Editing Gentamicin (section)

==Adverse effects==
Adverse effects of gentamicin can range from less severe reactions, such as nausea and vomiting, to more severe reactions including:<ref name="Baxter Corporation" />
* Low blood cell counts
* [[Hypersensitivity|Allergic reactions]] 
* [[Neuromuscular disease|Neuromuscular]] problems
* [[neuropathy|Nerve damage]] (neuropathy)
* [[Nephrotoxicity|Kidney damage]] (nephrotoxicity)
* [[Ototoxicity|Ear disorders]] (ototoxicity)
[[Nephrotoxicity]] and [[ototoxicity]] are thought to be dose related with higher doses causing greater chance of toxicity.<ref name="Baxter Corporation" /> These two toxicities may have delayed presentation, sometimes not appearing until after completing treatment.<ref name="Baxter Corporation" />

===Kidney damage===
[[Nephrotoxicity|Kidney damage]] is a problem in 10–25% of people who receive aminoglycosides, and gentamicin is one of the most nephrotoxic drugs of this class.<ref name="Lopez-Novoa_2011" /> Oftentimes, acute nephrotoxicity is reversible, but it may be fatal.<ref name="Baxter Corporation" /> The risk of nephrotoxicity can be affected by the dose, frequency, duration of therapy, and concurrent use of certain medications, such as [[Nonsteroidal anti-inflammatory drug|NSAIDs]], [[diuretics]], [[cisplatin]], [[ciclosporin]], [[cephalosporins]], [[amphotericin]], [[Iodinated contrast|iodide contrast media]], and [[vancomycin]].<ref name="Lopez-Novoa_2011" />

Factors that increase risk of nephrotoxicity include:<ref name="Lopez-Novoa_2011" />
* Increased age
* Reduced [[renal function]]
* Pregnancy
* [[Hypothyroidism]]
* Hepatic dysfunction
* Volume depletion
* [[Metabolic acidosis]]
* Sodium depletion
Kidney dysfunction is monitored by measuring [[creatinine]] in the blood, electrolyte levels, [[Oliguria|urine output]], [[Proteinuria|presence of protein in the urine]],  and concentrations of other chemicals, such as urea, in the blood.<ref name="Lopez-Novoa_2011">{{cite journal | vauthors = Lopez-Novoa JM, Quiros Y, Vicente L, Morales AI, Lopez-Hernandez FJ | title = New insights into the mechanism of aminoglycoside nephrotoxicity: an integrative point of view | journal = Kidney International | volume = 79 | issue = 1 | pages = 33–45 | date = January 2011 | pmid = 20861826 | doi = 10.1038/ki.2010.337 | doi-access = free }}</ref>

===Inner ear===
About 11% of the population who receives aminoglycosides experience damage to their [[inner ear]].<ref>{{cite journal | vauthors = East JE, Foweraker JE, Murgatroyd FD | title = Gentamicin induced ototoxicity during treatment of enterococcal endocarditis: resolution with substitution by netilmicin | journal = Heart | volume = 91 | issue = 5 | pages = e32 | date = May 2005 | pmid = 15831617 | pmc = 1768868 | doi = 10.1136/hrt.2003.028308 }}</ref> The common symptoms of inner ear damage include [[tinnitus]], hearing loss, [[vertigo]], [[ataxia|trouble with coordination]], and dizziness.<ref name="Selimoglu_2007" /> Chronic use of gentamicin can affect two areas of the ears. First, damage of the inner ear hair cells can result in irreversible hearing loss. Second, damage to the inner ear [[Vestibular system|vestibular]] apparatus can lead to balance problems.<ref name="Selimoglu_2007">{{cite journal | vauthors = Selimoglu E | title = Aminoglycoside-induced ototoxicity | journal = Current Pharmaceutical Design | volume = 13 | issue = 1 | pages = 119–126 | date = 1 January 2007 | pmid = 17266591 | doi = 10.2174/138161207779313731 }}</ref> To reduce the risk of ototoxicity during treatment, it is recommended to stay hydrated.<ref name="Baxter Corporation" />

Factors that increase the risk of inner ear damage include:<ref name="Baxter Corporation" /><ref name="Product Monograph" />
* Increased age
* [[Uremia|High blood uric acid levels]]
* Kidney dysfunction
* Liver dysfunction 
* Higher doses 
* Long courses of therapy
* Also taking strong diuretics (e.g., [[furosemide]])