Version May 2024
Superficial ocular infections: Ophthalmic: Instill 1 to 2 drops into affected eye(s) every 4 hours or 2 drops per hour for severe infections for 7 to 10 days.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
Refer to "Dosing: Adult."
The following adverse drug reactions are derived from product labeling unless otherwise specified. Adverse effects are reported for the individual agents rather than the combination product.
Postmarketing:
Hypersensitivity: Anaphylaxis
Local: Local ocular hypersensitivity reaction
Ophthalmic: Eye irritation
Hypersensitivity to neomycin, polymyxin B, gramicidin, or any component of the formulation.
Concerns related to adverse effects:
• Neomycin sensitization: Symptoms of neomycin sensitization include itching, reddening, edema, and failure to heal.
• Ocular effects (prolonged use): Glaucoma, defects in visual acuity, posterior subcapsular cataract formation, and secondary ocular infections may result from prolonged use.
• Superinfection: Prolonged use may lead to overgrowth of nonsusceptible organisms, including fungi. If superinfection is suspected, institute appropriate alternative therapy.
Other warnings/precautions:
• Appropriate use: For topical ophthalmic use only. Do not introduce directly into anterior chamber of the eye or inject subconjunctivally. Inadvertent contamination of multiple-dose ophthalmic tube tip has caused bacterial keratitis.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Ophthalmic [drops]:
Generic: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin 0.025 mg per 1 mL (10 mL)
Yes
Solution (Neomycin-Polymyxin-Gramicidin Ophthalmic)
1.75-10000-.025 (per mL): $6.13
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.
Ophthalmic: For ophthalmic use only; not for injection into the eye. Do not allow tip of dropper bottle to touch eye, eyelid, fingers, or any other surface.
Superficial ocular infections: Treatment of superficial external ocular infections (eg, blepharitis, blepharoconjunctivitis, conjunctivitis, keratitis, keratoconjunctivitis) caused by susceptible organisms.
None known.
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.
Aminoglycosides: Polymyxin B may enhance the nephrotoxic effect of Aminoglycosides. Polymyxin B may enhance the neurotoxic effect of Aminoglycosides. Risk X: Avoid combination
Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification
Bacitracin (Systemic): Polymyxin B may enhance the nephrotoxic effect of Bacitracin (Systemic). Risk X: Avoid combination
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy
Capreomycin: May enhance the neuromuscular-blocking effect of Polymyxin B. Risk C: Monitor therapy
Cefaloridine [Cephaloridine]: Polymyxin B may enhance the nephrotoxic effect of Cefaloridine [Cephaloridine]. Risk C: Monitor therapy
Cefazedone: May enhance the nephrotoxic effect of Polymyxin B. Risk C: Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination
Colistimethate: May enhance the nephrotoxic effect of Polymyxin B. Polymyxin B may enhance the neuromuscular-blocking effect of Colistimethate. Colistimethate may enhance the neurotoxic effect of Polymyxin B. Management: Coadministration of polymyxin B and other potentially neurotoxic or nephrotoxic agents, such as colistimethate, is generally not recommended. If this combination must be used, monitor carefully for enhanced neurotoxic and nephrotoxic effects. Risk D: Consider therapy modification
Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination
Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination
Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy
Kanamycin: Polymyxin B may enhance the adverse/toxic effect of Kanamycin. Management: Coadministration of kanamycin and other potentially ototoxic or nephrotoxic agents, such as polymyxin B, is not recommended. If this combination must be used, monitor carefully neurotoxic, ototoxic, or nephrotoxic effects. Risk D: Consider therapy modification
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy
Mecamylamine: Polymyxin B may enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination
Methoxyflurane: May enhance the nephrotoxic effect of Polymyxin B. Risk X: Avoid combination
Netilmicin (Ophthalmic): Polymyxin B may enhance the nephrotoxic effect of Netilmicin (Ophthalmic). Risk X: Avoid combination
Neuromuscular-Blocking Agents: Polymyxin B may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Management: If possible, avoid concomitant use of neuromuscular-blocking agents and polymyxin B. If concomitant use cannot be avoided, monitor for deeper, prolonged neuromuscular-blocking effects (eg, respiratory paralysis) in patients receiving this combination. Risk D: Consider therapy modification
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification
Animal reproduction studies have not been conducted with this combination. See individual monographs for Neomycin and Polymyxin B.
It is not known if neomycin, polymyxin B, or gramicidin is excreted into breast milk. The manufacturer recommends that caution be exercised when administering Neomycin, Polymyxin B, and Gramicidin to nursing women. See individual monographs for Neomycin and Polymyxin B.
Interferes with bacterial protein synthesis by binding to 30S ribosomal subunits; binds to phospholipids, alters permeability, and damages the bacterial cytoplasmic membrane permitting leakage of intracellular constituents
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