Aminoglycosides
Monitoring the blood level is the standard safeguard for this class, and for a person carrying one mitochondrial change it does not work — the hearing can go after a single ordinary dose at a normal level.
What this drug connects to
The genes involved
Avoid in a carrier of m.1555A>G unless the infection is life-threatening and no safe alternative exists. Hearing loss can follow a single standard dose at a therapeutic blood level, so monitoring drug levels does not protect this person — which is the point most easily missed, because level monitoring is the usual safeguard for this class. The guideline covers the whole class rather than only the drugs a hospital reaches for most often: dibekacin, netilmicin, paromomycin and ribostamycin carry the same warning as gentamicin.
CPIC Guideline for the Use of Aminoglycosides Based on MT-RNR1 Genotype (Clin Pharmacol Ther 2022, PMID 34032273).
Whose work this rests on
Every guideline above was written by people. Named here because they are contributors to this page in the same sense anybody else on this site is.
Questions about Aminoglycosides
What are aminoglycosides?
Aminoglycosides (amikacin, gentamicin, tobramycin and related antibiotics) are a class where a single mitochondrial variant, m.1555A>G, can cause permanent hearing loss after just one standard dose.
Does the MT-RNR1 m.1555A>G variant mean I can’t take aminoglycosides?
The guidance is to avoid them unless the infection is life-threatening and no safe alternative exists — hearing loss can follow a single standard dose at a therapeutic blood level in a carrier.
Doesn’t monitoring blood levels protect against m.1555A>G-related hearing loss?
No, and that’s the point most easily missed — level monitoring is the usual safeguard for aminoglycosides, but it doesn’t work here, because the harm occurs at a normal, therapeutic blood level rather than an excessive one.
Does the MT-RNR1 warning apply to every aminoglycoside, or just the common ones?
The whole class. Dibekacin, netilmicin, paromomycin and ribostamycin — drugs a hospital might reach for less often — carry the same warning as gentamicin and amikacin.
Quoting this page
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Aminoglycosides. MyGeneLog™. https://www.mygenelog.com/drugs/aminoglycosides