Patients treated with aminoglycosides should be under close clinical observation because of the potential toxicity associated with their use. Nephrotoxicity with netilmicin has been mild. However, as with other aminoglycosides, renal function should be closely monitored during therapy. The risk of nephrotoxicity is greater in patients with impaired renal function, in those who receive high dosage or prolonged therapy and in the elderly.
Although ototoxicity with netilmicin has been infrequent and appears to be milder than with other aminoglycosides, hearing loss and vestibular dysfunction can occur, primarily in patients with preexisting renal damage and in patients with normal renal function treated with higher doses and/or for longer periods than recommended.
Warning to Metabisulfite; Following oral ingestion, sodium metabisulfite is oxidized to sulfate and is excreted in the urine. Ingestion may result in gastric irritation to liberation of sulfurous acid while ingestion of large amounts of sodium metabisulfite can cause gastrointestinal upsets, circulatory failure and central nervous system disturbances.