Amikacin Inhalation: MAC Lung Infection, How to Use, Side Effects
Last updated September 7, 2026.
**Amikacin liposome inhalation suspension (brand name ARIKAYCE) is an inhaled aminoglycoside antibacterial that you breathe in through a nebulizer rather than take by mouth.** The amikacin is packaged inside tiny fat bubbles called liposomes, which helps the drug reach the lung tissue and the immune cells where slow-growing mycobacteria hide, and it kills the bacteria by blocking their ability to build proteins. It carries a boxed warning that inhaling it can trigger serious breathing problems, including inflammation deep in the lungs, wheezing, coughing up blood, and flares of existing lung disease. It is always used together with other antibacterial drugs, never on its own.
What does it treat?
Amikacin liposome inhalation is approved for adults with Mycobacterium avium complex (MAC) lung disease, a slow-growing nontuberculous mycobacterial infection that usually shows up as months of cough, sputum, fatigue, weight loss, low-grade fevers, night sweats, and sometimes streaks of blood in the sputum, often in people who already have bronchiectasis or chronic obstructive pulmonary disease. It is specifically for a narrow group: people who have already taken a multidrug background regimen for at least 6 straight months and whose sputum cultures still grow MAC. It is approved through a limited population pathway and under accelerated approval, which means it was cleared based on how many people cleared their sputum cultures rather than on long-term outcomes. It is not a rescue inhaler, not a treatment for ordinary pneumonia or bronchitis, and it does not replace the background regimen, which typically includes drugs such as azithromycin, ethambutol, and a rifamycin taken by mouth.
How do you take it?
It comes as a single-use vial of white liquid suspension, 590 mg in 8.4 mL, and the adult dose is one full vial inhaled once a day, every day, using only the Lamira Nebulizer System. No other nebulizer works with it, and nothing else should be mixed into the medication cup. Store vials in the refrigerator, take one out ahead of time and let it come to room temperature, then shake it well until the liquid looks uniform and milky before pouring it in. If you use a bronchodilator, use it before your amikacin dose, and if you use several inhaled treatments, take amikacin last. Food rules do not apply because you do not swallow it, but rinsing your mouth and sipping water afterward helps with hoarseness and throat irritation. If you miss a day, skip it and take your next dose the following day at the usual time, never two doses in one day. Your doctor will check sputum cultures along the way and will stop the drug if cultures still grow MAC after 6 months of treatment; if your cultures do turn negative, treatment usually continues for 12 more months. Stop dosing and call your doctor the same day if you get new or worse shortness of breath, wheezing that does not settle, fever with worsening cough, new hearing loss or ringing in the ears, dizziness or unsteadiness, or you cough up more blood than usual.
Side effects to know
- Common: Most people get some hoarseness or voice change, cough, sore or irritated throat, and muscle or joint aches, and diarrhea, nausea, tiredness, and mild shortness of breath are also common, especially in the first weeks.
- Serious: Stop the dose and get medical help for hypersensitivity pneumonitis (rising shortness of breath, fever, and cough that keeps building over days), severe bronchospasm or wheezing, or coughing up blood. Also call promptly for new hearing loss, ringing in the ears, balance trouble or spinning dizziness, dark or greatly reduced urine, marked muscle weakness, or a rash with facial and throat swelling.
Who should not take it?
This drug is for adults only; safety in people under 18 has not been established. Tell your doctor before starting if you have hearing loss, tinnitus, balance or inner ear problems, kidney disease, myasthenia gravis or another neuromuscular disorder, or asthma or COPD with frequent flares, since amikacin can worsen all of these. It should be avoided or used with close monitoring alongside other medicines that damage hearing or kidneys, including injected aminoglycosides such as gentamicin or tobramycin, loop diuretics such as furosemide, vancomycin, colistin and polymyxin B, amphotericin B, cisplatin, and cyclosporine, and it can deepen the effect of muscle relaxants used in surgery. Aminoglycosides cross the placenta and have caused permanent deafness in children exposed before birth, so tell your doctor if you are pregnant or could become pregnant and use effective contraception during treatment as advised. Because of the risk of hearing and kidney effects in an infant, breastfeeding is generally not recommended while you are taking it; discuss this with your doctor. Alcohol has no direct interaction with amikacin, but heavy drinking makes chronic lung infection and nutrition harder to manage, so keep intake low or skip it.
When is it an emergency?
Call 911 for sudden severe shortness of breath, gasping or noisy breathing at rest, chest tightness with wheezing you cannot break, coughing up a large amount of blood, fainting or collapse, or swelling of the lips, tongue, or throat with hives, which points to anaphylaxis. Call 911 also for sudden severe muscle weakness or trouble breathing after surgery or anesthesia, which can signal neuromuscular blockade. If someone swallows the suspension, uses far more than one vial, or a child gets into it, call Poison Control at 1-800-222-1222 right away, and watch for hearing loss, ringing in the ears, spinning dizziness, and a sharp drop in urine output, which are the signs of aminoglycoside overexposure. Same-day in-person care, not a message, is right for a fever with worsening cough and breathlessness over a few days, since that pattern can mean hypersensitivity pneumonitis or an infection flare.
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Common questions
What is the maximum dose of amikacin inhalation I can use in a day?
One vial, 590 mg in 8.4 mL, once every 24 hours is the entire daily dose for adults. There is no higher dose on the label and no second dose for a bad day. If you miss a day, skip it and go back to your normal schedule the next day rather than doubling up. Using more than one vial in a day raises your risk of hearing loss and kidney injury without adding benefit. If you accidentally take an extra dose, call your doctor or Poison Control at 1-800-222-1222.
Can I drink alcohol while using amikacin inhalation?
There is no listed interaction between alcohol and inhaled amikacin, so a drink will not change how the medicine works. The bigger issue is that MAC lung disease treatment runs for a year or longer and depends on good nutrition, sleep, and a strong cough. Heavy drinking works against all three and often worsens reflux and aspiration, which feed lung infection. Many people on this regimen also take rifampin or azithromycin by mouth, which put their own load on the liver. Keep alcohol light or skip it, and tell your doctor honestly how much you drink so liver monitoring can be set correctly.
Is amikacin inhalation safe in pregnancy or while breastfeeding?
Aminoglycosides cross the placenta, and systemic use during pregnancy has caused permanent bilateral deafness in exposed children, so the label warns that this drug can harm a developing baby. Tell your doctor if you are pregnant, think you might be, or are planning a pregnancy, and use reliable contraception during treatment unless your doctor says otherwise. If you become pregnant while taking it, do not just stop on your own; call the same day so the whole regimen can be reweighed. Breastfeeding is generally not recommended during treatment because of the potential for hearing and kidney effects in a nursing infant. Your doctor can help you weigh feeding options against the need to keep treating the infection.
Do I take it with food, and does it matter what time of day?
Food rules do not apply, because you inhale this drug instead of swallowing it, and it never reaches your stomach in a meaningful amount. Pick a time you can hold to every single day, since consistency matters more than the clock hour. If you use a bronchodilator, take it before your amikacin session, and if you have several inhaled treatments plus airway clearance, do amikacin last. Take the vial out of the refrigerator early enough to reach room temperature and shake it until the liquid looks even. Rinse your mouth and drink some water afterward to cut down hoarseness and throat irritation.
What are the signs I am getting too much or reacting badly?
The two organ systems to watch are your ears and your kidneys. New ringing in the ears, muffled or reduced hearing, a spinning sensation, or feeling unsteady on your feet all mean you should stop and call your doctor rather than push through. Kidney trouble shows up as much less urine, dark urine, swelling in the ankles, or new nausea and confusion. The lung side is different: shortness of breath that climbs over days along with fever and cough can mean hypersensitivity pneumonitis, and severe wheezing or coughing up blood needs urgent care. For a swallowed dose or any suspected overdose, call Poison Control at 1-800-222-1222, and call 911 for collapse or serious trouble breathing.
Which other medicines interact with amikacin inhalation?
The main conflicts are other drugs that damage hearing or kidneys, because their effects stack with amikacin. That list includes injected aminoglycosides such as gentamicin and tobramycin, loop diuretics such as furosemide, vancomycin, colistin and polymyxin B, amphotericin B, cisplatin, and cyclosporine. Amikacin can also intensify neuromuscular blocking agents used during anesthesia, so tell any surgeon or anesthesiologist that you are on it. It does not replace your oral MAC regimen, and drugs like azithromycin, ethambutol, and rifampin continue alongside it. Bring a full list of your prescriptions, over-the-counter products, and supplements to every visit so interactions can be checked before they cause trouble.