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Blood Test Tracker

Amikacin (Peak)

Shows how high the antibiotic amikacin gets in your blood soon after a dose, to help keep treatment effective and safe.

AI-verified against cited sources. Awaiting expert reviewLOINC 3319-1

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What it is

Amikacin is an antibiotic given by injection or IV drip for serious infections, including some that resist other antibiotics. A peak level is drawn shortly after a dose, when the drug is at its highest in the blood. Your care team uses it along with the trough level (the lowest level, just before the next dose) to adjust the dose for you.

Why it matters

Amikacin can harm the kidneys and the inner ear, which controls hearing and balance. Hearing damage can be permanent and may not cause warning symptoms during treatment. Peak and trough levels help your team balance fighting the infection against those risks.

If it’s low

A low peak can mean the dose is not reaching the level your team is aiming for. The right target depends on the infection and the dosing schedule, so a low number is a reason to review the plan, not a verdict.

Common causes

  • A dose that is small for your body size
  • Faster-than-usual clearance or a larger volume of body fluid, for example with fluid overload, burns or cystic fibrosis
  • A sample drawn later after the dose than intended

What can help

  • Ask your care team whether the timing of the sample matched the plan
  • Ask whether the dose or schedule should be reviewed

If it’s high

A peak above about 35 mcg/mL is higher than the FDA label recommends for usual dosing. High peaks held for a long time are linked to a greater chance of hearing, balance and kidney problems. Some treatments, such as those for certain mycobacterial infections, aim for higher peaks on purpose, so your team's goal matters more than a generic number.

Common causes

  • A dose that is large for how well the kidneys are clearing the drug
  • A sample drawn earlier after the dose than your protocol calls for
  • A sample drawn from the same line used for the infusion
  • A dose chosen on purpose to reach a higher target

What can help

  • Tell your care team right away about new hearing loss, ringing in the ears, dizziness, numbness or much less urine
  • Ask whether your kidney function is being checked during treatment
  • Ask your care team whether staying well hydrated is right for you while you are on this medicine

Usual ranges

What labs print as the reference range, by who was tested. Ranges differ a little between labs, so the range on your own report is the one your result is judged against.

For adults: up to 35 mcg/mL. Source: U.S. FDA label via NLM DailyMed (Hikma Pharmaceuticals), BMC Infectious Diseases, Journal of Pharmaceutical Health Care and Sciences.

What can affect your result

  • Kidney function, because amikacin leaves the body almost entirely through the kidneys
  • Exactly when the sample was drawn compared with the dose and the end of the infusion
  • Body weight, age and how much fluid the body is holding
  • Dosing schedule: several smaller doses a day or one larger daily dose
  • Other medicines that can also stress the kidneys or ears, such as strong water pills (loop diuretics) or other aminoglycosides
  • Drawing from the same line or arm that was used for the infusion can contaminate the sample and give a falsely high result.
  • Penicillin- and cephalosporin-type antibiotics can slowly inactivate amikacin in a collected blood sample that sits before testing, which can lower the measured result (FDA label). Labs handle such samples promptly, freeze them or treat them.
  • A sample drawn at the wrong time relative to the dose cannot be compared with a peak target.

Timed from the dose, not the clock: 30 to 90 minutes after an injection per the drug label. Hospitals set their own timing for IV infusions. Each dose produces its own peak. Kidneys clear almost all of the drug unchanged, so levels depend heavily on kidney function.

When to talk to a clinician

Tell your care team right away about new hearing loss, ringing in the ears, dizziness or loss of balance, numbness or tingling, muscle twitching, or a big drop in urine. Do not wait for the next scheduled blood draw.

Questions you could ask

  • When will the trough be drawn, and when will you review the results with me?
  • What symptoms should I report right away while I am on this medicine?
  • Is my kidney function being checked during treatment?
  • Should my hearing or balance be checked?
  • Is this peak where you wanted it for my type of infection?
  • Does the dose or schedule need another look?

Questions people ask

Why are amikacin targets different from gentamicin or tobramycin?

Amikacin is given in larger doses, so its peaks run higher. The FDA label for amikacin says to avoid peaks above 35 mcg/mL and troughs above 10 mcg/mL. Targets for the other two drugs should not be applied to it.

Why does the exact time of my blood draw matter?

The level rises quickly after a dose and then falls. A sample drawn a bit early or late can look very different from the true peak, so the draw time is written down and used to read the result.

How do I convert mcg/mL to µmol/L?

Multiply mcg/mL (the same as mg/L) by 1.71. For example, 35 mcg/mL is about 60 µmol/L.

Show the science and sources

Units

  • 1 mcg/mL = 1 mcg/mL
  • 1 mcg/mL = 1 mg/L
  • 1 mcg/mL = 1.708 µmol/L

Open the Amikacin peak unit converter

For clinicians and researchers

Amikacin is an aminoglycoside with concentration-dependent bactericidal activity, so peak concentration relative to the organism's MIC drives efficacy, while sustained high troughs drive nephrotoxicity and ototoxicity. The FDA label advises avoiding peaks above 35 mcg/mL (30 to 90 minutes after injection) and troughs above 10 mcg/mL, and notes that ototoxicity risk rises with exposure to either high peaks or high troughs and may be irreversible and silent during therapy. After intramuscular doses of 3.7, 5 and 7.5 mg/kg the label reports mean peaks of about 12, 16 and 21 mcg/mL at 1 hour, with about 98% excreted unchanged in urine within 24 hours when renal function is normal. Peak targets are higher than for gentamicin or tobramycin and should not be shared with them. Extended-interval (once-daily) regimens aim for high peaks with long drug-free troughs, and LOINC has separate codes for post extended-interval samples. Treatment-specific goals exist (for example, higher peaks in mycobacterial infections), and critically ill, burned, cystic fibrosis and neonatal patients have altered volume of distribution and clearance. Immunoassay and LC-MS/MS methods are used. Conversion: 1 mcg/mL = 1 mg/L = 1.71 µmol/L (free base, MW 585.6).

LOINC 3319-1 (primary), 50802-8, 31097-9. Specimen: serum-or-plasma.

Sources

  1. Amikacin Sulfate Injection prescribing information (Dosage and Administration, Boxed Warning, Clinical Pharmacology), U.S. FDA label via NLM DailyMed (Hikma Pharmaceuticals) (2024)
  2. Therapeutic drug monitoring of amikacin in Chinese premature infant: a population pharmacokinetic analysis and dosage optimization, BMC Infectious Diseases (2025)
  3. Therapeutic drug monitoring of intravenous amikacin during peritoneal dialysis for Mycobacterium abscessus exit-site infection: a case report, Journal of Pharmaceutical Health Care and Sciences (2026)
  4. Amikacin (PubChem CID 37768), PubChem, National Library of Medicine

AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-03. How we build and check these pages.

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