Amikacin/KETOconazole/Triamcinolone Acetonide clEARmix Thermo Gel Otic (3mL Syringe)

How to Use clEARmix Thermo Gel Otic (Ear Medication)

This is a liquid ear medication that turns into a gel once it warms up in your pet’s ear, helping it stay in place and work effectively. It comes in a soft-tipped syringe for easy use.

Step-by-Step:

1. Keep it cool – Store in the fridge if instructed. Before using, hold the syringe in your hands for a minute so it’s not too cold, but don’t warm it too much.
2. Get your pet ready – Have them sit comfortably and gently lift the ear flap. A second person can help hold them still if needed.
3. Clean the ear (if advised) – Use a vet-approved ear cleaner and cotton ball. Wipe out any debris and let the ear dry.
4. Apply the medication – Take off the cap. Gently insert just the tip into the ear opening (not deep), and slowly press the plunger to deliver the full dose.
5. Massage the ear – Rub the base of the ear for 30 seconds. The liquid will turn into a gel as it warms, and massaging helps it spread inside the ear.
6. Let them shake it out – It’s normal! Wipe away any extra gel you see near the ear opening.
7. Reward your pet – Offer praise or a treat to keep the experience positive.
8. Store and clean up – Recap the syringe and refrigerate if needed. Wash your hands afterward.

This compounded formulation combines active ingredients from different drug classes: amikacin, an aminoglycoside antibiotic; ketoconazole, an azole antifungal; and triamcinolone acetonide, a corticosteroid. In compounding practice, clinicians may consider a multi-ingredient preparation like this to address more than one aspect of a patient's physiology at once. Your veterinarian determines whether it is appropriate based on your animal's diagnostic findings.

At a pharmacological level, this medication functions through three distinct pathways. Amikacin acts as a bactericidal antibiotic by irreversibly binding to the 30S subunit of the bacterial ribosome, which interferes with protein synthesis and leads to cell death. Ketoconazole interferes with the synthesis of ergosterol, a vital component of the fungal cell membrane, which increases membrane permeability and may help address the growth of fungal organisms. Triamcinolone acetonide, a glucocorticoid, acts by binding to intracellular receptors to inhibit the synthesis of inflammatory mediators, such as prostaglandins and leukotrienes. Together, these actions work through their separate mechanisms — the antibacterial components on their targets and the corticosteroid on localized inflammation such as redness, swelling and itching. Your veterinarian will determine the clinical appropriateness of this combination based on your pet's diagnostic findings and previous response to other prescriptions.

This description reflects the general pharmacology of the active ingredient's drug class; your veterinarian determines whether this approach is appropriate for your animal.

Prescription only. Use only under the direction of a licensed veterinarian. This information is not a substitute for veterinary diagnosis, prescribing or monitoring. Compounded drugs are not approved by the FDA for safety or effectiveness.

Commonly observed effects of amikacin/ketoconazole/triamcinolone acetonide administration are primarily localized, though owners should watch for increased redness or sensitivity at the application site. Because aminoglycosides like amikacin have been associated with ototoxicity (damage to hearing or balance) if they enter the middle ear, your veterinarian will evaluate the integrity of the eardrum before prescribing this for an ear infection. Additionally, prolonged use of corticosteroids can lead to localized skin thinning or systemic effects such as increased thirst and urination. Owners should monitor for any loss of balance, head tilting or unusual behavioral shifts and contact their veterinarian promptly if these occur.

This medication is typically used with extra caution or avoided in patients with a ruptured tympanic membrane (eardrum) or known hypersensitivity to any of the components. It is also carefully evaluated in pregnant or lactating animals, as systemic absorption of corticosteroids and certain antifungals can influence fetal development. Before starting a protocol, ensure your veterinarian has a complete history of all other medications your pet is receiving, as concurrent use of other steroids or aminoglycosides may increase the risk of adverse effects. Your veterinarian is the right person to provide guidance on the necessary duration of use and the proper application technique to ensure the management approach remains suitable for your pet's individual health status.