Nephrotoxicity dosing regimens

Like all aminoglycosides, amikacin is nephrotoxic and ototoxic (particularly for the auditory portion of the eighth nerve). Serum concentrations should be monitored. Target peak serum concentrations for an every-12-hours dosing regimen are... 

Rybak MJ, Abate BJ, Kang SL, Ruffing MJ, Lerner SA, Drusano GL. Prospective evaluation of the effect of an aminoglycoside dosing regimen on rates of observed nephrotoxicity and ototoxicity. Antimicrob Agents Chemother 1999 43(7) 1549-55. 

Although differences in the incidence of renal adverse events between bisphosphonates have been reported from clinical trials, the reasons for these observations remain unknown but may be specific to a particular drug, dosing regimen, or prunary tumour type. Although more common in patients with pre-existing renal impairment, nephrotoxicity is not exclusive to this patient population. Clearly, further comparative chnical trials would be needed to directly compare the renal safety profiles of different i.v. bisphosphonates. 

Hemorrhagic cystitis always given with mesna and hydration nephrotoxicity renal tubular acidosis potassium, magnesium, and phosphate wasting, especially in high-dose regimens myelosuppression CNS effects somnolence, confusion, disorientation, cerebellar symptoms that are dose-related moderately emetogenic alopecia... 

Bennett WM, Plamp CE, Gilbert DN, Parker RA, Porter GA. The influence of dose regimen on experimental gentamcicn nephrotoxicity dissociation of peak serum levels from renal failure. J Infect Dis 1979 140 576-580. 

Adverse reactions to aminoglycosides, including nephrotoxicity, ototoxicity, and neuromuscular blockade, in patients in intensive care have been reviewed [3 ]. The use of a high-dose extended interval dosing regimen may reduce the incidence of acute kidney damage in one study the incidence was 1.2%, which is lower than the previously reported rate of 3-5%. 

Cyclosporine and tacrolimus are calcineurin inhibitors that are administered as part of immunosuppressive regimens in kidney, liver, heart, lung, and bone marrow transplant recipients. In addition, they are used in autoimmune disorders such as psoriasis and multiple sclerosis. The pathophysiologic mechanism for ARF is renal vascular vasoconstriction.41 It often occurs within the first 6 to 12 months of treatment, and can be reversible with dose reduction or drug discontinuation. Risk factors include high dose, elevated trough blood concentrations, increased age, and concomitant therapy with other nephrotoxic drugs.41 Cyclosporine and tacrolimus are extensively metabolized by... 

To decrease dose-related toxicity by using reduced doses of one or more components of the drug regimen. The use of flucytosine in combination with amphotericin for the treatment of cryptococcal meningitis in non-HIV-infected patients allows for a reduction in amphotericin dosage with decreased amphotericin -induced nephrotoxicity. 

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