Neomycin (Systemic)

Warning

Neurotoxicity and Ototoxicity

• Neurotoxicity (manifested as both auditory and vestibular ototoxicity) can occur, even at recommended doses.

• Risk of eighth-cranial nerve impairment is increased in patients with preexisting renal damage and in those with normal renal function who receive doses higher or treatment longer than recommended.

• Aminoglycoside-induced ototoxicity is irreversible, usually bilateral, and may be partial or total.

• Patients developing cochlear damage may not have symptoms during aminoglycoside treatment to warn them of eighth-cranial nerve toxicity and total or partial, irreversible, bilateral deafness may occur after drug discontinued.

Nephrotoxicity

• Potentially nephrotoxic, even at recommended doses.

• Nephrotoxicity develops principally in patients with preexisting renal damage and in those with normal renal function who receive doses higher or treatment longer than recommended.

Patient Monitoring

• Patients should be under close clinical observation because of potential toxicities.

• Oral neomycin is absorbed systemically; toxic reactions may occur.

• Closely monitor renal and eighth-cranial nerve function. Perform serial, vestibular, and audiometric tests and tests of renal function, particularly in high-risk patients.

• Advanced age and dehydration may increase risk of toxicity.

Neuromuscular Blockade

• Neuromuscular blockage and respiratory paralysis reported with oral neomycin.

• Concomitant use of an aminoglycoside with anesthesia and muscle-relaxing drugs may cause neuromuscular blockade with respiratory paralysis.

• Consider possibility of neuromuscular blockade and respiratory paralysis when administering aminoglycosides, especially if used