Furosemide with aminoglycosides

Furosemide 40-80 mg/day 120 mg t.i.d. 70% 100% 100% 100% Ototoxicity increased in ESRD, especially in combination with aminoglycosides high doses effective in ESRD NC NC No data... 

A study assessing the risk factors for nephrotoxicity with aminoglycosides (tobramycin and gentamicin) enrolled 1489 patients, 157 of whom developed clinical nephrotoxicity. Of these patients 118 had no immediately identifiable cause (such as acute renal failure) and further evaluation of other risk factors found that the concurrent use of furosemide significantly increased the risk of nephrotoxicity. A clinical study evaluating a possible interaction found that furosemide increased aminoglycoside-... 

The severity of aminoglycoside nephrotoxicity is additive with that of vancomycin, polymixin, gallium, furosemide, enflurane, cisplatin, and cephalosporins. Aminoglycoside nephrotoxicity is synergistic with that of amphotericin B and cyclosporine. 

LOOP DIURETICS AMINOGLYCOSIDES t risk of ototoxicity and possible deafness as a result of concomitant use of furosemide and gentamicin Both furosemide and gentamicin are associated with ototoxicity this risk is t if they are used together If used concurrently patients should be monitored for any hearing impairment... 

One advantage of bumetanide is that it is less ototoxic than furosemide (1-3). It is sensible to prefer bumetanide to furosemide in patients with hearing problems or who concurrently need ototoxic drugs, such as an aminoglycoside antibiotic. 

In a similar vein, Leehey et al. [201] have reported on the frequency of aminoglycoside-induced nephrotoxicity using three different dosing schemes, including two that were based on pharmacokinetic principles. It is noteworthy that despite careful calculation of the dosing scheme, this did not alter the incidence of nephrotoxicity. However, the duration of dosing correlated positively with nephrotoxicity incidence, as did treatment with furosemide, old age, and liver disease. 

Beta-lactam induced renal toxicity can results from their use in monotherapy or when used in combination with other nephrotoxic drugs such as aminoglycosides, amphotericin B, cisplatin, cyclosporine, furosemide, ifosfamide, vancomycin and nephrotoxic p-lactams. While the risk of nephrotoxic injury from monotherapy with p-lactams is relatively low, this risk is substantially increased when multiple drug combinations are required. 

Clinically important, potentially hazardous interactions with adefovir, aldesleukin, aminoglycosides, atracurium, bumetanide, cephalexin, doxacurium, ethacrynic acid, furosemide, succinylcholine, teicoplanin, torsemide... 

Clinically important, potentially hazardous interactions with acetazolamide, aminoglycosides, anticholinesterases, bambuterol, calcium channel blockers, chloroquine, chlorpromazine, clindamycin, d-pencillamine, ecothiophate iodine, enflurane, furosemide, halothane, hexomethonium, isoflurane, ketamine, lidocaine, lincomycin, lithium salts, magnesium salts, mannitol, MAO inhibitors, organophosphates, pancuronium, phenytoin, polymyxins, procainamide, quinidine, sevoflurane, spectinomycin, tetracyclines... 

Drugs with nephrotoxic potential include ACE inhibitors, acetazolamide. aminoglycosides, aspirin, amphotericin B, cyclosporine, furosemide, gold salts, lithium, methicillin, methoxyflurane, NSAIDs, pentamidine, sulfonamides, tetracyclines (degraded), thiazides, and triamterene. 

Vancomycin is both potentially nephrotoxic and ototoxic, and its manufacturers therefore suggest that it should be used with particular care, or avoided in patients with renal impairment or deafiiess. They also advise the avoidance of other drugs that have nephrotoxic potential, because the effects could be additive. They list amphotericin B, aminoglycosides, bacitracin, colistin, poymyxin B, viomycin and cisplatin. They also list etacrynic acid and furosemide as potentially aggravating ototoxicity. 

Acta Otolaryngol 82(l-2) 33 0. doi 10.3109/00016487609120860 Comis SD, Osborne M, Jeffries D (1990) Effect of furosemide upon morphology of hair bundles in guinea pig cochlear hair cells. Acta Otolaryngol 109(l-2) 49-56 Conlon BJ, Aran J, Erre J, Smith D (1999) Attenuation of aminoglycoside-induced cochlear damage with the metabolic antioxidant alpha-lipoic acid. Hear Res 128(l-2) 40-44. doi 10. 1016/80378-5955(98)00195-6... 

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