Amikacin Injection and Ethacrynic Acid: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ethacrynic Acid
Amikacin Injection
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased amikacin plasma and tissue concentrations and additive ototoxicity
Interaction Deep Dive
Concomitant use of amikacin and ethacrynic acid should be avoided2 due to potential additive ototoxicity. Concurrent administration of intravenous ethacrynic acid may increase amikacin toxicity by altering amikacin serum and tissue concentrations 1. If concurrent therapy is required, monitor for additive ototoxicity or nephrotoxicity. Renal impairment may also enhance the incidence of ototoxicity 45.
Why it happens (mechanism)
Additive or synergistic toxicity
Literature reports
2 reports — tap to read
a) Three patients experienced permanent hearing loss following the administration of streptomycin and ethacrynic acid. Patient 1, a 24-year-old male, received streptomycin 4 grams over five days and two doses of ethacrynic acid 100 mg. After complaining of ringing in the ears, an audiometry demonstrated a bilateral 35- to 45-decibel sensorineural loss. Patient 2, a 35-year-old woman, was given ethacrynic acid 500 mg over a period of four days, along with streptomycin 1.5 grams. Although her hearing was normal prior to this event, an audiogram showed a bilateral sensorineural hearing loss of 70 decibels. The third patient experienced permanent deafness following the administration of ethacrynic acid 200 mg, streptomycin 3.5 grams, kanamycin 500 mg, and colonic irrigations of neomycin 15 grams. The Food and Drug Administration has also reported a case of permanent deafness following a single dose of kanamycin and ethacrynic acid 3.
b) Two non-uremic patients experienced neurosensory hearing loss after the intravenous administration of ethacrynic acid. Both patients also received aminoglycoside antibiotics. In the first case, a 45-year-old female received gentamicin 60 mg intramuscularly every six hours and one dose of ethacrynic acid 50 mg. Within 15 minutes, she experienced total bilateral hearing loss and failed to response to shouting commands. Nine hours later, the hearing was subjectively normal. The second case involved a 64-year-old female who was receiving kanamycin 500 mg intramuscularly every 12 hours. She received two doses of ethacrynic acid 50 mg, separated by six hours. Within ten minutes of the second dose, she complained of total bilateral hearing loss which lasted six hours until she became comatose 4.
Common questions
Can I take Amikacin Injection and Ethacrynic Acid together?
Increased amikacin plasma and tissue concentrations and additive ototoxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amikacin Injection and Ethacrynic Acid interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Amikacin Injection or Ethacrynic Acid need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (5)
- Product Information: amikacin sulfate injection, amikacin sulfate injection. Sicor Pharmaceuticals,Inc, Irvine, CA, 2005. DailyMed
- Product Information: EDECRIN(R) oral tablets, ethacrynic acid oral tablets. Merck & Co,Inc, Whitehouse Station, NJ, 2005. DailyMed
- Mathog RH & Klein WJ Jr: Ototoxicity of ethacrynic acid and aminoglycoside antibiotics in uremia. N Engl J Med 1969; 280:1223-1224. DOI
- Meriwether WD, Mangi RJ, & Serpick AA: Deafness following standard intravenous dose of ethacrynic acid. JAMA 1971; 216:795-798. DOI
- Prazma J, Browder JP, & Fischer ND: Ethacrynic acid ototoxicity potentiation by kanamycin. Ann Otol Rhinol Laryngol 1974; 83:111-118. PubMed
Keep reading about Ethacrynic Acid
Keep reading about Amikacin Injection
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist