RESEARCH STARTER

Aminoglycosides (drug interactions)

Aminoglycosides are a class of antibiotics administered intravenously to treat specific infections, known for their effectiveness but also for potential interactions with various substances. Certain herbal supplements, minerals, and medications may affect their effectiveness or increase the risk of harmful side effects. For example, ginkgo, which is thought to protect nerve cells, may actually exacerbate damage to the auditory nerve when used alongside aminoglycosides and should be avoided. Additionally, there is weak evidence suggesting that gentamicin might lower levels of essential minerals like magnesium and calcium, making supplementation possibly beneficial for long-term use. Vitamin B12 has also been tentatively linked to preventing hearing damage caused by gentamicin. However, N-acetylcysteine could potentially reduce the effectiveness of aminoglycosides. It's crucial for patients to consult healthcare professionals before initiating aminoglycoside treatment, especially if they are taking other medications or have conditions that elevate the risk of kidney damage. Lastly, the concurrent use of aminoglycosides with penicillin or certain diuretics may diminish their therapeutic effect and amplify adverse reactions.

Full Article

DEFINITION: Antibiotics given intravenously to treat certain infections.

  • INTERACTIONS: Calcium, ginkgo, magnesium, N-acetylcysteine, vitamin B12
  • TRADE NAMES: Amikacin (Amikin), Gentamicin (Garamycin), Tobramycin (Tobi, Tobrex)

Ginkgo

Effect: Possible Harmful Interaction

The herb ginkgo is thought to increase circulation and protect nerve cells from damage. Based on this, it has been proposed as a possible treatment to help protect the auditory nerve from damage caused by aminoglycosides. However, one animal study performed to evaluate this potential benefit found that the herb actually increased damage to the auditory nerve. Based on this finding, persons using aminoglycoside drugs should avoid ginkgo.

Minerals: Magnesium and Calcium

Effect: Possible Harmful Interaction

Weak evidence from animal studies suggests that gentamicin may reduce magnesium and calcium levels. Supplementation may, therefore, be helpful on general principles if gentamicin treatment is used for an extended time. One animal study suggests that calcium supplements, in particular, might help prevent gentamicin-induced kidney damage.

Vitamin B12

Effect: Supplementation Possibly Helpful

One animal study weakly hints that vitamin B12 might help prevent hearing damage caused by gentamicin.

N-acetylcysteine

Effect: May Decrease Effectiveness of the Drug

One animal study suggested that N-acetylcysteine might help protect the kidneys from damage caused by gentamicin.

Other Interactions

Individuals should consult their doctor before taking aminoglycosides if they use Theracrys (BCG live intravesical), Zanosar (streptozocin), Vistide (cidofovir), or loop diuretics. Also, because many neuromuscular blocking agents used during surgery may increase the chances of adverse side effects of aminoglycosides, one should discuss the use of the drug before any surgery.

The major concern with aminoglycoside use remains its increased risk of damaging the kidneys, and concurrent use with any other nephrotoxic drug should be avoided. Patients who experience hearing loss may also develop balance problems. Penicillin and beta-lactam antibiotics become less effective when taken with aminoglycosides. Patients taking Warfarin and Methotrexate should avoid aminoglycosides.


Bibliography

“Aminoglycosides General Statement Monograph for Professionals.” Drugs.com, www.drugs.com/monograph/aminoglycosides-general-statement.html. Accessed 12 Dec. 2025.

Block, Megan, and Dana L. Blanchard. "Aminoglycosides - StatPearls." NCBI, 17 July 2023, www.ncbi.nlm.nih.gov/books/NBK541105. Accessed 12 Dec. 2025.

Chou, Chu, et al. "Aminoglycosides Use Has a Risk of Acute Kidney Injury in Patients Without Prior Chronic Kidney Disease." Scientific Reports, vol. 12, no. 17212, 2022, pp. 1-9, doi.org/10.1038/s41598-022-21074-x. Accessed 12 Dec. 2025.

Jin, X., and X. Sheng. "Methylcobalamin as Antagonist to Transient Ototoxic Action of Gentamicin." Acta-Oto-Laryngologica, vol. 121, 2001, pp. 351-4.

Miman, M. C., et al. "Amikacin Ototoxicity Enhanced by Ginkgo biloba Extract (EGb 761)." Hearing Research, vol. 169, 2002, pp. 121-9.

Wiley, Frieda. "What Are Aminoglycosides?" Everyday Health, 21 Oct. 2023, www.everydayhealth.com/aminoglycosides/guide. Accessed 12 Dec. 2025.


Full Article

DEFINITION: Antibiotics given intravenously to treat certain infections.

  • INTERACTIONS: Calcium, ginkgo, magnesium, N-acetylcysteine, vitamin B12
  • TRADE NAMES: Amikacin (Amikin), Gentamicin (Garamycin), Tobramycin (Tobi, Tobrex)

Ginkgo

Effect: Possible Harmful Interaction

The herb ginkgo is thought to increase circulation and protect nerve cells from damage. Based on this, it has been proposed as a possible treatment to help protect the auditory nerve from damage caused by aminoglycosides. However, one animal study performed to evaluate this potential benefit found that the herb actually increased damage to the auditory nerve. Based on this finding, persons using aminoglycoside drugs should avoid ginkgo.

Minerals: Magnesium and Calcium

Effect: Possible Harmful Interaction

Weak evidence from animal studies suggests that gentamicin may reduce magnesium and calcium levels. Supplementation may, therefore, be helpful on general principles if gentamicin treatment is used for an extended time. One animal study suggests that calcium supplements, in particular, might help prevent gentamicin-induced kidney damage.

Vitamin B12

Effect: Supplementation Possibly Helpful

One animal study weakly hints that vitamin B12 might help prevent hearing damage caused by gentamicin.

N-acetylcysteine

Effect: May Decrease Effectiveness of the Drug

One animal study suggested that N-acetylcysteine might help protect the kidneys from damage caused by gentamicin.

Other Interactions

Individuals should consult their doctor before taking aminoglycosides if they use Theracrys (BCG live intravesical), Zanosar (streptozocin), Vistide (cidofovir), or loop diuretics. Also, because many neuromuscular blocking agents used during surgery may increase the chances of adverse side effects of aminoglycosides, one should discuss the use of the drug before any surgery.

The major concern with aminoglycoside use remains its increased risk of damaging the kidneys, and concurrent use with any other nephrotoxic drug should be avoided. Patients who experience hearing loss may also develop balance problems. Penicillin and beta-lactam antibiotics become less effective when taken with aminoglycosides. Patients taking Warfarin and Methotrexate should avoid aminoglycosides.


Bibliography

“Aminoglycosides General Statement Monograph for Professionals.” Drugs.com, www.drugs.com/monograph/aminoglycosides-general-statement.html. Accessed 12 Dec. 2025.

Block, Megan, and Dana L. Blanchard. "Aminoglycosides - StatPearls." NCBI, 17 July 2023, www.ncbi.nlm.nih.gov/books/NBK541105. Accessed 12 Dec. 2025.

Chou, Chu, et al. "Aminoglycosides Use Has a Risk of Acute Kidney Injury in Patients Without Prior Chronic Kidney Disease." Scientific Reports, vol. 12, no. 17212, 2022, pp. 1-9, doi.org/10.1038/s41598-022-21074-x. Accessed 12 Dec. 2025.

Jin, X., and X. Sheng. "Methylcobalamin as Antagonist to Transient Ototoxic Action of Gentamicin." Acta-Oto-Laryngologica, vol. 121, 2001, pp. 351-4.

Miman, M. C., et al. "Amikacin Ototoxicity Enhanced by Ginkgo biloba Extract (EGb 761)." Hearing Research, vol. 169, 2002, pp. 121-9.

Wiley, Frieda. "What Are Aminoglycosides?" Everyday Health, 21 Oct. 2023, www.everydayhealth.com/aminoglycosides/guide. Accessed 12 Dec. 2025.


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