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As a rule, the drug should not be administered to patients who have hearing loss by peptide antibiotics or aminoglycoside antibiotics or other underlying hearing loss, but if absolutely necessary, the drug should be used with caution.
Patients with renal impairment such as acute urinary retention (because this drug is accumulated due to delayed excretion, it should be administered cautiously with the monitoring of serum concentration).
Patients with hepatic impairment (hepatic impairment may be caused or deteriorated).
The elderly.
Premature infants, neonates.
Patients with impaired vestibular organ or impaired cochlea.
Precautions in Administration: The drug is irritating to tissue and it must not be given by intramuscular injection. Careless intravenous administration extravasation may cause pain, tenderness on pressure, necrosis, etc.
Thrombophlebitis may occur by intravenous administration with high concentration, but the frequency and severity of which can be minimized by enough dilution (2.5-5 g/L), slow infusion and rotation of venous access sites.
Rapid bolus administration over several minutes may cause hypotension and rarely, cardiac arrest. To avoid rapid-infusion-related reactions, the drug should be administered over a period of not less than 60 minutes. Stopping the infusion usually results in prompt cessation of these reactions.
The safety and efficacy of administration via lumbar vertebrae and cerebral ventricles are not evaluated yet.
Due to the low pH of solution, mixing with other substances may cause physical or chemical instability. Do not mix drug with alkaline solutions.
Solution of the drug and beta-lactam antibiotics are physically incompatible. The likelihood of precipitation increases with higher concentrations of the drug. It is recommended to adequately flush the intravenous lines between administration of these antibiotics. It is also recommended to dilute solutions of the drug to 5 mg/mL or less.
Administration of the drug into the vitreous body is not permitted. A Precipitation has been reported when this drug and ceftazidime were injected into the vitreous body of patients with endophthalmitis using separate syringe and needle. Precipitate gradually dissolved and two months later, vitreous cavity became transparent completely and sight was improved.
Before injection, the drug should be inspected visually for particulate matter and discoloration.
Use in Children: Premature infants, neonates and toddlers are at the stage of renal development. Because high serum concentration may last for a long time due to prolonged half-life in these groups, caution should be taken in the administration.
Use in the Elderly: Due to age-related reduction in renal function, renal function should be tested before and during administration, and the drug should be administered with caution by reducing doses according to the decreased renal function.
