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Pronunciation |
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(nee
oh MYE
sin) |

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U.S. Brand
Names |
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Mycifradin® Sulfate Oral;
Mycifradin® Sulfate Topical; Neo-fradin® Oral;
Neo-Tabs®
Oral |

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Generic
Available |
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Yes |

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Synonyms |
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Neomycin Sulfate |

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Pharmacological Index |
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Ammonium Detoxicant; Antibiotic, Aminoglycoside; Antibiotic,
Topical |

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Use |
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Orally to prepare GI tract for surgery; topically to treat minor skin
infections; treat diarrhea caused by E. coli; adjunct in the treatment
of hepatic encephalopathy |

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Pregnancy Risk
Factor |
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C |

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Contraindications |
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Hypersensitivity to neomycin or any component, or other aminoglycosides;
patients with intestinal obstruction |

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Warnings/Precautions |
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Use with caution in patients with renal impairment, pre-existing hearing
impairment, neuromuscular disorders; neomycin is more toxic than other
aminoglycosides when given parenterally; do not administer parenterally;
topical neomycin is a contact sensitizer with sensitivity occurring in 5% to 15%
of patients treated with the drug; symptoms include itching, reddening, edema,
and failure to heal; do not use as peritoneal lavage due to significant
systemic adsorption of the drug |

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Adverse
Reactions |
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1% to 10%:
Dermatologic: Dermatitis, rash, urticaria, erythema
Local: Burning
Ocular: Contact conjunctivitis
<1%: Nausea, vomiting, diarrhea, neuromuscular blockade, ototoxicity,
nephrotoxicity |

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Overdosage/Toxicology |
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Symptoms of overdose (rare due to poor oral bioavailability) include
ototoxicity, nephrotoxicity, and neuromuscular toxicity
The treatment of choice following a single acute overdose appears to be the
maintenance of good urine output of at least 3 mL/kg/hour. Dialysis is of
questionable value in the enhancement of aminoglycoside elimination. If
required, hemodialysis is preferred over peritoneal dialysis in patients with
normal renal function. Chelation with penicillin may be of benefit.
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Drug
Interactions |
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Decreased effect: May decrease GI absorption of digoxin and methotrexate
Increased effect: Synergistic effects with penicillins
Increased toxicity:
Oral neomycin may potentiate the effects of oral anticoagulants
Increased adverse effects with other neurotoxic, ototoxic, or nephrotoxic
drugs |

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Stability |
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Use reconstituted parenteral solutions within 7 days of mixing, when
refrigerated |

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Mechanism of
Action |
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Interferes with bacterial protein synthesis by binding to 30S ribosomal
subunits |

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Pharmacodynamics/Kinetics |
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Absorption: Oral, percutaneous: Poor (3%)
Distribution: Vd: 0.36 L/kg
Metabolism: Slight hepatic
Half-life: 3 hours (age and renal function dependent)
Time to peak serum concentration: Oral: 1-4 hours; I.M.: Within 2 hours
Elimination: In urine (30% to 50% as unchanged drug); 97% of an oral dose
eliminated unchanged in feces |

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Usual Dosage |
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Children: Oral:
Preoperative intestinal antisepsis: 90 mg/kg/day divided every 4 hours for 2
days; or 25 mg/kg at 1 PM, 2 PM, and 11 PM on the day preceding surgery as an
adjunct to mechanical cleansing of the intestine and in combination with
erythromycin base
Hepatic coma: 50-100 mg/kg/day in divided doses every 6-8 hours or 2.5-7
g/m2/day divided every 4-6 hours for 5-6 days not to exceed 12 g/day
Children and Adults: Topical: Apply ointment 1-4 times/day; topical solutions
containing 0.1% to 1% neomycin have been used for irrigation
Adults: Oral:
Preoperative intestinal antisepsis: 1 g each hour for 4 doses then 1 g every
4 hours for 5 doses; or 1 g at 1 PM, 2 PM, and 11 PM on day preceding surgery as
an adjunct to mechanical cleansing of the bowel and oral erythromycin; or 6
g/day divided every 4 hours for 2-3 days
Hepatic coma: 500-2000 mg every 6-8 hours or 4-12 g/day divided every 4-6
hours for 5-6 days
Chronic hepatic insufficiency: 4 g/day for an indefinite period
Hemodialysis: Dialyzable (50% to 100%) |

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Monitoring
Parameters |
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Renal function tests, audiometry in symptomatic patients |

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Mental Health: Effects
on Mental Status |
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None reported |

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Mental Health:
Effects on Psychiatric
Treatment |
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None reported |

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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |

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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |

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Patient
Information |
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Oral: Take as directed. Maintain adequate hydration (2-3 L/day of fluids
unless instructed to restrict fluid intake). You may experience nausea or
vomiting (small frequent meals, frequent mouth care, sucking lozenges, or
chewing gum may help); constipation (exercise, increased fluid or fiber in diet
may help, or consult prescriber); or diarrhea (buttermilk, boiled milk, or
yogurt may help). Report immediately any change in hearing,; ringing or sense of
fullness in ears; persistent diarrhea; changes in voiding patterns; or numbness,
tingling, or pain in any extremity. Pregnancy/breast-feeding
precautions: Inform prescriber if you are or intend to be pregnant. Consult
prescriber if breast-feeding.
Topical: Apply a thin film of cream or ointment; do not overuse. Report rash,
itching, redness, or failure of condition to improve. |

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Dosage Forms |
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Cream, as sulfate: 0.5% (15 g)
Injection, as sulfate: 500 mg
Ointment, topical, as sulfate: 0.5% (15 g, 30 g, 120 g)
Solution, oral, as sulfate: 125 mg/5 mL (480 mL)
Tablet, as sulfate: 500 mg [base 300 mg] |

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References |
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Begg EJ and Barclay ML, "Aminoglycosides - 50 Years On," Br J Clin
Pharmacol, 1995, 39(6):597-603.
Edson RS and Terrell CL, "The Aminoglycosides," Mayo Clin Proc, 1991,
66(11):1158-64.
Feigin RD and Cherry JD, Textbook of Pediatric Infectious Diseases,
4th ed, Philadelphia, PA: WB Saunders Co, 1997.
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