Dosing & Uses
Systemic Infections
IV: 15,000-25,000 units/kg/day divided q12hr; not to exceed 25,000 units/kg/day
IM: 25,000-30,000 units/kg/day divided q4-6hr
Intrathecal: 50,000 qDay for 3-4 days; then qDay or qODay for at least 2 weeks after CSF cultures are negative and normal for glucose content
Total daily dose not to exceed 2,000,000 units/day
Renal Impairment
CrCl >20 mL/minute: give 75-100% usual dose/day divided q12hr
CrCl 5-20 mL/minute: give 50% usual dose/day divided q12hr
CrCl <5 mL/minute: give 15% usual dose/day q12hr
Other Information
Monitor: renal function
Other Indications & Uses
Bacterial Septicemia due to P. aeruginosa, E. aerogenes, & K. pneumoniae, H. Influenzae Meningitis, UTI due to E. coli
Systemic Infections
Infants
- IM: May receive up to 40,000 units/kg/day divided q6hr if renal function healthy
- IV: May receive up to 40,000 units/kg/day divided q12hr;
- Intrathecal: 20,000 units/day for 3-4 days; follow with 25,000 units qODay for at least 2 weeks after CSF cultures are negative and CSF (glucose) has returned to normal
Children
- IM: 25,000-30,000 units/kg/day divided q12hr
- IV: 15,000-25,000 units/kg/day divided q12hr; not to exceed 25,000 units/kg/day
- Intrathecal: 50,000 qDay for 3-4 days; then qDay or qODay for at least 2 weeks after CSF cultures are negative and normal for glucose content
Renal Impairment
CrCl >20 mL/min: give 75-100% usual dose/day divided q12hr
CrCl 5-20 mL/min: give 50% usual dose/day divided q12hr
CrCl <5 mL/min: give 15% usual dose/day q12hr
Other Information
Monitor: renal function
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- allogeneic cultured keratinocytes/fibroblasts in bovine collagen
polymyxin B decreases effects of allogeneic cultured keratinocytes/fibroblasts in bovine collagen by Other (see comment). Contraindicated. Comment: Exposure to topical antibiotics has been antibiotics shown to degrade Gintuit; if exposed, irrigate the wound thoroughly with saline and allow a suitable wash-out period to elapse before applying Gintuit.
Serious - Use Alternative (14)
- amphotericin B deoxycholate
amphotericin B deoxycholate and polymyxin B both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- atracurium
polymyxin B increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.
- bacitracin
polymyxin B and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs
- cholera vaccine
polymyxin B, 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.
- cidofovir
cidofovir and polymyxin B both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- cisatracurium
polymyxin B increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.
- incobotulinumtoxinA
polymyxin B increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.
- neomycin PO
neomycin PO and polymyxin B both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- onabotulinumtoxinA
polymyxin B increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.
- pancuronium
polymyxin B increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.
- rapacuronium
polymyxin B increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.
- rocuronium
polymyxin B increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.
- succinylcholine
polymyxin B increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.
- vecuronium
polymyxin B increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.
Monitor Closely (19)
- acyclovir
acyclovir and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- amikacin
amikacin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- capreomycin
capreomycin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- carboplatin
carboplatin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- cephaloridine
cephaloridine and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- cisplatin
cisplatin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- colistin
colistin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- contrast media (iodinated)
contrast media (iodinated) and polymyxin B both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- cyclosporine
cyclosporine and polymyxin B both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
polymyxin B and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- gentamicin
gentamicin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- ioversol
ioversol and polymyxin B both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- oxaliplatin
oxaliplatin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
polymyxin B 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.
- streptozocin
polymyxin B and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tacrolimus
polymyxin B and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- teicoplanin
polymyxin B and teicoplanin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- tobramycin
polymyxin B and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- voclosporin
voclosporin, polymyxin B. 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.
Minor (9)
- adefovir
adefovir and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- entecavir
polymyxin B, 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.
- foscarnet
foscarnet and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- methoxyflurane
methoxyflurane and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- paromomycin
paromomycin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- pentamidine
pentamidine and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- streptomycin
polymyxin B and streptomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- vancomycin
polymyxin B and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- verteporfin
polymyxin B increases levels of verteporfin by pharmacodynamic synergism. Minor/Significance Unknown.
Adverse Effects
Frequency Not Defined
Anaphylactoid reactions with dyspnea and tachycardia
Eosinophilia
Fever
Nephrotoxicity
Neurotoxicity
Skin exanthemata
Urticaria
Warnings
Contraindications
Hypersensitivity
Cautions
Caution in oliguria, myasthenia gravis, pregnancy, renal disease
Potential risk of nephrotoxicity and neurotoxicity
May inhibit neuromuscular transmission
Inactivated by strong acidic or alkaline solution
Clostridium difficile-associated diarrhea (CDAD) has reported; may range in severity from mild diarrhea to fatal colitis; if CDAD suspected or confirmed ongoing, antibiotic use not directed at C. Difficile may need to be discontinued
Prescribing polymyxin B in absence of proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases risk of development of drug-resistant bacteria
Baseline renal function should be done prior to therapy, with frequent monitoring of renal function and blood levels of the drug during parenteral therapy; discontinue if diminished urine output, rise in SCr or BUN, or signs of respiratory paralysis appear
Do not use IM routinely, particularly in peds, because of severe inj site pain
Avoid concurrent use of a curaiform muscle relaxant and other neurotoxic drugs which may precipitate respiratory depression; if signs of respiratory paralysis appear, respiration should be assisted as required, and drug discontinued
As with other antibiotics, use may result in overgrowth of nonsusceptible organisms, including fungi; if superinfection occurs, appropriate therapy should be instituted
Pregnancy & Lactation
Pregnancy Category: B: use when benefits outweigh risks
Lactation: use caution; no data
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
Distribution: wide, does not cross placenta or aqueous humor of eye; does not appear in CSF or synovial fluid
Peak Plasma
Time: IM: 2 hr
Concentration: 20-40 KU IM dose: 1-8 mcg/mL
Other Information
Protein Bound: 79-92%
Half-life elimination: 4.3-6 hr with normal renal function
Metabolism: N/A
Excretion: urine 60% (<1% as unchanged drug)
Dialyzable: HD; no; PD: no
Mechanism of Action
Bactericidal; causes leakage of bacterial membrane by binding to phospholipids.
Administration
IV Incompatibilities
Additive: amphotericin B, chloramphenicol Na succinate, chlorothiazide, heparin, MgSO4
Syringe: ampicillin(?)
IV Compatibilities
Additive: amikacin, ascorbic acid, colistimethate, diphenhyramine, erythromycin lactobionate, hydrocortisone Na succinate, kanamycin, pencillin G potassium, penicillin G Na, phenobarbital, ranitidine, vit B/C
Syringe: penicillin G Na
Y-site: esmolol
IV/IM/IT Preparation
IV: dilute 500,000 U in 300-500 mL D5W
IM: reconstitute vial with 2 mL SWI , NS, or procaine HCl 1% solution
Intrathecal (IT): reconstitute vial with10 mL NS; DO NOT use procaine HCl for IT
IV/IM Administration
IV: infuse over 60-90 min
IM: give deep into upper outer quadrant of gluteal muscles
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| polymyxin B sulfate injection - | 500,000 unit vial |  | |
| polymyxin B sulfate injection - | 500,000 unit vial |  | |
| polymyxin B sulfate injection - | 500,000 unit vial |  | |
| polymyxin B sulfate injection - | 500,000 unit vial |  | |
| polymyxin B sulfate injection - | 500,000 unit vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
polymyxin B sulfate injection
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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