Furosemide × Gentamicin

Gentamicin (an aminoglycoside) is directly oto- and nephrotoxic. Furosemide can also damage the cochlea and reduces renal perfusion via volume depletion. Effects are additive – irreversible sensorineural hearing loss and acute kidney injury have been reported.

Tinnitus, hearing loss, vertigo. Severe cases progress to deafness that does not recover after withdrawal. In parallel: reduced urine output, rising creatinine.

Avoid the combination. If unavoidable, use the minimum effective furosemide dose with daily creatinine and hearing checks (audiometry where possible). Dose gentamicin once daily by weight and renal function, with protocol-driven level monitoring.