Professional Information
Kanamycin (Oral-Local)
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VA CLASSIFICATION
Primary: AM300
Secondary: GA900
Commonly used brand name(s): Kantrex.
Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).
†Not commercially available in Canada.
Category:
Hepatic encephalopathy therapy adjunct—
bowel preparation (preoperative) adjunct{01}—
Indications
Accepted
Bowel preparation, preoperative—Oral-local kanamycin is indicated in preoperative bowel preparation for the prophylaxis of infections. {01} {04}
Hepatic coma (treatment)—Oral-local kanamycin has been used as adjunctive treatment of hepatic coma; however, it generally has been replaced by safer and more effective agents.
—Not all species or strains of a particular organism may be susceptible to kanamycin.
Unaccepted
Oral kanamycin is not indicated in the treatment of systemic infections. {04}
Pharmacology/Pharmacokinetics
Physicochemical characteristics:
Molecular weight—
582.58 {05}
Mechanism of action/Effect:
Aminoglycoside; actively transported across the bacterial cell membrane, binds to a specific receptor protein on the 30 S subunit of bacterial ribosomes, and interferes with an initiation complex between mRNA (messenger RNA) and the 30 S subunit, inhibiting protein synthesis. DNA may be misread, thus producing nonfunctional proteins; polyribosomes are split apart and are unable to synthesize protein. {09}
Note: Aminoglycosides are bactericidal, while most other antibiotics that interfere with protein synthesis are bacteriostatic.
Oral nonabsorbable antibiotics suppress the growth of bacteria in the bowel, including those which produce ammonia.
Absorption:
Although only negligible amounts (approximately 1%) of kanamycin are absorbed through intact intestinal mucosa, significant amounts may be absorbed through ulcerated or denuded mucosa or if inflammation is present. {04}
Elimination:
Fecal. {04}
Precautions to Consider
Cross-sensitivity and/or related problems
Patients hypersensitive to one aminoglycoside may be hypersensitive to other aminoglycosides also.
Pregnancy/Reproduction
Problems in humans have not been documented.
Breast-feeding
It is not known whether oral-local kanamycin is excreted in breast milk. However, problems in humans have not been documented.
Pediatrics
Appropriate studies on the relationship of age to the effects of oral-local kanamycin have not been performed in the pediatric population. However, no pediatrics-specific problems have been documented to date.
Geriatrics
No information is available on the relationship of age to the effects of oral kanamycin in geriatric patients.
Drug interactions and/or related problems
Because of minimal absorption of oral kanamycin, serum concentrations are not usually high enough to interact systemically with other medications, even in severe renal failure. For systemic drug interactions with parenteral kanamycin, see Aminoglycosides (Systemic).
Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).
Except under special circumstances, this medication should not be used when the following medical problem exists:
» Intestinal obstruction
Risk-benefit should be considered when the following medical problems exist
» Eighth-cranial-nerve impairment{04} (patients who receive prolonged kanamycin therapy may be at increased risk of ototoxicity)
Hypersensitivity to kanamycin or other aminoglycosides
» Renal function impairment{04} (patients receiving prolonged, high-dose therapy may require a reduction of dosage due to potential renal toxicity)
» Ulcerative lesions of the bowel (ulcerative lesions of the bowel may increase the systemic absorption of kanamycin, increasing the risk of toxicity)
Side/Adverse Effects
The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:
Those indicating need for medical attention
Incidence rare
—with prolonged, high-dose therapy{04}
Nephrotoxicity (greatly decreased frequency of urination or amount of urine; increased thirst)
auditory ototoxicity (any loss of hearing; ringing or buzzing; a feeling of fullness in the ears)
vestibular ototoxicity (clumsiness; dizziness; unsteadiness)
Those indicating need for medical attention only if they continue or are bothersome
Incidence more frequent {04}
Gastrointestinal disturbances (diarrhea; nausea or vomiting)
Incidence rare
—with prolonged therapy{04}
Malabsorption syndrome (diarrhea; increased amount of gas; light-colored, frothy, fatty-appearing stools)
Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Kanamycin (Oral).
In providing consultation, consider emphasizing the following selected information (» = major clinical significance):
Before using this medication
» Conditions affecting use, especially:
Hypersensitivity to kanamycin or other aminoglycosides
Other medical problems, especially eighth-cranial-nerve impairment, intestinal obstruction, renal function impairment, or ulcerative lesions of the bowel
Proper use of this medication
Taking on a full or empty stomach
» Compliance with full course of therapy
» Proper dosing
» Proper storage
For use as a preoperative bowel preparation
Missed dose: Taking as soon as possible; not taking if almost time for next dose; not doubling doses
Side/adverse effects
Signs of potential side effects, especially nephrotoxicity, auditory ototoxicity, and vestibular ototoxicity
General Dosing Information
Kanamycin may be taken on a full or empty stomach.
Oral Dosage Forms
Note: The dosing and strengths of the dosage forms available are expressed in terms of kanamycin base (not the sulfate salt).
KANAMYCIN SULFATE CAPSULES USP
Usual adult and adolescent dose
Hepatic encephalopathy therapy adjunct
Oral, 2 to 3 grams (base) every six hours. {04}
Bowel preparation (preoperative) adjunct
Oral, 1 gram (base) every hour for four hours, then 1 gram every six hours for thirty-six to seventy-two hours. {04}
Usual pediatric dose
Hepatic encephalopathy therapy adjunct—See Usual adult and adolescent dose.
Bowel preparation (preoperative) adjunct—See Usual adult and adolescent dose.
Strength(s) usually available
U.S.—
500 mg (base) (Rx) [Kantrex (lactose)]
Canada—
Not commercially available.
Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.
Auxiliary labeling:
• Continue medicine for full time of treatment.
Revised: 03/17/1994
References
- Indications Index review, 1986.
- Kantrex (Bristol). In: PDR Physicians' desk reference. 40th ed. 1986. Oradell, NJ: Medical Economics Company, 1986: 698-700.
- USP DI 1989, VA Medication Classification System: 2472.
- Kantrex capsules package insert (Bristol—US), Rev 9/88, Rec 1/89; Rev 11/89, Rec 2/91.
- Fleeger CA, editor. USAN 1989. USAN and the USP dictionary of drug names. Rockville, MD: The United States Pharmacopeial Convention, Inc., 1988: 307.
- USP Description and Solubility, 4/3/89.
- Personal communication, Bristol (Canada), 6/28/89.
- USP DI 1989, USP Requirements, IV/50.
- Gilman AG, Goodman LS, Rall TW, Murad F, editors. Goodman and Gilman's the pharmocological basis of therapeutics. 7th ed. New York: Macmillan, 1985: 1165.
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