Amikacin sulfate

How Medicare covers it

Usual path Part B (injections given by a clinician — J0278, see the Part B basis in this package). The Part D aggregation in this package is carried exactly as computed. Part A during a covered inpatient stay.

What it treats

Treats serious infections due to susceptible strains of Gram-negative bacteria, including Pseudomonas species, E. coli, indole-positive and indole-negative Proteus species, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter species — shown effective in bacterial septicemia (including neonatal sepsis), serious infections of the respiratory tract, bones and joints, central nervous system (including meningitis), and skin and soft tissue, intra-abdominal infections (including peritonitis), burns and postoperative infections, and serious complicated and recurrent urinary tract infections. Aminoglycosides including amikacin are not indicated in uncomplicated initial urinary tract infections unless the organisms are not susceptible to less toxic antibiotics. Amikacin has been effective against gentamicin- and/or tobramycin-resistant strains (particularly Proteus rettgeri, Providencia stuartii, Serratia marcescens, and Pseudomonas aeruginosa) and in certain staphylococcal infections.

What it is for, in depth

Amikacin is a strong antibiotic in the aminoglycoside group. It treats serious infections caused by certain susceptible Gram-negative bacteria, including Pseudomonas species, E. coli, Proteus species, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter species. The label lists bacterial septicemia, including neonatal sepsis, serious infections of the breathing passages, bones and joints, the central nervous system including meningitis, and skin and soft tissue, infections inside the abdomen including peritonitis, burns and infections after surgery, and serious complicated and returning urinary tract infections. It is not meant for uncomplicated first urinary tract infections unless the bacteria are not susceptible to less toxic antibiotics. It has also worked against some bacteria resistant to gentamicin and/or tobramycin, and in certain staphylococcal infections. It is given by injection into a muscle or by IV infusion in a clinic or hospital for short-term treatment, and safety for treatment longer than 14 days has not been established. The dose is based on body weight before treatment and is adjusted for kidney function.

How it works

It is a semi-synthetic aminoglycoside antibiotic derived from kanamycin. Like other aminoglycosides, it kills susceptible bacteria by binding to the bacterial ribosome and disrupting their protein production.

How it is taken

Given intramuscularly (IM) or intravenously (IV) in a clinic or hospital, for short-term treatment — safety for treatment periods longer than 14 days has not been established. The dose is calculated from the patient's pretreatment body weight and adjusted for kidney function; the status of renal function is estimated before therapy and reassessed periodically, serum amikacin concentrations should be measured when possible (peak concentrations above 35 micrograms/mL and trough concentrations above 10 micrograms/mL should be avoided), and patients should be well hydrated.

Common side effects

The label does not report a frequency table of common effects; it states that all aminoglycosides have the potential to induce auditory, vestibular, and renal toxicity and neuromuscular blockade, occurring more frequently in patients with present or past kidney impairment, treatment with other ototoxic or nephrotoxic drugs, and treatment for longer periods and/or with higher doses than recommended. Diarrhea, including C. difficile-associated diarrhea, is addressed in the warnings.

Serious warnings

See the boxed warning below for the ototoxicity, nephrotoxicity, and neuromuscular blockade risks. In addition: aminoglycosides can cause fetal harm when administered to a pregnant woman (there have been reports of total irreversible bilateral congenital deafness in children whose mothers received streptomycin during pregnancy). The injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in susceptible people, seen more frequently in asthmatic people. C. difficile-associated diarrhea has been reported with nearly all antibacterial agents including amikacin and may range from mild diarrhea to fatal colitis, occurring even over two months after administration.

Boxed warning

WARNING — Patients treated with parenteral aminoglycosides should be under close clinical observation because of the potential ototoxicity and nephrotoxicity associated with their use; safety for treatment periods which are longer than 14 days has not been established. Neurotoxicity, manifested as vestibular and permanent bilateral auditory ototoxicity, can occur in patients with preexisting renal damage and in patients with normal renal function treated at higher doses and/or for periods longer than those recommended; the risk of aminoglycoside-induced ototoxicity is greater in patients with renal damage, high-frequency deafness usually occurs first and can be detected only by audiometric testing, and aminoglycoside-induced ototoxicity is usually irreversible. Aminoglycosides are potentially nephrotoxic, with risk greater in impaired renal function and with high doses or prolonged therapy. Neuromuscular blockade and respiratory paralysis have been reported following parenteral injection and other routes of administration. Renal and eighth-nerve function should be closely monitored, especially in patients with known or suspected renal impairment, serum amikacin concentrations should be monitored, and concurrent and/or sequential use of other neurotoxic or nephrotoxic products — and concurrent use with potent diuretics — should be avoided; advanced age and dehydration may increase the risk of toxicity.

Who should be careful

A history of hypersensitivity to amikacin is a contraindication, and a history of hypersensitivity or serious toxic reactions to aminoglycosides may contraindicate the use of any other aminoglycoside because of known cross-sensitivities in this class. Use with caution in premature and neonatal infants (renal immaturity prolongs the drug's half-life), in elderly patients (renal function may be reduced even when routine BUN or creatinine looks normal — creatinine clearance is more useful, and monitoring renal function during aminoglycoside treatment is particularly important), in dehydration, and in patients with muscular disorders such as myasthenia gravis or parkinsonism, since aminoglycosides may aggravate muscle weakness through a curare-like effect. If the drug is used in pregnancy the patient should be apprised of the potential hazard to the fetus; it is not known whether amikacin is excreted in human milk, so a decision should be made whether to discontinue nursing or the drug.

Major interactions

Concurrent and/or sequential systemic, oral, or topical use of other neurotoxic or nephrotoxic products should be avoided, particularly bacitracin, cisplatin, amphotericin B, cephaloridine, paromomycin, viomycin, polymyxin B, colistin, vancomycin, or other aminoglycosides. Increased nephrotoxicity has been reported following concomitant parenteral administration of aminoglycoside antibiotics and cephalosporins (and cephalosporins may spuriously elevate creatinine readings). Aminoglycosides should not be given concurrently with potent diuretics (such as ethacrynic acid or furosemide). Neuromuscular blockade risk applies especially in patients receiving anesthetics or neuromuscular blocking agents such as tubocurarine, succinylcholine, and decamethonium, or massive transfusions of citrate-anticoagulated blood; calcium salts may reverse the blockade, but mechanical respiratory assistance may be necessary. In vitro mixing of aminoglycosides with beta-lactam antibiotics (penicillins or cephalosporins) can significantly inactivate both, so they are administered by separate routes.

Why it is in its tier

Amikacin is placed at Tier 4 in most Part D plans. In the CMS Part D formulary data for plan year 2027, it is listed by 5495 plans, which is a listing share of 100.0%. Tier 4 is the modal tier, used by 76.18% of the plans that list it. The tier distribution is 127 plans at Tier 1, 743 plans at Tier 2, 416 plans at Tier 3, 4186 plans at Tier 4, and 23 plans at Tier 6. Tier 1 is the lowest tier, with $0-$15 copays, and Tier 5 is the specialty tier, the highest tier. Tier 4 is therefore near the high end of the tier scale. For context, the CMS Part D Drug Spending Dashboard reports average spending per beneficiary in 2024 of 389.44260386 for Amikacin Sulfate; that is a CMS program average, not a copay.

Sources

• AMIKACIN SULFATE injection, solution — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Amikacin Injection

What official patient guides say

The MedlinePlus page covers amikacin injection given in a hospital and also, in some cases, administered at home, which is broader than this package's clinic and hospital focus. Amikacin injection comes as a liquid given into a vein over 30 to 60 minutes or into a muscle, usually every 8 to 24 hours, and the length of treatment depends on the type of infection. If it is ever given at home, your healthcare provider will show you how to use it, and you should make sure you understand those directions and ask about anything unclear. You should begin to feel better during the first few days of treatment, and you should call your doctor if your symptoms do not improve or get worse. Keep using amikacin until you finish the prescription, even if you feel better, because stopping too soon or skipping doses may leave the infection incompletely treated and the bacteria may become resistant to antibiotics. If you forget a dose, take it as soon as you remember, unless it is almost time for the next dose, in which case skip the missed dose and do not take a double dose. Store the medicine only as your healthcare provider directs, and keep it out of sight and reach of children.

Source: MedlinePlus — Amikacin Injection

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 2.4323 per unit (AMIKACIN SULF 500 MG/2 ML VIAL) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 5,495 list Amikacin sulfate — 100% of plans. Most of those plans put it on Tier 4: 4,186 plans, 76.2% of the plans that list it. Other plans place it on Tier 2 (743 plans), Tier 3 (416 plans) or Tier 1 (127 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 4; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 4; Aetna Medicare Value Plus (PPO) puts it on Tier 4. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.