Nivemycin
neomycin sulfate
Pharmacologic class: Aminoglycoside
Therapeutic class: Anti-infective
Pregnancy risk category D
FDA Box Warning
Systemic absorption follows oral use and may lead to toxic reactions. Observe patient closely for indications of toxicity. Neurotoxicity (including ototoxicity) and nephrotoxicity have occurred, even at recommended doses. Perform serial, vestibular, and audio-metric tests as well as renal function tests, especially in high-risk patients. Risk of nephrotoxicity and ototoxicity is greater in patients with renal impairment. Ototoxicity may be delayed, and patients developing cochlear damage won't have symptoms during therapy; total or partial deafness may occur long after drug is stopped.
Neuromuscular blockage and respiratory paralysis may follow oral use. Consider these risks, especially to patients receiving anesthetics or neuromuscular blockers (such as tubocurarine, succinylcholine, and decamethonium) and those receiving massive transfusions of citrated anti-coagulated blood. If blockage occurs, calcium salts may reverse these phenomena, but patient may need mechanical respiratory assistance.
Avoid concurrent or sequential systemic, oral, or topical use of other aminoglycosides or neurotoxic drugs, as toxicity may be additive.
Advanced age and dehydration increase risk of toxicity.
Avoid giving drug concurrently with potent diuretics, as some diuretics are ototoxic. Also, I.V. diuretics may enhance neomycin toxicity by altering its blood and tissue levels.
Action
Interferes with bacterial protein synthesis by binding to 30S ribosomal subunit, causing misreading of genetic code. Inaccurate peptide sequence then forms in protein chain, causing bacterial death.
Availability
Ointment: 0.5%
Oral solution: 125 mg/5 ml
Tablets: 500 mg
Indications and dosages
➣ Preoperative intestinal antisepsis
Adults: 1 g P.O. q hour for four doses, then 1 g q 4 hours for 24 hours or 1 g at 19 hours, 18 hours, and 9 hours before surgery
➣ Hepatic encephalopathy
Adults: 4 to 12 g/day P.O. in divided doses
➣ Superficial bacterial infections
Adults: Apply ointment topically one to five times daily.
Contraindications
• Hypersensitivity to drug or other aminoglycosides
• Intestinal obstruction
Precautions
Use cautiously in:
• renal impairment, neuromuscular diseases (such as myasthenia gravis), hearing impairment
• obese patients
• elderly patients
• pregnant or breastfeeding patients
• children under age 18 (safety not established).
Administration
• Give preoperative dose before bowel surgery, after cathartic administration, as ordered.
Adverse reactions
CNS: neuromuscular blockade
EENT: ototoxicity (with prolonged, high-dose use)
GI: nausea, vomiting, diarrhea, malabsorption syndrome
GU: nephrotoxicity (with prolonged, high-dose use)
Other: superinfection
Interactions
Drug-drug. Acyclovir, amphotericin B, cephalosporin, cisplatin, other amino-glycosides, vancomycin: increased risk of ototoxicity and nephrotoxicity
Digoxin: decreased digoxin absorption
Dimenhydrinate: masking of ototoxicity symptoms
Oral anticoagulants: increased anticoagulant effect
Potent loop diuretics: increased risk of ototoxicity
Patient monitoring
• Assess for neuromuscular blockade, ototoxicity, and nephrotoxicity.
• Monitor kidney function tests.
Patient teaching
• Instruct patient to drink plenty of water.
• Tell patient to complete full course of therapy.
• Inform patient that drug may cause muscle weakness.
• Instruct patient to report hearing problems and change in urination pattern.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects neuromuscular status.
• Tell patient he'll undergo frequent blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.