Vancomycin and Amikacin Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Vancomycin
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
An increased risk of ototoxicity and/or an increased risk of nephrotoxicity
Interaction Deep Dive
Avoid concomitant use of amikacin and vancomycin1. Concomitant use of vancomycin and aminoglycosides, such as amikacin may increase the risk of ototoxicity. Ototoxicity has occurred in patients administered vancomycin IV or orally. It may be transient or permanent. Discontinue vancomycin if ototoxicity occurs. Serial tests of auditory function may be helpful in order to minimize the risk of ototoxicity 23. Some studies have found that nephrotoxicity has been associated with coadministration of vancomycin and an aminoglycoside. However, the extent to which the coadministration enhances the rate of nephrotoxicity compared with the rate that would occur with either drug alone is not clearly defined 4. If concurrent therapy is required, monitor for additive ototoxicity and nephrotoxicity 1.
Why it happens (mechanism)
Additive ototoxicity; additive nephrotoxic effects
Literature reports
4 reports — tap to read
a) A study evaluated 101 children with fever and neutropenia to see if vancomycin enhanced amikacin-induced tubular nephrotoxicity. Although amikacin was subclinically nephrotoxic, the addition of vancomycin did not enhance clinical or tubular nephrotoxicity 5.
b) Although there is some controversy, the best evidence suggests that concurrent use of vancomycin and an aminoglycoside antibiotic is associated with a higher incidence of nephrotoxicity than either agent alone 678. One prospective study of 136 elderly patients reported a 24% incidence of nephrotoxicity (increase in serum creatinine of at least 0.5 mg/dL) with the combination compared to vancomycin alone (19%) or aminoglycoside alone (12%). A follow-up meta-analysis of 8 studies of this interaction found that the incidence of nephrotoxicity with the combination was 13% greater than vancomycin alone (p=0.01) and 4% greater than aminoglycoside alone (p=0.05). Risk factors which have been reported include creatinine clearance less than 40 mL/min, age greater than 65, and gentamicin/tobramycin trough serum levels greater than 1.5 mcg/mL 6.
c) In a retrospective chart review of 98 consecutive patients receiving a course of IV vancomycin, 35% of patients receiving concurrent aminoglycoside therapy experienced a prominent rise in serum creatinine compared with a 5% incidence in patients receiving no aminoglycoside. Of 34 patients coadministered vancomycin and an aminoglycoside, 12 patients experienced a pronounced rise in creatinine levels and 3 showed some increase in creatinine. Only 3 of 60 patients not receiving an aminoglycoside had any increase in serum creatinine 4.
d) A study evaluated the records of 229 cancer patients receiving vancomycin alone, an aminoglycoside alone, or combined vancomycin and an aminoglycoside. The incidence of nephrotoxicity was 15% to 18% in all patients including those receiving either drug alone and those coadministered vancomycin-aminoglycoside. A significantly higher incidence of nephrotoxicity was reported in patients with vancomycin trough concentrations of 10 mcg/mL or more and/or aminoglycoside trough concentrations of 2 mcg/mL or more 9.
Common questions
Can I take Vancomycin and Amikacin Injection together?
An increased risk of ototoxicity and/or an increased risk of nephrotoxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Vancomycin and Amikacin Injection 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 "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Vancomycin or Amikacin Injection 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 (9)
- Product Information: amikacin sulfate injection, amikacin sulfate injection. Sicor Pharmaceuticals,Inc, Irvine, CA, 2005. DailyMed
- Product Information: VANCOMYCIN HYDROCHLORIDE intravenous injection, vancomycin hydrochloride intravenous injection. Hikma Pharmaceuticals USA Inc. (per Dailymed), Berkeley Heights, NJ, 2024. DailyMed
- Product Information: TYZAVAN intravenous injection, vancomycin hydrochloride intravenous injection. Hikma Pharmaceuticals USA Inc (per FDA), Berkeley Heights, NJ, 2025. DailyMed
- Farber BF & Moellering RC Jr: Retrospective study of the toxicity of preparations of vancomycin from 1974 to 1981. Antimicrob Agents Chemother 1983; 23:138-141. PubMed
- Goren MP, Baker DK Jr, & Shenep JL: Vancomycin does not enhance amikacin-induced tubular nephrotoxicity in children. Pediatr Infect Dis J 1989; 8:278-282.
- Goetz MB & Sayers J: Nephrotoxicity of vancomycin and aminoglycoside therapy separately and in combination. J Antimicrob Chemother 1993; 32:325-334. PubMed
- Pauly DJ, Musa DM, Lestico MR, et al: Risk of nephrotoxicity with combination vancomycin-aminoglycoside antibiotic therapy. Pharmacotherapy 1990; 10:378-382. DOI
- Downs NJ, Neihart RE, Dolezal JM, et al: Mild nephrotoxicity associated with vancomycin use. Arch Intern Med 1989; 149:1777-1781. DOI
- Cimino MA, Rotstein C, Slaughter RL, et al: Relationship of serum antibiotic concentrations to nephrotoxicity in cancer patients receiving concurrent aminoglycoside and vancomycin therapy. Am J Med 1987; 83:1091-1097. PubMed
Keep reading about Vancomycin
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