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Bacitracin, neomycin, polymyxin B, and hydrocortisone (ophthalmic): Drug information

Bacitracin, neomycin, polymyxin B, and hydrocortisone (ophthalmic): Drug information
(For additional information see "Bacitracin, neomycin, polymyxin B, and hydrocortisone (ophthalmic): Patient drug information" and see "Bacitracin, neomycin, polymyxin B, and hydrocortisone (ophthalmic): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Neo-Polycin HC
Pharmacologic Category
  • Antibiotic, Ophthalmic;
  • Corticosteroid, Ophthalmic
Dosing: Adult
Inflammatory ocular conditions

Inflammatory ocular conditions: Ophthalmic: Apply to inside of lower lid of affected eye(s) every 3 or 4 hours (depending on severity of condition)

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. Dosage adjustment unlikely due to low systemic absorption.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. Dosage adjustment unlikely due to low systemic absorption.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Bacitracin, neomycin, polymyxin B, and hydrocortisone (ophthalmic): Pediatric drug information")

Inflammatory ocular conditions

Inflammatory ocular conditions: Limited data available: Children and Adolescents: Ophthalmic: Apply sparingly to inside of lower lid of affected eye(s) every 3 to 4 hours has been used by some centers; dosing based on experience with other combination ophthalmic products with similar ingredients

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.

Adverse Reactions

See individual agents.

Contraindications

Hypersensitivity to bacitracin, neomycin, polymyxin B, hydrocortisone, or any component of the formulation; most viral diseases of the cornea and conjunctiva, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia and varicella; mycobacterial ophthalmic infection; fungal diseases of ocular structures.

Warnings/Precautions

Concerns related to adverse effects:

• Infection: Steroids may mask infection, enhance existing ocular infection, or reactivate latent disease (eg, herpes infection of cornea); prolonged use may result in secondary bacterial or fungal superinfection due to immunosuppression. Lack of prompt clinical response may indicate resistance to therapy and warrant discontinuation of therapy and further evaluation.

• Neomycin sensitization: Neomycin may cause cutaneous sensitization. Symptoms of neomycin sensitization include itching, reddening, edema, and failure to heal. Discontinuation of product and avoidance of similar products should be considered.

• Ocular effects: Avoid prolonged use of corticosteroids, which may result in ocular hypertension and/or glaucoma, with damage to the optic nerve, defects in visual acuity and fields of vision, and posterior subcapsular cataract formation. Use with caution in glaucoma. Monitor intraocular pressure (routinely if duration of therapy is >10 days). Long-term use may cause corneal and scleral thinning; potentially resulting in perforation. Ophthalmic ointments may retard corneal wound healing.

Other warnings/precautions:

• Appropriate use: For topical use only. Do not inject subconjunctivally or introduce directly into anterior chamber of the eye. Use following ocular cataract surgery may delay healing and increase the incidence of filtering blebs. Inadvertent contamination of multiple-dose ophthalmic tube tip has caused bacterial keratitis. Use of topical corticosteroids to prevent scarring in the healing stages of herpes simplex infection should be done with extreme caution and close observation; may reactivate disease. A maximum of 8 g should be prescribed initially; reevaluate patients (eg, intraocular pressure and exams using magnification and fluorescein staining, where appropriate) prior to additional refills. Use >10 days should include routine monitoring of intraocular pressure.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Ointment, Ophthalmic:

Neo-Polycin HC: Bacitracin 400 units, neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone 10 mg per g (3.5 g)

Generic: Bacitracin 400 units, neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone 10 mg per g (3.5 g)

Generic Equivalent Available: US

Yes

Pricing: US

Ointment (Neo-Polycin HC Ophthalmic)

1% (per gram): $17.14

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

Ophthalmic: For topical ophthalmic use only; apply directly into conjunctival sac. To avoid contamination, do not touch tube tip to eyelids or other surfaces when placing ointment in eye(s).

Administration: Pediatric

Ophthalmic: Do not use topical ointment in the eyes; wash hands before use; avoid contact of tube tip with skin or eye

Use: Labeled Indications

Inflammatory ocular conditions: Corticosteroid-responsive inflammatory ocular conditions where bacterial infection or risk of bacterial infection exists

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Nonsteroidal Anti-Inflammatory Agents (Ophthalmic): May enhance the adverse/toxic effect of Corticosteroids (Ophthalmic). Healing of ophthalmic tissue during concomitant administration of ophthalmic products may be delayed. Risk C: Monitor therapy

Pregnancy Considerations

Adverse events have been observed with topical corticosteroids in animal reproduction studies. If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease potential exposure to the fetus (Samples, 1988). Refer to individual agents.

Breastfeeding Considerations

It is not known if systemic absorption following topical administration results in detectable quantities in human milk. The manufacturers recommend a decision be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of treatment to the mother. Refer to individual agents.

Monitoring Parameters

If ophthalmic ointment is used >10 days or in patients with glaucoma, monitor intraocular pressure (IOP).

Mechanism of Action

See individual agents.

Pharmacokinetics (Adult Data Unless Noted)

See individual agents.

  1. Neomycin and polymyxin B sulfates, bacitracin zinc, and hydrocortisone [prescribing information]. Bridgewater, NJ: Bausch & Lomb Inc; November 2016.
  2. Neomycin and polymyxin B sulfates, bacitracin zinc, and hydrocortisone [prescribing information]. Lake Forest, IL: Akorn Inc; June 2016.
  3. Neo-Polycin HC (neomycin and polymyxin B sulfates, bacitracin zinc, and hydrocortisone) [prescribing information]. Minneapolis, MN: Perrigo; December 2013.
  4. Samples JR, Meyer SM. Use of ophthalmic medications in pregnant and nursing women. Am J Ophthalmol. 1988;106(5):616-623. [PubMed 2903673]
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