Arikayce
Arikayce, the brand name for inhaled amikacin, belongs to the aminoglycoside antibiotic drug class. It's used to treat Mycobacterium avium complex (MAC) lung infections in people who've already tried other antibiotics for 6 months. This medication works by stopping the bacteria from making proteins that they need to survive. Arikayce (amikacin) is given as an inhalation through the mouth using the Lamira® Nebulizer System once per day. Side effects include changes in your voice, cough, and wheezing or shortness of breath.
What is Arikayce (amikacin)?
What is Arikayce (amikacin) used for?
Treatment of Mycobacterium avium complex (MAC) lung disease in adults who haven't cleared the bacteria after taking multiple antibiotics for at least 6 months
How Arikayce (amikacin) works
Arikayce (amikacin) is an aminoglycoside antibiotic. It works by preventing bacteria from making certain proteins. As a result, the bacteria can't survive and can't spread throughout your body.
Drug Facts
What are the side effects of Arikayce (amikacin)?
Common Side Effects
- Hoarse voice (48%)
- Cough (40%)
- Tight airways, leading to shortness of breath (29%)
- Coughing up blood (18%)
- Pain in the muscles or bones (18%)
- Upper throat irritation (18%)
- Ear damage (e.g., ringing in the ears, hearing loss; 17%)
- Feeling weak or having low energy (16%)
- Worsening of lung disease (15%)
- Diarrhea (13%)
- Nausea (12%)
- Headache (10%)
Other Side Effects
- Fever
- Weight loss
- Vomiting
- Chest discomfort
Serious Side Effects
- Serious allergic reactions: hives, itching, swelling of face or tongue, difficulty breathing
- Bronchospasm (narrowing of your airways): difficulty breathing, wheezing, chest pain or tightness, fatigue, cough
- Hearing loss
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Coughing up blood
- Dry cough, shortness of breath or trouble breathing
- Hearing loss, ringing in ears
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Wheezing or trouble breathing
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Change in voice, hoarseness
- Cough
- Diarrhea
- Headache
- Nausea
- Sore throat
Pros and cons of Arikayce (amikacin)
Pros
Can help clear MAC lung disease for several months when added to usual treatment
Once-a-day dosing
Can use in people with liver or kidney problems (with careful monitoring)
Available as an inhalation, which can be a good option for people who have difficulty swallowing pills
Cons
Only for people who didn't have success from taking multiple antibiotics for at least 6 months
Each inhalation takes up to 20 minutes
Nebulizer can be tricky to use for some people
Has risk for ear damage
Not studied in children
Pharmacist tips for Arikayce (amikacin)
It can take about 1 to 4 months for Arikayce (amikacin) to clear the bacteria from your body. Make sure to take the medication exactly as prescribed and continue your treatment course, even if you're feeling better. Stopping the medication earlier than prescribed can make your infection come back and become harder to treat.
Mark your appointments in your calendar for any follow-up visits with your care team and for any lab tests. This will help make sure your treatment with Arikayce (amikacin) is going well and that the medication is as safe as possible for you.
If you forget to take your Arikayce (amikacin) dose, just take your next scheduled dose the next day. Don't double your dose to make up for the missed dose or use more than 1 vial in a day.
Let your care team know if you have other breathing problems, like asthma or COPD. You might be prescribed albuterol (ProAir, Ventolin) or levalbuterol (Xopenex) to use before you take your dose of Arikayce (amikacin). They'll help relax and open up your airways and lower your chance that you'll have difficulty breathing from Arikayce (amikacin).
Tips for using Arikayce (amikacin) at home (if instructed by your care team):
Your care team will train you on how to use the Lamira® Nebulizer System to take your dose of Arikayce (amikacin). Make sure you know how to properly prepare the nebulizer and inhale the medication so your treatment works as best that it can.
Carefully read the directions on how to use the Lamira® Nebulizer System to take Arikayce (amikacin). Call the medical office or your pharmacist if you have any questions. You can also call Arikares Support at 1-833-274-5273 for more assistance.
Keep Arikayce (amikacin) vials in the refrigerator. If you're traveling and don't have access to a refrigerator, you can keep the vials at room temperature for up to 28 days. Don't use Arikayce (amikacin) if it's been at room temperature for longer than 28 days.
When it's time for your dose, take the Arikayce (amikacin) vial(s) out of the refrigerator and let it reach room temperature. This will take at least 45 minutes. Don't try to warm up the medication in any other way (e.g., microwave, heat pad), otherwise you might damage it.
Once it's at room temperature, shake the Arikayce (amikacin) vial well for 10 to 15 seconds. Then, open the vial and pour the medication into the nebulizer. Don't mix Arikayce (amikacin) with other medications in your nebulizer.
Turn on the nebulizer machine, and breathe in and out normally until your treatment is complete. It'll take about 14 to 20 minutes to inhale the full dose of Arikayce (amikacin).
Only prepare your Arikayce (amikacin) dose when you're ready to take your medication because it needs to be inhaled right after you add it into the nebulizer. If you're not ready to use the medication you've prepared, you'll need to throw the dose away and prepare a new dose.
Make sure to clean your nebulizer before you use it for the first time and after each use. This helps lower your risk for other infections from germs that come from using dirty equipment.
Frequently asked questions about Arikayce (amikacin)
How to save using GoodRx
What are the risks and warnings for Arikayce (amikacin)?
Arikayce (amikacin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Allergic reaction in the lungs (hypersensitivity pneumonitis)
In clinical trials, some people reported having an allergic reaction called hypersensitivity pneumonitis while they used Arikayce (amikacin). Symptoms include cough, shortness of breath, chest pain, weight loss, and abnormal sounds when you breathe. Let your care team know if you have any of these symptoms. You might need to stop taking Arikayce (amikacin) and start treatment for this condition.
Coughing up blood
In clinical trials, some people who took Arikayce (amikacin) coughed up blood, which can be concerning. Get medical help right away if you notice blood when you cough.
Difficulty breathing
Risk factors: History of lung problems (e.g., asthma, COPD)
Inhaled medications, including Arikayce (amikacin), can cause bronchospasm, or a muscle spasm in your lungs. This can cause your airways to tighten and lead to difficulty breathing, wheezing, cough, or chest discomfort. Get medical help right away if you become short of breath after you use Arikayce (amikacin).
Tell your care team if you have a history of lung problems such as asthma or chronic obstructive pulmonary disease (COPD). They might prescribe a bronchodilator like albuterol (ProAir, Ventolin) or levalbuterol (Xopenex) for you to use before your dose of Arikayce (amikacin) to help you breathe easier.
Serious allergic reactions
Rarely, Arikayce (amikacin) can cause serious allergic reactions, including those that are life-threatening. Get medical help right away if you experience hives, difficulty breathing, dizziness, swelling in your face or throat, or other signs of anaphylaxis.
Ear damage
Risk factors: History of hearing problems, including difficulty with hearing | History of balance problems | Taking other medications that cause hearing loss
Arikayce (amikacin) can cause ringing in the ears or sometimes even permanent partial or total hearing loss. Your risk is higher if you're also taking other medications that can cause hearing loss, such as water pills (e.g., furosemide (Lasix)). Depending on how long you need treatment with Arikayce (amikacin), you might need to get hearing tests done regularly while you're taking the medication. Seek medical help right away or contact your care team if you notice changes in your hearing (e.g., ringing in the ears), feel dizzy, or feel off balance.
Kidney injury
Risk factors: Kidney problems | Taking other medications that can cause kidney injury
Aminoglycoside antibiotics, like Arikayce (amikacin), can raise your risk for kidney injury. Your care team might check your blood work to make sure your kidneys are okay while you're taking this medication if you already have kidney problems. Let your care team know if you're making less urine than normal or if you notice fluid buildup in your legs and feet, since these are potential signs of kidney injury.
Muscle weakness
Risk factors: Myasthenia gravis | Other neuromuscular conditions
Aminoglycoside antibiotics, like Arikayce (amikacin), might cause muscle weakness, especially in people who have neuromuscular conditions, like myasthenia gravis. In severe cases, this can be paralyzing and affect your ability to breathe. Let your care team know right away if you have any kind of muscle weakness while you're taking this medication.
Harm to unborn babies
Aminoglycoside antibiotics, like Arikayce (amikacin), can cause harm to your unborn baby if you take them while pregnant. There isn't enough information to know whether Arikayce (amikacin) specifically can cause harm during pregnancy. And it might not be as likely to happen with Arikayce (amikacin) because the medication mostly stays in the lungs. But it's important to be aware of this risk because there are reports of deafness in unborn babies with other forms of aminoglycoside antibiotics (e.g., injection). Talk to your care team about the risks and benefits of using Arikayce (amikacin) if you're pregnant or plan to become pregnant.
Arikayce (amikacin) dosage forms
Typical dosing for Arikayce (amikacin)
The typical dose is 1 vial (590 mg) inhaled by mouth using a nebulizer device (Lamira® Nebulizer System) once per day.
Arikayce (amikacin) contraindications
Known allergy to other aminoglycoside antibiotics (e.g., tobramycin)
What are alternatives to Arikayce (amikacin)?
Treatment of Mycobacterium avium complex (MAC) lung disease in adults who haven't cleared the bacteria after taking multiple antibiotics for at least 6 months
Sudden worsening of chronic obstructive pulmonary disease (COPD) from a bacterial infection
Skin infections (e.g., cellulitis)
Urethra or cervix infections
Ear infections (ages 6 months and older)
Pneumonia (ages 6 months and older)
Strep throat (ages 2 years and older)
Tonsil infections (ages 2 years and older)
Prevention of Mycobacterium avium complex (MAC) disease in people with severe HIV infection
Get savings updates for Arikayce (amikacin)
Receive price alerts, news, and other messages from GoodRx about Arikayce (amikacin) and other healthcare topics and relevant savings offers.By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx.
References
Best studies we foundAlmadhoun, K., et al. (2023). Bronchodilators. StatPearls.
American Lung Association. (n.d.). MAC lung disease.
Bush, L. M. (2024). Pseudomonas infections. Merck Manual Consumer Version.
Griffith, D. E., et al. (2018). Amikacin liposome inhalation suspension for treatment-refractory lung disease caused by Mycobacterium avium complex (CONVERT). A prospective, open-label, randomized study. American Journal of Respiratory and Critical Care Medicine.
Hikma Pharmaceuticals USA Inc. (2024). Amikacin sulfate- amikacin sulfate injection [package insert]. DailyMed.
Insmed Incorporated. (2023). Arikayce- amikacin suspension [package insert]. DailyMed.
Mingeot-Leclercq, M. P., et al. (1999). Aminoglycosides: Nephrotoxicity. Antimicrobial Agents and Chemotherapy.
National Heart, Lung, and Blood Institute. (2022). Hypersensitivity pneumonitis.
PARI Pharma GmbH. (n.d.). Lamira® nebuliser system.
PARI Respiratory Equipment. (2021). Lamira® nebulizer system: Instructions for use.
Shirley, M. (2019). Amikacin liposome inhalation suspension: A review in Mycobacterium avium complex lung disease. Drugs.
Sockrider, M. (2020). Nebulizer breathing treatments at home. American Journal of Respiratory and Critical Care Medicine.
Browse medications
View AllResearch prescriptions and over-the-counter medications from A to Z, compare drug prices, and start saving.