BUN (blood urea nitrogen) and serum creatinine levels. Monitoring renal function during treatment with Netilmicin, especially important in such patients. Syndromes such as Fanconi with aminoaciduria and metabolic acidosis were reported in some adults and infants receiving injections of Netilmicin. Patients must be well hydrated during treatment.
Treatment with Netilmicin Sulfate can cause excessive growth of non-susceptible organisms, if this happens, appropriate therapy is recommended.
A small amount of Netilmicin is excreted in breast feeding mother so it needs to be decided whether to stop giving milk or stop using the drug.
Aminoglycosides must be used cautiously in premature and neonatal because in these patients the kidney is not fully developed and the longer half-life of the drug.
Products containing metabisulfite sodium can cause allergy-type reactions which include anaphylactic and life-threatening symptoms or asthmatic episodes that are less severe in certain vulnerable patients. Sensitivity is difficult to find more often in patient with asthma than non-asthmatic patients.
Safety of use during pregnancy has not been established.
