Synergistic with ampicillin, benzylpenicillin and other ?-lactam antibiotics. Increased risk of severe respiratory depression when used concurrently with anaesthetics or opioids. May reduce renal clearance of zalcitabine and induce hypocalcaemia when used with biphosphonates. Not to be used with agalsidase alfa or beta as it may inhibit alpha-galactosidase activity. Potentially Fatal: Increased incidence of ototoxicity when combined with ethacrynic acid and furosemide. Cephalosporins, ciclosporin, cisplatin, vancomycin, hydrocortisone and indometacin potentiate nephrotoxicity. Potentiates neuromuscular blocking agents.