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
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
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
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.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
Patient Handout
Formulary
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