Neomycin Sulfate
Pronouncation: (NEE-oh-MY-sin SULL-fate)
Class: Aminoglycoside
Trade Names:
Neomycin Sulfate
- Tablets 500 mg
Trade Names:
Neo-fradin
- Oral solution 125 mg per 5 mL
Mechanism of Action
Pharmacology
Inhibits production of protein in bacteria, causing bacterial cell death.
Pharmacokinetics
Absorption
Poorly absorbed from the GI tract (3%).
Distribution
Small amount absorbed is rapidly distributed to the tissues. Removed by dialysis.
Elimination
Small fraction absorbed is eliminated by the kidney. The unabsorbed portion (97%) is eliminated unchanged in the feces.
Indications and Usage
As adjunctive treatment for suppression of normal bacterial flora of the bowel (tablet); as adjunctive therapy in hepatic coma to reduce ammonia-forming bacteria in the intestinal tract (tablet and solution).
Contraindications
Patients with intestinal obstruction; inflammatory or ulcerative GI disease; history of sensitivity to aminoglycosides or any component of the product.
Dosage and Administration
Hepatic Coma
Adults
PO 4 to 12 g/day in divided doses. Treatment should be continued over a period of 5 to 6 days.
Preoperative Prophylaxis
Adults
PO As part of a bowel preparation regimen, 1 g of neomycin and 1 g of erythromycin are given orally on pre-op day 1 at 1 PM, 2 PM, and 11 PM.
General Advice
- Administer without regard to meals. Administer with food if GI upset occurs.
Storage/Stability
Store tablets at controlled room temperature (68° to 77°F). Store oral solution at controlled room temperature (59° to 86°F).
Drug Interactions
Aminoglycosides, polymyxins, neurotoxic or nephrotoxic agents
Neomycin ototoxicity or nephrotoxicity may be enhanced.
Anticoagulants (eg, warfarin)
May increase the anticoagulant effects by decreasing vitamin K availability.
Digoxin, fluorouracil, methotrexate, penicillin V, vitamin B-12
Intestinal absorption of these agents may be inhibited by neomycin.
Potent diuretics (eg, ethacrynic acid, furosemide)
When administered IV, diuretics may enhance neomycin toxicity by altering the concentration in serum and tissue.
Laboratory Test Interactions
None well documented.
Adverse Reactions
EENT
Ototoxicity.
GI
Nausea; vomiting; diarrhea.
Genitourinary
Nephrotoxicity.
Metabolic
Malabsorption syndrome.
Musculoskeletal
Neuromuscular blockade.
Precautions
Warnings
Systemic absorption of neomycin occurs after oral administration, and toxic reactions may occur (eg, ototoxicity, nephrotoxicity). Neuromuscular blockade and respiratory paralysis have been reported. The risk of toxicity may be increased by dehydration or advanced age.
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Pregnancy
Category D .
Lactation
Undetermined.
Children
Safety and efficacy not established.
Renal Function
If renal insufficiency develops during oral therapy, consider reducing the neomycin dose or discontinuing therapy.
Special Risk Patients
Use with caution in patients with muscular disorders (eg, myasthenia gravis, parkinsonism) because neomycin may aggravate muscle weakness.
Superinfection
Prolonged or repeated use may result in bacterial or fungal overgrowth of nonsusceptible organisms and secondary infections.
Bile acid
Bile acid fecal excretion may be increased.
Hearing loss
Risk may continue after drug withdrawal.
Lactase
Intestinal lactase activity may be reduced.
Malabsorption syndrome
Oral neomycin (12 g/day) produces malabsorption of a variety of substances including fat, nitrogen, cholesterol, carotene, glucose, xylose, lactose, sodium, calcium, cyanocobalamin, and iron.
Overdosage
Symptoms
Neurotoxicity, ototoxicity, nephrotoxicity.
Patient Information
- Explain name, dose, action, and potential side effects of drug.
- Review dosing schedule and prescribed length of therapy with patient.
- Advise patient to take each dose without regard to meals but to take with food if stomach upset occurs.
- Remind patient to complete entire course of therapy.
- Caution patient not to change the dose or discontinue therapy unless advised by health care provider.
- Warn patient that diarrhea containing blood or pus may be a sign of a serious disorder and to seek medical care if noted and not treat at home.
- Advise patient to contact health care provider immediately if experiencing ringing in the ears, hearing loss, vestibular symptoms (eg, dizziness, incoordination), severe diarrhea, muscle twitching, numbness, skin tingling, or loose, foul-smelling stools.
- Advise women to notify health care provider if pregnant, planning to become pregnant, or breastfeeding.
- Instruct patient not to take any prescription or OTC medications, dietary supplements, or herbal preparations unless advised by health care provider.
- Advise patient that follow-up examinations and lab tests will be required to monitor therapy and to keep appointments.
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