neomycin sulphate

CLINICAL USE

Antibacterial agent:Bowel sterilisation before surgery Hepatic coma

DOSE IN NORMAL RENAL FUNCTION

Bowel sterilisation: 1 g every hour for 4 hours, then 1 g every 4 hours for 2–3 daysHepatic coma: up to 4 g daily in divided doses usually for a maximum of 14 days

PHARMACOKINETICS

Molecular weight :711.7

%Protein binding :0–30

%Excreted unchanged in urine : 30–50

Volume of distribution (L/kg) :0.25

half-life – normal/ESRD (hrs) :2–3/12–24

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function. Use with caution and monitor renal function

10 to 20 : Dose as in normal renal function. Use with caution and monitor renal function

<10 : Dose as in normal renal function. Use with caution and monitor renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Dialysed. Dose as in GFR

<10 : mL/min

HD :Dialysed. Dose as in GFR

<10 : mL/min

HDF/high flux :Dialysed. Dose as in GFR

<10 : mL/min

CAV/VVHD :Dialysed. Dose as in GFR=10–20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anticoagulants: altered INR with coumarins or phenindioneBotulinum toxin: neuromuscular block enhanced (risk of toxicity)

Ciclosporin: increased risk of nephrotoxicityCytotoxics: possibly reduced methotrexate absorption; increased risk of nephrotoxicity and possibly of ototoxicity with platinum compounds

Diuretics: increased risk of ototoxicity with loop diureticsMuscle relaxants: enhanced effects of suxamethonium and non-depolarising muscle relaxantsParasympathomimetics: antagonism of effect of neostigmine and pyridostigmine

Tacrolimus: increased risk of nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral, topical

Rate of Administration

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Comments

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OTHER INFORMATION

Only 3% of an oral dose is absorbed About 97% of an orally administered dose is excreted unchanged in the faeces. Impaired GI motility may increase absorption of the drug; therefore, possible that prolonged therapy could result in ototoxicity and nephrotoxicity, particularly in patients with a degree of renal failureIf renal impairment occurs the dose should be reduced or treatment discontinuedHigh doses associated with nephrotoxicity and ototoxicityIn mild renal failure, i.e. a GFR>50 mL/ min, the frequency should be reduced to every 6 hoursneomycin sulphate.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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