Version July 2025
Superficial ocular infection: 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.
Refer to individual components.
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 drug interactions program by clicking on the “Launch drug interactions program” link above.
Aminoglycosides: Polymyxin B may increase nephrotoxic effects of Aminoglycosides. Polymyxin B may increase neurotoxic effects of Aminoglycosides. Risk X: Avoid
Bacillus clausii: Antibiotics may decrease therapeutic effects 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 increase nephrotoxic effects of Bacitracin (Systemic). Risk X: Avoid
BCG (Intravesical): Antibiotics may decrease therapeutic effects of BCG (Intravesical). Risk X: Avoid
BCG Vaccine (Immunization): Antibiotics may decrease therapeutic effects of BCG Vaccine (Immunization). Risk C: Monitor
Capreomycin: May increase neuromuscular-blocking effects of Polymyxin B. Risk C: Monitor
Cefazedone: May increase nephrotoxic effects of Polymyxin B. Risk C: Monitor
Cephaloridine: Polymyxin B may increase nephrotoxic effects of Cephaloridine. Risk C: Monitor
Cholera Vaccine: Antibiotics may decrease therapeutic effects 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
Colistimethate: May increase nephrotoxic effects of Polymyxin B. Colistimethate may increase neurotoxic effects of Polymyxin B. Polymyxin B may increase neuromuscular-blocking effects of Colistimethate. 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 decrease therapeutic effects of Antibiotics. Risk X: Avoid
Fecal Microbiota (Live) (Rectal): Antibiotics may decrease therapeutic effects of Fecal Microbiota (Live) (Rectal). Risk X: Avoid
Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may decrease therapeutic effects of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor
Kanamycin: Polymyxin B may increase adverse/toxic effects 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 decrease therapeutic effects of Lactobacillus and Estriol. Risk C: Monitor
Mecamylamine: Polymyxin B may increase neuromuscular-blocking effects of Mecamylamine. Risk X: Avoid
Methoxyflurane: May increase nephrotoxic effects of Polymyxin B. Risk X: Avoid
Mycophenolate: Antibiotics may decrease active metabolite exposure of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor
Netilmicin (Ophthalmic): Polymyxin B may increase nephrotoxic effects of Netilmicin (Ophthalmic). Risk X: Avoid
Neuromuscular-Blocking Agents: Polymyxin B may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor
Sodium Picosulfate: Antibiotics may decrease therapeutic effects 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 decrease therapeutic effects 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
