Neomycin
MYCIFRADIN
What it isAminoglycoside inhibiting the 30S ribosomal subunit; topical use and gut decontamination.
Why this oneMinimal oral absorption lets it act on gut flora, which is how it is used before colorectal surgery and in encephalopathy.
What limits itThe small absorbed fraction is still nephrotoxic and ototoxic in renal impairment. It is a common cause of contact dermatitis.
FDA-approved for
- hepatic encephalopathy adjunct and bowel preparation
- topical infection
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hepatic coma (adjunct) | Adults | 4–12 g/day in divided doses ×5–6 days | up to 4 g/day for chronic hepatic insufficiency | 12 g/day |
| Preoperative bowel prep (elective colorectal surgery) | Adults | 1 g (with erythromycin 1 g) at 1 pm, 2 pm, and 11 pm pre-op day 1 | per regimen | per regimen |
Renal Increased nephro/oto/neurotoxicity risk in renal impairment; monitor renal function and neomycin serum levels
Hepatic Undefined
Do not exceed 2 weeks of therapy
Instructions
- Use lowest possible dose for shortest period
- Treatment longer than 2 weeks is not recommended
- Monitor renal function, audiometric/vestibular tests, and neomycin serum concentrations
Contraindications
- Intestinal obstruction
- Inflammatory or ulcerative GI disease (enhanced GI absorption)
- Cross-sensitivity with other aminoglycosides
Cautions
- Neurotoxicity/ototoxicity — often delayed, may be permanent (bilateral auditory, sometimes vestibular)
- Nephrotoxicity
- Neuromuscular blockade and respiratory paralysis (esp. with anesthetics/NMBAs, massive citrate-blood transfusion)
- Additive toxicity with other aminoglycosides and nephro/neurotoxic drugs; avoid potent diuretics
- Malabsorption syndrome with prolonged therapy
Adverse reactions
- Nausea
- Vomiting
- Diarrhea
- Malabsorption syndrome
- Nephrotoxicity
- Ototoxicity
- Neuromuscular blockade
Pregnancy Undefined (refer to systemic-toxicity warnings)
Lactation Undefined
⚠ BOXED WARNINGS
- Nephrotoxicity and ototoxicity
- Neuromuscular blockade and respiratory paralysis
Cost, est. cash$10–$300/month
Generic entry2002
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityNephrotoxicity and often irreversible ototoxicity require renal and concentration monitoring.
Mechanism of action: Neomycin ballicule
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Memory aids: mascots and interaction avatars
"-fradin" reference the source organism, Streptomyces fradiae
