Neomycin
🧬 Cross-allergy: Aminoglycosides
JFDA label: Cicatrin Cream
- Toxicity:
- Neuromuscular blockade:
- Concurrent therapy:
Mechanism of Action
Inhibitor of Bacterial 70S ribosome — Bacterial 70S ribosome inhibitor
| Target | Action | Gene / class |
|---|---|---|
| Bacterial 70S ribosome efficacy | INHIBITOR |
Indications
Approved
- Hepatic coma (portal-systemic encephalopathy)
- Surgical (perioperative) prophylaxis
Antimicrobial Spectrum
Expected / intrinsic spectrum (EUCAST breakpoints & labels) — not local resistance. Source: openfda-label.
Bacteria
| Organism | Activity | MIC |
|---|---|---|
| Escherichia coli | Active | — |
| Haemophilus influenzae | Active | — |
| Pseudomonas aeruginosa | Active | — |
| Serratia marcescens | Active | — |
| Staphylococcus aureus | Active | — |
| Streptococcus pneumoniae | Active | — |
Contraindications
Source: Lexicomp
- Hypersensitivity to the neomycin or any component of the formulation Absolute
- intestinal obstruction Absolute
- patients with inflammatory or ulcerative GI disease. Patients with a history of hypersensitivity or serious toxic reaction to other aminoglycosides may have a cross-sensitivity to neomycin Absolute
Adverse Reactions
Nervous system disorders (1)
Very Common Sore mouth
Gastrointestinal disorders (6)
Very Common Anorectal pain · diarrhea · mouth irritation · nausea · rectal irritation · vomiting
Dosing
Source: Lexicomp
Warnings & Precautions
Source: Lexicomp
Malabsorption
Small amounts of neomycin are absorbed through intact intestinal mucosa; increases in fecal bile acid excretion and reduction of intestinal lactase activity may occur. Oral doses of >12 g/day produce malabsorption of fats, nitrogen, cholesterol, carotene, glucose, xylose, lactose, sodium, calcium, cyanocobalamin and iron.
Nephrotoxicity
May cause nephrotoxicity; usual risk factors include preexisting renal impairment, concomitant nephrotoxic medications, advanced age and dehydration. Discontinue treatment if signs of nephrotoxicity occur; renal damage is usually reversible.
Neuromuscular blockade and respiratory paralysis
May cause neuromuscular blockade and respiratory paralysis; especially when given soon after anesthesia or muscle relaxants.
Neurotoxicity
May cause neurotoxicity; symptoms also include numbness, skin tingling, muscle twitching and seizures. Usual risk factors include preexisting renal impairment and concomitant neuro-/nephrotoxic medications. Discontinue treatment if signs of ototoxicity occur; risk of hearing loss continues after drug withdrawal.
Superinfection
Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment. Disease-related concerns:
Hearing impairment
Use with caution in patients with preexisting vertigo, tinnitus, or hearing loss.
Neuromuscular disorders
Use with caution in patients with neuromuscular disorders, including myasthenia gravis and Parkinson disease.
Renal impairment
Use with caution in patients with preexisting renal insufficiency; dosage modification required. Concurrent drug therapy issues:
Drug-drug interactions
Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Dosage form specific issues:
Benzyl alcohol and derivatives
Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC, 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors, 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling. Other warnings/precautions:
Parenteral administration
More toxic than other aminoglycosides when given parenterally; do not administer parenterally.
Surgical irrigation
Do not use as surgical irrigation due to significant systemic absorption of the drug.
Pregnancy & Lactation
Pregnancy
Animal reproduction studies have not been conducted. Aminoglycosides cross the placenta. Aminoglycosides may cause fetal harm if administered to a pregnant woman. There are several reports of total irreversible bilateral congenital deafness in children whose mothers received another aminoglycoside (streptomycin) during pregnancy. Although serious side effects to the fetus/infant have not been reported following maternal use of all aminoglycosides, a potential for harm exists. Large oral doses may cause malabsorption of some nutrients in the mother.
Lactation
It is not known if neomycin is excreted into breast milk. Due to the potential for serious adverse reactions in the nursing infant, the manufacturer recommends a decision be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of treatment to the mother. As a class, aminoglycosides are expected to be poorly distributed into breast milk, limiting systemic exposure to a nursing infant. In general, modification of bowel flora may occur with any antibiot
LactMed: monitor the infant.
Monitoring
| Clinical pearl | Serum creatinine/BUN at baseline and periodically during chronic therapy; audiometry in symptomatic patients |
|---|
Chemistry & Properties
| Formula | C23H46N6O13 |
|---|---|
| Molecular weight | 614.6 g/mol |
| IUPAC name | (2R,3S,4R,5R,6R)-5-amino-2-(aminomethyl)-6-[(1R,2R,3S,4R,6S)-4,6-diamino-2-[(2S,3R,4S,5R)-4-[(2R,3R,4R,5S,6S)-3-amino-6-(aminomethyl)-4,5-dihydroxyoxan-2-yl]oxy-3-hydroxy-5-(hydroxymethyl)oxolan-2-yl]oxy-3-hydroxycyclohexyl]oxyoxane-3,4-diol |
| CAS | 1404-04-2 |
| PubChem CID | 8378 |
| InChIKey | PGBHMTALBVVCIT-VCIWKGPPSA-N |
| logP | -9.0 (XLogP -9.0) |
| Polar surface area | 353.0 Ų |
| H-bond acceptors / donors | 19 / 13 |
SMILES
C1C(C(C(C(C1N)OC2C(C(C(C(O2)CN)O)O)N)OC3C(C(C(O3)CO)OC4C(C(C(C(O4)CN)O)O)N)O)O)NBiology & Pharmacokinetics
Pharmacokinetics
| BBB penetrant | No |
|---|
Transporters
BCRP (Inhibitor)BSEP (Inhibitor)BSEP (Inhibitor)MRP1 (Inhibitor)MRP2 (Inhibitor)MRP3 (Inhibitor)OATP1B1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)OATP1B3 (Inhibitor)P-gp (Inhibitor)P-gp (Substrate)
Drug–drug interactions (100+, DDInter)
| Interacting drug | Severity | Management |
|---|---|---|
| Atracurium | major | |
| Bacitracin | major | |
| Botulinum Toxin Type B | major | |
| Botulinum toxin type A | major | |
| Bumetanide | major | |
| Capreomycin | major | |
| Cidofovir | major | |
| Cisatracurium | major | |
| Colistimethate | major | |
| Deferasirox | major | |
| Diatrizoate | major | |
| Doxacurium | major | |
| Etacrynic acid | major | |
| Everolimus | major | |
| Foscarnet | major | |
| Furosemide | major | |
| Gallium nitrate | major | |
| Human Rho(D) immune globulin | major | |
| Human botulinum neurotoxin A/B immune globulin | major | |
| Human cytomegalovirus immune globulin | major | |
| Human immunoglobulin G (intravenous and subcutaneous) | major | |
| Human immunoglobulin G (intravenous) | major | |
| Inotersen | major | |
| Iodipamide | major | |
| Iodixanol | major | |
| Iohexol | major | |
| Iopamidol | major | |
| Iopromide | major | |
| Iothalamic acid | major | |
| Ioversol | major | |
| Ioxilan | major | |
| Magnesium sulfate | major | |
| Mannitol | major | |
| Metocurine | major | |
| Mivacurium | major | |
| Pancuronium | major | |
| Pipecuronium | major | |
| Polymyxin B | major | |
| Rapacuronium | major | |
| Rocuronium | major |
Showing 40 of 100+.
Registered Products (33)
| Brand | Form / strength | Pack | Agent | Citizen (JOD) |
|---|---|---|---|---|
| Atasorb-N Suspension | Suspension , 3 g | 60 ml | Hikma Pharmaceuticals Co.Ltd/Jordan | 0.500 |
| Cicatrin Cream | Cream 3300 IU, 250 IU | 15 g tube | Suleiman Tannous & Sons Co. Ltd | 0.740 |
| Betaval-N Ointment | Ointment (as 17-valerate) 0.1 %, ( as sulphate) 0.5 % | 15 g tube | The Arab Pharmaceutical Manufactruing Co. | 0.760 |
| Betaval-N Cream | Cream 0.1 %, 0.5 % | 15 g tube pack varies | The Arab Pharmaceutical Manufactruing Co. | 0.810 |
| NEOBACIN SKIN OINT. | Ointment (as Neomycin Sulfate)5 mg, (as Bacitrain Zinc)250 IU | 15 g tube | Dar Al Dawa Development and Investment Co Ltd/Jordan | 0.810 |
| Cicatrin Powder | Powder 3300 IU, 250 IU | 15 g | Suleiman Tannous & Sons Co. Ltd | 0.830 |
| Detroz | Solution 0.35 %, 0.1 % | 5 ml | Dar Al Dawa Development and Investment Co Ltd/Jordan | 0.850 |
| Otosporin Ear / Drops | Eye/Ear Drops 10 mg/ml, 3400 IU, 10000 IU | 5 ml | Suleiman Tannous & Sons Co. Ltd | 0.940 |
| multicin Z center oint. | Ointment 3.5 mg, 5000 IU, 400 IU | 15 g tube pack varies | MIDDLE EAST PHARMA&CHEMICAL IND/JORDAN | 0.970 |
| BANEOCIN Powder | Powder 250 IU, 5000 IU | 10 g | Nabulsi Drug Store | 1.040 |
| Betaval-N Ointment | Ointment (as 17-valerate) 0.1 %, (as sulphate) 0.5 % | 30 g tube | The Arab Pharmaceutical Manufactruing Co. | 1.100 |
| Detroz-P | Injection 1 mg/ml, 3500 IU/ml, 6000 IU/ml | 5 ml | Dar Al Dawa Development and Investment Co Ltd/Jordan | 1.140 |
| Cebemyxine e/o | Ophthalmic Ointment 1000000 IU, 430000 IU | 5 g tube | Petra Drug Store | 1.320 |
| Betaval-N Cream | Cream 0.1 %, 0.5 % | 30 g tube pack varies | The Arab Pharmaceutical Manufactruing Co. | 1.350 |
| kenacin cream | Cream 100000 IU, 0.1 %, 0.025 %, 0.25 % | 15 g tube pack varies | MIDDLE EAST PHARMA&CHEMICAL IND/JORDAN | 1.370 |
| kenacin oint | Ointment 100000 IU, 0.1 %, 0.025 %, 0.25 % | 15 g tube pack varies | MIDDLE EAST PHARMA&CHEMICAL IND/JORDAN | 1.370 |
| Panderm Cream | Cream 10.000000 IU/100 g, 0.025 g/100 g, 0.25 g/100 g, 0.1 g/100 g | 15 g tube pack varies | Professional Drug Store | 1.420 |
| petralar N cream. | Cream 0.25 mg/g, 3.50 mg/g | 15 g tube | MIDDLE EAST PHARMA&CHEMICAL IND/JORDAN | 1.500 |
| petralar N oint. | Ointment 0.25 mg/g, 3.50 mg/g | 15 g tube | MIDDLE EAST PHARMA&CHEMICAL IND/JORDAN | 1.500 |
| Kenaphil Cream | Cream 0.326 g/tube, 0.00375 g/tube, 0.055161 g/tube, 0.015 g/tube | 15 g tube | PHILADELPHIA PHAEMACEUTICALS.COMP/JORDAN | 1.510 |
| multicin z center powder | Powder (as Sulphate)3.5 mg/g, (as Sulphate)5000 IU/g, (as zinc)400 IU/g | 15 g | MIDDLE EAST PHARMA&CHEMICAL IND/JORDAN | 1.560 |
| BANEOCIN OINT | Ointment 250 IU/g, 5000 IU/g | 20 g tube | Nabulsi Drug Store | 1.600 |
| Menaderm Cream | Cream 0.025 %, 0.5 % | 30 g tube pack varies | ORIENT DRUG STORE CO | 1.670 |
| Menaderm Lotion | Lotion 0.025 %, 0.5 % | 30 g pack varies | ORIENT DRUG STORE CO | 1.670 |
| Neopred-P eye ear drops | Ophthalmic Solution 10000 IU, 5 mg, 5 mg | 10 ml | Amman Pharmaceutical Industries Co | 1.800 |
| multicin Z center oint. | Ointment 3.5 mg, 5000 IU, 400 IU | 30 g tube pack varies | MIDDLE EAST PHARMA&CHEMICAL IND/JORDAN | 1.840 |
| Neodex Eye/Ear drops | Ophthalmic Solution 5 mg, 1 mg | 10 ml | Amman Pharmaceutical Indusries | 1.910 |
| Maxitrol Eye Drops | Ophthalmic Solution 1 mg/ml, 6.000 IU/ml, 3.500 IU/ml | 5 ml | The Jordan Drugstore Co | 2.460 |
| Panderm Cream | Cream 10.000000 IU/100 g, 0.025 g/100 g, 0.25 g/100 g, 0.1 g/100 g | 30 g tube pack varies | Professional Drug Store | 2.480 |
| Synalar-N cream | Cream 0.025 %, 0.5 % | 15 g tube | Nabulsi Drug Store | 3.200 |
| Synalar-N ointment | Ointment 0.025 %, 0.5 % | 15 g tube | Nabulsi Drug Store | 3.200 |
| Polygynax 12 Ovules | Ovule 100000 IU, 35000 IU, 35000 IU | 12 | Quality Drug Store | 4.710 |
| Multisol Aerosol 150 gm | Cream 500.000 IU, 150.000 IU, 40.000 IU | 150 gm | MIDDLE EAST PHARMA&CHEMICAL IND/JORDAN | 7.320 |