Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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 (66)
- 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.
- levoketoconazole
levoketoconazole 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.
- voclosporin
voclosporin, neomycin PO. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
- warfarin
neomycin PO increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.
Minor (65)
- 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.
- levoketoconazole
levoketoconazole decreases levels of neomycin PO by unknown mechanism. Minor/Significance Unknown.
- 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.
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)
Warnings
Black Box Warnings
Patients treated with neomycin should be under close clinical observation because of potential toxicity associated with use
Neurotoxicity, including ototoxicity, and nephrotoxicity following oral use reported even when used in recommended doses; risk greater in patients with impaired renal function
Potential for nephrotoxicity, permanent bilateral auditory and vestibular ototoxicity, can occur in patients with preexisting renal damage and in patients with normal renal function even when 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; perform serial vestibular, and audiometric tests,as well as tests of renal function, especially in high risk patients
Ototoxicity is often delayed in onset and patients developing cochlear damage will not have symptoms during therapy to warn them of developing eighth nerve destruction and total or partial deafness may occur long after neomycin has been discontinued
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
Other factors which increase risk of toxicity are advanced age and dehydration
Avoid concurrent use of neomycin with potent diuretics such as ethacrynic acid or furosemide; certain diuretics by themselves may cause ototoxicity; when administered intravenously, diuretics may enhance neomycin toxicity by altering antibiotic concentration in serum and tissue
Contraindications
Hypersensitivity
Patients with a history of hypersensitivity or serious toxic reactions to other aminoglycosides
Patients with inflammatory or ulcerative gastrointestinal disease
Cautions
Potential for enhanced gastrointestinal absorption of neomycin in patients with inflammatory or ulcerative gastrointestinal disease; use is contraindicated
Rsk of hearing loss continues after drug withdrawal
Aminoglycoside antibiotics cross placenta; there have been several reports of total irreversible bilateral congenital deafness in children whose mothers received streptomycin during pregnancy
Prescribing this antibiotic in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria
Use of this drug may result in overgrowth of non-susceptible organisms, particularly fungi; if this occurs, appropriate therapy should be instituted
Neomycin is quickly and almost totally absorbed from body surfaces (except the urinary bladder) after local irrigation and when applied topically in association with surgical procedures
Delayed-onset, irreversible deafness, renal failure, and death due to neuromuscular blockade (regardless of status of renal function) reported following irrigation of both small and large surgical fields with minute quantities of neomycin
Cross-allergenicity among aminoglycosides has been demonstrated; aminoglycosides should be used with caution in patients with muscular disorders such as myasthenia gravis or parkinsonism since these drugs may aggravate muscle weakness because of their potential curare-like effect on neuromuscular junction
Small amounts of orally administered neomycin are absorbed through intact intestinal mucosa; there have been many reports in the literature of nephrotoxicity and/or ototoxicity with oral use of neomycin
If renal insufficiency develops during oral therapy, consider reducing the drug dosage or discontinuing therapy
An oral neomycin dose of 12 g/day produces malabsorption syndrome for various substances including fat, nitrogen, cholesterol, carotene, glucose, xylose, lactose, sodium, calcium, cyanocobalamin, and iron.
Orally administered neomycin increases fecal bile acid excretion and reduces intestinal lactase activity
Pregnancy & Lactation
Pregnancy
Although serious side effects to fetus or newborn have not been reported in treatment of pregnant women with other aminoglycosides, potential for harm exists
Animal data
- Animal reproduction studies not conducted; if this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus
Lactation
Not known whether neomycin is excreted in human milk but shown to be excreted in cow milk following a single intramuscular injection; other aminoglycosides have been shown to be excreted in human milk
Because of potential for serious adverse reactions from aminoglycosides in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account importance of drug to mother
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.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
Images
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
