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Amikacin nebuliser

Updated 2 Feb 2023 | Aminoglycosides


Nebuliser dispersion of amikacin sulfate in liposomal formulation.

Drugs List

  • amikacin liposomal 590mg nebuliser dispersion vial with device
  • ARIKAYCE LIPOSOMAL 590mg nebuliser dispersion vial with Lamira handset
  • Therapeutic Indications


    Treatment of Mycobacterium infection (non-tuberculous)

    Treatment of non-tuberculous mycobacterial (NTM) lung infections caused by Mycobacterium avium Complex (MAC) in adults with limited treatment options who do not have cystic fibrosis.


    Liposomal amikacin sulfate should be used in combination with other antibacterial agents active against Mycobacterium avium Complex lung infections.


    One vial (590mg) once daily.

    Treatment should be continued for 12 months after sputum culture conversion.

    Treatment should not be continued beyond a maximum of 6 months if sputum culture conversion (SCC) has not been confirmed.

    Maximum duration of treatment should not exceed 18 months.

    Additional Dosage Information

    Missed doses
    If a daily dose is missed, the next dose should be administered the next day. A double dose should not be given.


    For inhalation use only.

    To be administered by supplied nebuliser handset only.


    Children under 18 years
    Myasthenia gravis
    Severe renal impairment

    Precautions and Warnings

    Auditory impairment
    Mild renal impairment
    Neuromuscular disorder
    Pulmonary disease
    Vestibular impairment

    Advise ability to drive/operate machinery may be affected by side effects
    Before initiating therapy enquire about previous hypersensitivity reactions
    Consult national/regional policy on the use of anti-infectives
    Treatment to be initiated and supervised by a specialist
    Contains soya or soya derivative
    Use designated delivery device only
    Monitor auditory and vestibular function
    Monitor neuromuscular function
    Monitor renal function regularly
    Advise patient to seek medical advice if COPD seems to be worsening
    Consider discontinuation if nephrotoxicity occurs
    Consider discontinuation if ototoxicity occurs
    May cause bronchospasm
    Discontinue if hypersensitivity reactions occur
    Bronchodilator therapy may be used to reduce bronchospasm

    Inhaled liposomal amikacin should be administered after using a short-acting bronchodilator in patients with a history of reactive airway disease, asthma or bronchospasm. If there is evidence of bronchospasm due to liposomal amikacin inhalation, the patient may be pre-treated with bronchodilators.

    Exacerbation of underlying pulmonary disease (chronic obstructive pulmonary disease, infective exacerbation of chronic obstructive pulmonary disease, infective exacerbation of bronchiectasis) was reported with a higher frequency in patients treated with inhaled liposomal amikacin. Caution should be exercised in patients presenting with these underlying conditions. Discontinuation of treatment should be considered if signs of exacerbation are observed.

    Ototoxicity has been reported with inhaled liposomal amikacin. Auditory and vestibular function should be periodically monitored in all patients. Frequent monitoring is recommended in patients with known or suspected auditory or vestibular dysfunction.

    Nephrotoxicity has been reported with inhaled liposomal amikacin. Renal function should be monitored periodically during treatment. In patients with pre-existing renal dysfunction, frequent monitoring is recommended.

    Pregnancy and Lactation


    Liposomal amikacin is contraindicated during pregnancy.

    The manufacturer does not recommend using liposomal amikacin during pregnancy.

    At the time of writing, there is no data from the use of liposomal amikacin during pregnancy. Systemic exposure to amikacin following inhalation of inhaled liposomal amikacin is expected to be low compared to parental administration. Aminoglycosides can cause foetal harm and are known to cross the placenta, the potential for harm exists.


    Use liposomal amikacin with caution during breastfeeding.

    The manufacturer advises that the patient either discontinues liposomal amikacin or discontinues breastfeeding.

    At the time of writing, there is limited data regarding the presence of amikacin in human milk. Systemic exposure to amikacin following inhalation of inhaled liposomal amikacin is expected to be low compared to parental administration.

    Side Effects

    Allergic alveolitis
    Anaphylactic reaction
    Chest discomfort
    Decreased appetite
    Dry mouth
    Exacerbation of obstructive pulmonary disease
    Hypersensitivity reactions
    Increased sputum
    Loss of balance
    Muscle weakness
    Oropharyngeal pain
    Peripheral neuropathy
    Productive cough
    Renal impairment
    Throat irritation
    Weight loss


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: June 2021

    Reference Sources

    Summary of Product Characteristics: Arikayce liposomal 590mg nebuliser dispersion. Insmed Limited. Revised September 2020.

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