Names and pronunciation
Arikayce
PDF page 64
Loading InternPractice…
Drug reference
Arikayce
PDF page 64
Func. class.: Antiinfective
PDF page 64
Chem. class.: Aminoglycoside
PDF page 64
Do not confuse: amikacin/Kineret
PDF page 64
ACTION: Interferes with protein syn- thesis in bacterial cells by binding to ribosomal subunits, which causes mis- reading of genetic code; inaccurate pep- tide sequence forms in protein chain, thereby causing bacterial death
PDF page 64
USES: Severe systemic infections of CNS, respiratory tract, GI tract, urinary tract, bone, skin, soft tissues caused by Staphylococcus aureus (MSSA), Pseu domonas aeruginosa, Escherichia coli, Enterobacter, Acinetobacter, Providen cia, Citrobacter, Serratia, Proteus, Klebsiella pneumoniae Unlabeled uses: Mycobacterium avium complex (MAC) (intrathecal or intraventricular) in combination; actino- mycotic mycetoma, febrile neutropenia, cystic fibrosis
PDF page 65
CONTRAINDICATIONS: Preg- nancy, hypersensitivity to aminoglyco- sides, sulfites Precautions: Breastfeeding, neonates, geriatric patients, myasthenia gravis, Par- kinson’s disease, mild to moderate infec- tions, dehydration
PDF page 65
Black Box Warning: Hearing impair- ment, renal/neuromuscular disease Black Box Warning: Increase: nephro- toxicity—cephalosporins, acyclovir, van- comycin, amphotericin B, cycloSPORINE, loop diuretics, cidofovir Black Box Warning: Increase: ototoxic- ity—IV loop diuretics Black Box Warning: Increase: neuromus- cular blockade, respiratory depression— anesthetics, nondepolarizing neuromuscu- lar blockers Decrease: amikacin effect in renal dis- ease—parenteral penicillins, cephalo- sporins do not combine Drug/Lab Test Increase: BUN, creatinine, AST/ALT, alka- line phosphatase, bilirubin, LDH Black Box Warning: Nephrotoxicity: renal impairment; obtain urine for CCr, BUN, serum creatinine; in renal impair- ment; nephrotoxicity may be reversible if product is stopped at first sign; I&O ra- tio; urinalysis daily for proteinuria, cells, casts; report sudden change in urine output Black Box Warning: Ototoxicity: deaf- ness: audiometric testing, ringing, roaring in ears, vertigo; assess hearing before, during, after treatment • Dehydration: high specific gravity, de- crease in skin turgor, dry mucous mem- branes, dark urine, keep well hydrated 2000 mL/day • Overgrowth of infection: increased temperature, malaise, redness, pain, swelling, perineal itching, diarrhea, sto- matitis, change in cough, sputum • Vestibular dysfunction: nausea, vomit- ing, dizziness, headache; product should be discontinued if severe Black Box Warning: Neuromuscular blockade; respiratory paralysis may oc- cur; more common in those receiving anesthetics, neuromuscular blockers; use of calcium salts may be used to reverse effect
PDF pages 65, 66, 67
SIDE EFFECTS CNS: Dizziness, vertigo EENT: Ototoxicity, deafness GU: Nephrotoxicity HEMA: Eosinophilia, anemia INTEG: Rash, burning, urticaria, derma- titis, alopecia RESP: Apnea SYST: Hypersensitivity
PDF page 66
INTERACTIONS Increase: masking ototoxicity: dimenhy- DRINATE, ethacrynic acid Increase: neurotoxicity—NSAIDs
PDF page 66
DOSAGE AND ROUTES • Adult/child: IV INFUSION 15 mg/kg/ day in 2-3 divided doses q8-12hr in 100- 200 mL D5W over 30-60 min, max 1.5 g/ day; pulse dosing (once-daily dosing) may be used with some infections; IM 10-15 mg/kg/day in divided doses q8- 12hr; or extended-interval dosing as an alternative dosing regimen • Neonate: IV/IM 10 mg/kg initially, then 7.5 mg/kg q8-12hr Renal dose (extended-interval dosing) • Adult: IV CCr 40-59 mL/min 15 mg/kg q36hr; CCr 20-39 mL/min 15 mg/kg q48hr; <20 mL/min adjust based on se- rum concentrations and MIC (use tradi- tional dosing) Mycobacterium avium complex (MAC) • Adult and adolescent: IM/IV 15-20 mg/kg/day or 5× per week; NEB (Ari- kayce) 590 mg daily in combination • Child: IV 15-30 mg/kg/day divided q12-24hr as part of multiple-drug regi- men, max 1.5 g/day Actinomycotic mycetoma A (unlabeled) • Adult: IM/IV 15 mg/kg/day in 2 di- vided doses × 3 wk with co-trimoxazole for 5 wk; repeat cycle once, may be re- peated 2×
PDF page 65
Available forms: Injection 50, 250 mg/ mL; suspension for oral inhalation 590 mg/8.4 mL
PDF page 65
Administer: • Obtain C&S before administration; begin treatment before results are re- ceived IM route • Inject in large muscle mass; rotate injection sites • Obtain peak 1 hr after IM, trough be- fore next dose Inhalation route (nebulizer) • Use Lamira Nebulizer System • May pretreat with short-acting β2- antagonists • Allow to warm to room temperature • Shake well, pour medication into res- ervoir • Press and hold on/off button • Insert mouthpiece, take slow deep breaths, a beep will be heard when done • Clean after use Intermittent IV INFUSION route • Dilute 500 mg of product/100-200 mL of D5W, 0.9% NaCl and give over ½-1 hr; dilute in sufficient volume to allow for infusion over 1-2 hr (infants); flush after administration with D5W or 0.9% NaCl; solution clear or pale yel- low; discard if precipitate or dark color develops • In children, amount of fluid will de- pend on ordered dose; in infants, infuse over 1-2 hr • In evenly spaced doses to maintain blood level, separate from penicillins by at least 1 hr Y-site compatibilities: Acyclovir, ala trofloxacin, aldesleukin, alemtuzumab, alfentanil, amifostine, aminophylline, amio- darone, amsacrine, anidulafungin, argatro- ban, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, ceFAZolin, cefepime, cefoni- cid, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorpro MAZINE, cimetidine, cisatracurium, CISpla- tin, clindamycin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytara- bine, DACTINomycin, DAPTOmycin, dexa- methasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTa- mine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epi- rubicin, epoetin alfa, eptifibatide, ertape- nem, erythromycin, esmolol, etoposide, famotidine, fentaNYL, filgrastim, flucon- azole, fludarabine, fluorouracil, foscarnet, furosemide, gemcitabine, gentamicin, gly- copyrrolate, granisetron, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, IL-2, imipenem/cilastin, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methylPRED- NISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoXANtrone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, niCARdi pine, nitroglycerin, nitroprusside, norepi- nephrine, octreotide, ondansetron, oxali platin, oxytocin, PACLitaxel, palonosetron, pantoprazole, papaverine, PEMEtrexed, penicillin G, pentazocine, perphenazine, PHENobarbital, phenylephrine, phytonadi- one, piperacillin/tazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quinupristin/dalfopristin, ranit- idine, remifentanil, riTUXimab, rocu ronium, sargramostim, sodium acetate, sodium bicarbonate, succinylcholine, SUFen tanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazo- line, trimethaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vori- conazole, warfarin, zidovudine, zole- dronic acid
PDF pages 65, 66
Assess: • Weight before treatment; calculation of dosage is usually based on ideal body weight but may be calculated on actual body weight; in those underweight and not obese, use total body weight (TBW) instead of ideal body weight • IV site for thrombophlebitis including pain, redness, swelling q30min; change site if needed; apply warm compresses to discontinued site
PDF page 67
Evaluate: • Therapeutic response: absence of fe- ver, draining wounds; negative C&S after treatment
PDF page 67
CLINICAL CONSIDERATIONS
PDF page 67
Patient and caregiver information: A • To report headache, dizziness, symp- toms of overgrowth of infection, renal impairment, symptoms of nephrotoxicity, hepatotoxicity • Ototoxicity: To report loss of hearing; ringing, roaring in ears; feeling of fullness in head • To report hypersensitivity: rash, itch- ing, trouble breathing, facial edema; no- tify health care provider • Pregnancy/breastfeeding: tell pre- scriber if pregnancy is planned or sus- pected or if breastfeeding; do not use in pregnancy, breastfeeding TREATMENT OF HYPERSEN- SITIVITY: Hemodialysis, exchange transfusion in the newborn, monitor serum levels of product, may give ticar- cillin or carbenicillin
PDF page 67
PHARMACOKINETICS IM: Onset rapid, peak 1 hr, leads to unpredictable concentrations, IV pre- ferred IV: Onset immediate, peak 15-30 min, half-life 2 hr, prolonged up to 7 hr in infants; not metabolized; excreted unchanged in urine; crosses placenta; removed by hemodialysis
PDF page 66
• Adult/child: IV INFUSION 15 mg/kg/ day in 2-3 divided doses q8-12hr in 100- 200 mL D5W over 30-60 min, max 1.5 g/ day; pulse dosing (once-daily dosing) may be used with some infections; IM 10-15 mg/kg/day in divided doses q8- 12hr; or extended-interval dosing as an alternative dosing regimen
PDF page 65
• Adult: IV CCr 40-59 mL/min 15 mg/kg q36hr; CCr 20-39 mL/min 15 mg/kg q48hr; <20 mL/min adjust based on se- rum concentrations and MIC (use tradi- tional dosing) Mycobacterium avium complex (MAC)
PDF page 65
• Adult and adolescent: IM/IV 15-20 mg/kg/day or 5× per week; NEB (Ari- kayce) 590 mg daily in combination
PDF page 65
• Adult: IM/IV 15 mg/kg/day in 2 di- vided doses × 3 wk with co-trimoxazole for 5 wk; repeat cycle once, may be re- peated 2×
PDF page 65