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 concurrently with anesthetics or neuromuscular-blocking agents (e.g., tubocurarine, succinylcholine, decamethonium) or in patients receiving massive transfusions of citrate-anticoagulated blood. (See Specific Drugs under Interactions.)
Calcium salts may reduce manifestations if blockade occurs; may require mechanical respiratory assistance.
Interactions
Avoid concurrent and/or sequential use of other systemic, topical, or oral neurotoxic or nephrotoxic drugs, particularly other aminoglycosides (including paromomycin), amphotericin B, bacitracin, cisplatin, colistin, polymyxin B, vancomycin, and viomycin (not commercially available in the US). (See Interactions.)
Avoid concurrent use of potent diuretics (e.g., ethacrynic acid, furosemide) since diuretics themselves may cause ototoxicity and IV diuretics enhance toxicity by altering serum and tissue aminoglycoside concentrations. (See Interactions.)
Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Take your medicine at regular intervals. Do not take your medicine more often than directed. Take all of your medicine as directed even if you think you are better. Do not skip doses or stop your medicine early.
Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.
What if I miss a dose?
If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
What should I watch for while using this medicine?
Visit your doctor or health care professional for check ups as directed. Tell your doctor if your symptoms do not improve or if they get worse.
What side effects may I notice from receiving this medicine?
Side effects that you should report to your doctor or health care professional as soon as possible:
allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
difficulty breathing
difficulty passing urine or change in amount of urine
dizziness
fever
greasy looking stools
increased thirst
loss of balance
muscle weakness
ringing in the ears, hearing loss
unusually weak or tired
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Where should I keep my medicine?
Keep out of the reach of children.
Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Throw away any unused medicine after the expiration date.
NOTE:This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.
Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for the indication prescribed.
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