neomycin PO (Rx)

Brand and Other Names:Neo-Fradin, Myciguent, more...Mycifradin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 500mg

oral solution

  • 25mg/mL

Pre-Op Intestinal Antisepsis

1 g PO at 19, 18, and 9 hours pre-op OR

1 g PO q1hr for 4 doses, THEN 1 g q4hr to complete 24 hours of dosing OR

88 mg/kg/day divided PO q4hr for 2-3 days pre-op  

Maximum: Up to 12 grams 24 to 48 hours prior to surgery

Hepatic Encephalopathy

Acute: 4-12 g/day PO divided q6hr for 5-6 days OR 3-6 g/day for 1-2 weeks

Chronic: Up to 4 g/day PO

Diarrhea Caused by Enteropathogenic E.coli

3 g/day PO divided q6hr

Other Indications & Uses

Off-label: reduce LDL

Dosage Forms & Strengths

tablet

  • 500mg

oral solution

  • 25mg/mL

Neonates

Diarrhea, preterm & newborns: 50 mg/kg/day PO divided q6hr  

Children

Hepatic encephalopathy: 50-100 mg/kg/day PO divided q8hr for 5-6 days, no more than 12 g/24 hours  

Bowel prep: 90 mg/kg/day PO divided q4hr for 2-3 days

Diarrhea caused by enteropathogenic E.coli: 50mg/kg/day PO divided q6hr for 2-3days

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Interactions

Interaction Checker

and neomycin PO

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            Contraindicated (7)

            • amikacin

              amikacin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • amphotericin B deoxycholate

              amphotericin B deoxycholate and neomycin PO both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • cidofovir

              cidofovir and neomycin PO both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • contrast media (iodinated)

              contrast media (iodinated) and neomycin PO both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • ioversol

              ioversol and neomycin PO both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • tacrolimus

              neomycin PO and tacrolimus both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • teicoplanin

              neomycin PO and teicoplanin both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            Serious - Use Alternative (25)

            • acyclovir

              acyclovir and neomycin PO both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • atracurium

              neomycin PO increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • BCG vaccine live

              neomycin PO decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

            • bumetanide

              bumetanide, neomycin PO. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

            • capreomycin

              capreomycin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • cephaloridine

              cephaloridine and neomycin PO both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • cholera vaccine

              neomycin PO, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

            • cisatracurium

              neomycin PO increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • colistin

              colistin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • ethacrynic acid

              ethacrynic acid, neomycin PO. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

            • furosemide

              furosemide, neomycin PO. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

            • gentamicin

              gentamicin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • incobotulinumtoxinA

              neomycin PO increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • onabotulinumtoxinA

              neomycin PO increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • pancuronium

              neomycin PO increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • polymyxin B

              neomycin PO and polymyxin B both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • quinidine

              quinidine will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • rapacuronium

              neomycin PO increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • rimabotulinumtoxinB

              neomycin PO, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Anticholinergics may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • rocuronium

              neomycin PO increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • succinylcholine

              neomycin PO increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            • tobramycin

              neomycin PO and tobramycin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • torsemide

              torsemide, neomycin PO. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

            • typhoid vaccine live

              neomycin PO decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

            • vecuronium

              neomycin PO increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

            Monitor Closely (64)

            • abobotulinumtoxinA

              neomycin PO increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • adefovir

              adefovir and neomycin PO both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • amiodarone

              amiodarone will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • bazedoxifene/conjugated estrogens

              neomycin PO will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • carboplatin

              carboplatin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • cisplatin

              cisplatin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • clarithromycin

              clarithromycin will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • clotrimazole

              clotrimazole will decrease the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • conjugated estrogens

              neomycin PO will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • cyclosporine

              cyclosporine will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • digoxin

              neomycin PO will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              neomycin PO decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • dronedarone

              dronedarone will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              neomycin PO and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • erythromycin base

              erythromycin base will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • erythromycin lactobionate

              erythromycin lactobionate will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • erythromycin stearate

              erythromycin stearate will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • estradiol

              neomycin PO will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • estrogens conjugated synthetic

              neomycin PO will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • estropipate

              neomycin PO will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • ethinylestradiol

              neomycin PO will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • felodipine

              felodipine will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • foscarnet

              foscarnet and neomycin PO both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • indinavir

              indinavir will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • ketoconazole

              ketoconazole will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

              neomycin PO will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

            • loratadine

              loratadine will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • magnesium supplement

              magnesium supplement, neomycin PO. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Each enhance the neuromuscular blocking effect of the other; may have negative respiratory effects.

            • mestranol

              neomycin PO will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • methotrexate

              neomycin PO decreases levels of methotrexate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Neomycin may decrease intestinal absorption of methotrexate or interfere with enterohepatic circulation by inhibiting bowel flora and suppressing metabolism of the drug by bacteria.

            • methoxyflurane

              methoxyflurane and neomycin PO both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • nefazodone

              nefazodone will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • nicardipine

              nicardipine will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • nifedipine

              nifedipine will decrease the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • nilotinib

              nilotinib will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • oxaliplatin

              neomycin PO and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • paromomycin

              neomycin PO and paromomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • penicillin G aqueous

              neomycin PO decreases levels of penicillin G aqueous by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • penicillin VK

              neomycin PO decreases levels of penicillin VK by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • pentamidine

              neomycin PO and pentamidine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • peramivir

              neomycin PO increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

            • phenobarbital

              phenobarbital will decrease the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • phenytoin

              phenytoin will decrease the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • prabotulinumtoxinA

              neomycin PO increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • quercetin

              quercetin will decrease the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • rifampin

              rifampin will decrease the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • ritonavir

              ritonavir will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • sirolimus

              sirolimus will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • sodium picosulfate/magnesium oxide/anhydrous citric acid

              neomycin PO decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of neomycin PO by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of neomycin PO by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sorafenib

              neomycin PO decreases levels of sorafenib by unknown mechanism. Use Caution/Monitor. AUC decreased by 54% in healthy volunteers.

            • St John's Wort

              St John's Wort will decrease the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • streptomycin

              neomycin PO and streptomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • streptozocin

              neomycin PO and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • tacrolimus

              tacrolimus will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • tenofovir DF

              neomycin PO and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              neomycin PO increases levels of tenofovir DF by decreasing elimination. Use Caution/Monitor.

            • tobramycin inhaled

              tobramycin inhaled and neomycin PO both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

            • tolvaptan

              tolvaptan will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • trazodone

              trazodone will decrease the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • vancomycin

              neomycin PO and vancomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • verapamil

              verapamil will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • warfarin

              neomycin PO increases effects of warfarin by unknown mechanism. Use Caution/Monitor.

            Minor (64)

            • aceclofenac

              aceclofenac increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • acemetacin

              acemetacin increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • aspirin

              aspirin increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • aspirin rectal

              aspirin rectal increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • aztreonam

              aztreonam, neomycin PO. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Pseudomonas spp. and Enterobacteriaceae.

            • balsalazide

              neomycin PO will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • biotin

              neomycin PO will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • calcium acetate

              neomycin PO decreases levels of calcium acetate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • calcium carbonate

              neomycin PO decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • calcium chloride

              neomycin PO decreases levels of calcium chloride by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • calcium citrate

              neomycin PO decreases levels of calcium citrate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • calcium gluconate

              neomycin PO decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • celecoxib

              celecoxib increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • clotrimazole

              clotrimazole decreases levels of neomycin PO by unknown mechanism. Minor/Significance Unknown.

            • cordyceps

              cordyceps decreases toxicity of neomycin PO by unspecified interaction mechanism. Minor/Significance Unknown.

            • cyanocobalamin

              neomycin PO decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • diclofenac

              diclofenac increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • diflunisal

              diflunisal increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • entecavir

              neomycin PO, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

            • etodolac

              etodolac increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • fenoprofen

              fenoprofen increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • fluconazole

              fluconazole decreases levels of neomycin PO by unknown mechanism. Minor/Significance Unknown.

            • flurbiprofen

              flurbiprofen increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • ibuprofen

              ibuprofen increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • ibuprofen IV

              ibuprofen IV increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • indomethacin

              indomethacin increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • ketoconazole

              ketoconazole decreases levels of neomycin PO by unknown mechanism. Minor/Significance Unknown.

            • ketoprofen

              ketoprofen increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • ketorolac

              ketorolac increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • ketorolac intranasal

              ketorolac intranasal increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • lornoxicam

              lornoxicam increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • magnesium chloride

              neomycin PO decreases levels of magnesium chloride by increasing renal clearance. Minor/Significance Unknown.

            • magnesium citrate

              neomycin PO decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

            • magnesium hydroxide

              neomycin PO decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

            • magnesium oxide

              neomycin PO decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

            • magnesium sulfate

              neomycin PO decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

            • meclizine

              meclizine, neomycin PO. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Ototoxicity of aminoglycoside may be masked.

            • meclofenamate

              meclofenamate increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • mefenamic acid

              mefenamic acid increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • meloxicam

              meloxicam increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • miconazole vaginal

              miconazole vaginal decreases levels of neomycin PO by unknown mechanism. Minor/Significance Unknown.

            • nabumetone

              nabumetone increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • naproxen

              naproxen increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • oxaprozin

              oxaprozin increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • pantothenic acid

              neomycin PO will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • parecoxib

              parecoxib increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • piperacillin

              piperacillin increases effects of neomycin PO by pharmacodynamic synergism. Minor/Significance Unknown.

            • piroxicam

              piroxicam increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • posaconazole

              posaconazole decreases levels of neomycin PO by unknown mechanism. Minor/Significance Unknown.

            • pyridoxine

              neomycin PO will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • pyridoxine (Antidote)

              neomycin PO will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • salicylates (non-asa)

              salicylates (non-asa) increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • salsalate

              salsalate increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • sulfasalazine

              sulfasalazine increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • sulindac

              sulindac increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • thiamine

              neomycin PO will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • ticarcillin

              ticarcillin decreases effects of neomycin PO by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.

            • tolfenamic acid

              tolfenamic acid increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • tolmetin

              tolmetin increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

            • vitamin A

              neomycin PO decreases levels of vitamin A by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. (Vitamin A).

            • voriconazole

              voriconazole decreases levels of neomycin PO by unknown mechanism. Minor/Significance Unknown.

            • zoledronic acid

              neomycin PO, zoledronic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypocalcemia.

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            Adverse Effects

            >10%

            Diarrhea

            Nausea/vomiting

            Irritation or soreness of mouth or rectal area

            Contact dermatitis (topical)

            <1%

            Dyspnea

            Eosinophilia

            Nephrotoxicity

            Neurotoxicity

            Ototoxicity (auditory, vestibular)

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            Warnings

            Black Box Warnings

            Neurotoxicity, manifested as both bilateral auditory and vestibular ototoxicity, can occur in patients with preexisting renal damage and in patients with normal renal function treated at higher doses and/or for periods longer than those recommended. High-frequency deafness usually occurs first and can be detected only by audiometric testing

            Aminoglycosides are potentially nephrotoxic. Risk is greater in patients with impaired renal function and in those who receive high doses or prolonged therapy. Rarely, nephrotoxicity may not become apparent until the first few days after cessation of therapy

            Use with caution in premature infants and neonates because of renal immaturity and the resulting prolongation of serum half-life of the drug

            Neuromuscular blockade and respiratory paralysis have been reported following parenteral injection, topical instillation (as in orthopedic and abdominal irrigation or in local treatment of empyema), and oral use of aminoglycosides, especially when given soon after anesthesia or muscle relaxants. If blockage occurs, calcium salts may reverse these phenomena, but mechanical respiratory assistance may be necessary

            Avoid concurrent or sequential use of neurotoxic and/or nephrotoxic drugs including other aminoglycosides (eg, amikacin, streptomycin, neomycin, kanamycin, gentamicin, paromomycin

            Cumulative listing of drugs to avoid from all aminoglycoside package inserts includes amphotericin B, bacitracin, cephaloridine, cisplatin, colistin, polymixin B, vancomycin, and viomycin. Avoid potent diuretics (eg, ethacrynic acid, furosemide) because they increase risk of ototoxicity. When administered intravenously, diuretics may enhance aminoglycoside toxicity by altering antibiotic concentrations in serum and tissue

            Contraindications

            Hypersensitivity

            Ulcerative bowel disease

            Intestinal obstruction

            Cautions

            Renal impairment: reduce dose

            Auditory neurotoxicity, disorder of 8th cranial nerve, myasthenia gravis, Parkinsonism

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: unknown if excreted in breast milk

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Half Life: 3 hr

            Peak Plasma Time: oral: 1-4 hr; IM ~2 hr

            Absorption: oral, percutaneous: poor (3%)

            Vd: 0.36 L/kg

            Metabolism: slightly hepatic

            Excretion

            Feces: 97% of oral dose as unchanged drug

            Urine: 30-50% of absorbed drug as unchanged drug

            Mechanism of Action

            Interferes with bacterial protein synthesis by binding to 30S ribosomal subunits, thus reducing the number of ammonia-producing bacteria in the intestine

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            Images

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            Patient Handout

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.