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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Polymyxin B Sulfate, Neomycin Sulfate, Pramoxine Hydrochloride
Brand Name
Walgreens Multi-antibiotic With Pain Relief Cream
Generic Name
Polymyxin B Sulfate, Neomycin Sulfate, Pramoxine Hydrochloride
Active Ingredient
NeomycinCategory
Corticosteroid [EPC]
Salt Form
Sulfate
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 3.5 mg/g | CREAM | TOPICAL | 0363-2123 |
Detailed information about Walgreens Multi-antibiotic With Pain Relief Cream
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Walgreens Multi-antibiotic With Pain Relief Cream, you must consult a qualified healthcare professional.
Neomycin is a potent aminoglycoside antibiotic used primarily for intestinal antisepsis and as adjunctive therapy in hepatic encephalopathy. It works by inhibiting bacterial protein synthesis, though its systemic use is limited by significant toxicity risks.
Dosage for Neomycin varies significantly based on the indication and the patient's clinical status.
Neomycin use in children is generally limited. For hepatic coma, the suggested dose is 50 to 100 mg/kg/day divided into four doses. It is not routinely recommended for bowel prep in pediatric patients unless specifically directed by a specialist. Safety and effectiveness in children for other uses have not been extensively established.
Neomycin is potentially nephrotoxic. In patients with pre-existing renal disease or those developing renal insufficiency during therapy, the dose must be reduced or the dosing interval increased. Serum drug levels should be monitored if significant absorption is suspected.
While Neomycin is used to treat hepatic coma, patients with severe liver disease may have altered fluid status or concomitant renal issues (hepatorenal syndrome), requiring close monitoring for systemic accumulation.
Elderly patients are at a higher risk for age-related declines in renal function. Healthcare providers typically perform a baseline creatinine clearance test before initiating therapy to avoid toxicity.
If a dose is missed, it should be taken as soon as remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. Do not double the dose to catch up, as this increases the risk of systemic toxicity.
Signs of Neomycin overdose include acute kidney injury (decreased urination), hearing loss, tinnitus (ringing in the ears), and neuromuscular blockade (difficulty breathing or muscle weakness). In the event of an overdose, contact a Poison Control Center or seek emergency medical attention immediately. Hemodialysis may be required to remove absorbed Neomycin from the blood.
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance.
Because Neomycin is mostly retained in the gut, the most frequent side effects are gastrointestinal in nature. Patients may experience:
> Warning: Stop taking Neomycin and call your doctor immediately if you experience any of these:
Chronic administration of Neomycin (often in the management of hepatic encephalopathy) can lead to cumulative toxicity. The most significant concern is the gradual accumulation of the drug in the inner ear and kidneys, leading to irreversible damage. Periodic audiometric testing and renal function monitoring are required for long-term users.
According to the FDA-approved label, Neomycin carries several Black Box Warnings:
Report any unusual symptoms to your healthcare provider.
Neomycin is a high-alert medication due to its potential for severe toxicity if absorbed systemically. It should only be used for the specific indications approved by your healthcare provider. Patients must be aware that even though it is taken orally, enough drug can be absorbed through the intestinal wall to cause permanent injury to the ears or kidneys, especially if the intestinal lining is damaged or if kidney function is not optimal.
Full FDA Text Summary: Neomycin Sulfate is associated with significant nephrotoxicity and ototoxicity. These toxicities are primarily dependent on the serum concentration of the drug. The risk of ototoxicity is permanent and can occur even after drug discontinuation. Neuromuscular blockade and respiratory paralysis have also been reported following the use of aminoglycosides. Clinical monitoring of renal and auditory function is mandatory during prolonged therapy.
Healthcare providers will typically order the following tests:
Neomycin generally does not cause drowsiness. However, if vestibular toxicity occurs (dizziness or vertigo), patients should not drive or operate heavy machinery until these symptoms are evaluated.
While there is no direct chemical interaction between Neomycin and alcohol, alcohol can exacerbate liver disease and dehydration, both of which increase the risk of Neomycin-induced toxicity. It is generally advised to avoid alcohol during treatment for hepatic encephalopathy.
Neomycin should be used for the shortest duration necessary. For bowel prep, it is a limited 24-hour regimen. For hepatic coma, the drug is tapered based on clinical response and ammonia levels. Do not stop the medication prematurely without consulting your doctor, as this may lead to a recurrence of symptoms.
> Important: Discuss all your medical conditions with your healthcare provider before starting Neomycin.
Neomycin may cause false elevations in urinary glucose tests and may interfere with certain tests for urinary steroids. It can also cause a decrease in serum cholesterol levels due to interference with bile acid metabolism.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking.
Neomycin must NEVER be used in the following circumstances:
Conditions requiring a careful risk-benefit analysis include:
Patients allergic to Neomycin are likely to be allergic to other aminoglycosides, including:
> Important: Your healthcare provider will evaluate your complete medical history before prescribing Neomycin.
FDA Pregnancy Category D. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience. Aminoglycosides can cross the placenta and have been associated with total irreversible bilateral congenital deafness in children whose mothers took the drug during pregnancy. Neomycin should be used during pregnancy only in life-threatening situations where safer drugs are ineffective.
It is not known whether Neomycin is excreted in human milk. However, because many drugs are excreted in milk and because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
Safety and effectiveness in pediatric patients for preoperative bowel prep have not been established. In the treatment of hepatic coma, it has been used, but the risk of toxicity is high. Growth monitoring is not typically an issue with short-term use, but renal and auditory monitoring is paramount.
Clinical studies have shown that patients over the age of 65 are at a significantly higher risk for Neomycin-induced toxicities. This is primarily due to the natural decline in glomerular filtration rate (GFR). Dose selection should be cautious, usually starting at the low end of the dosing range, and renal function must be monitored frequently.
In patients with a GFR below 60 mL/min, the risk of Neomycin accumulation is severe. Dose adjustments are mandatory. If GFR is below 30 mL/min, systemic Neomycin is generally avoided unless the clinical need outweighs the high risk of permanent toxicity.
While used to treat hepatic encephalopathy, the presence of liver failure often leads to secondary renal issues. Healthcare providers must monitor for "hepatorenal syndrome," where the kidneys fail due to liver dysfunction, as this would make Neomycin therapy extremely dangerous.
> Important: Special populations require individualized medical assessment.
Neomycin is a bactericidal aminoglycoside. It acts by binding irreversibly to the 30S ribosomal subunit of susceptible bacteria. This binding induces a conformational change in the A-site of the ribosome, leading to the incorporation of incorrect amino acids into the polypeptide chain. This "mistranslation" results in the production of "nonsense proteins" that insert into the bacterial cell membrane, causing leakage and eventually cell death. It is highly active against aerobic gram-negative bacilli and some gram-positive bacteria.
Neomycin exhibits concentration-dependent killing. This means that higher peak concentrations are more effective at killing bacteria than maintaining a constant level above the Minimum Inhibitory Concentration (MIC). It also possesses a post-antibiotic effect (PAE), where bacterial growth continues to be suppressed even after the drug concentration falls below the MIC.
| Parameter | Value |
|---|---|
| Bioavailability | <3% (Oral) |
| Protein Binding | 0% - 10% |
| Half-life | 2 - 3 hours (Normal Renal Function) |
| Tmax | 1 - 4 hours (for the absorbed fraction) |
| Metabolism | None |
| Excretion | Fecal (~97%), Renal (~3% absorbed portion) |
Neomycin is classified as an Aminoglycoside Antibacterial. It is related to medications such as Gentamicin, Tobramycin, and Kanamycin. Unlike newer antibiotics, it is not metabolized by the Cytochrome P450 system but is a substrate for various bacterial modifying enzymes.
Common questions about Walgreens Multi-antibiotic With Pain Relief Cream
Neomycin is primarily used as an oral medication to reduce the risk of infection before intestinal surgery by cleaning out the bacteria in the bowels. It is also used as an add-on treatment for hepatic encephalopathy, a condition where liver failure causes a buildup of toxins that affect the brain. By killing ammonia-producing bacteria in the gut, Neomycin helps lower toxin levels in the blood. Additionally, it is found in many topical creams for minor skin infections. It is not used for common viral infections like the flu or the cold.
When taken orally, the most common side effects are related to the digestive system because the drug stays mostly in the intestines. Patients frequently report nausea, vomiting, and diarrhea shortly after taking the medication. Some people may also experience stomach cramps or a general feeling of bloating. If used for a long time, it can cause a malabsorption syndrome where the body fails to absorb nutrients properly from food. Most of these symptoms resolve once the medication is finished, but you should report severe diarrhea to your doctor.
It is generally recommended to avoid alcohol while taking Neomycin, especially if you are being treated for liver-related conditions like hepatic encephalopathy. Alcohol can place additional stress on the liver and may contribute to dehydration, which increases the risk of Neomycin-induced kidney damage. While there is no specific chemical 'disulfiram-like' reaction, the combination can complicate the management of your underlying health issues. Always consult your healthcare provider about your alcohol consumption habits before starting this drug. Staying hydrated with water is much safer during treatment.
Neomycin is generally considered unsafe during pregnancy and is classified as FDA Category D. Clinical data suggests that aminoglycoside antibiotics can cross the placenta and cause permanent hearing loss (deafness) in the developing fetus. Because of this risk, it is only used in pregnant women when there are no safer alternatives and the mother's life is at risk. If you are pregnant or planning to become pregnant, you must inform your doctor immediately. They will likely choose a different antibiotic that does not carry the same risk of fetal injury.
The onset of action for Neomycin depends on the condition being treated. For preoperative bowel preparation, the drug begins working within hours to reduce bacterial counts in the gut, which is why it is given the day before surgery. In the case of hepatic encephalopathy, it may take 24 to 48 hours to see a noticeable improvement in mental clarity as ammonia levels begin to drop. It is important to complete the full course as prescribed by your doctor to ensure the bacteria are properly suppressed. Do not stop taking it early even if you feel better.
You should not stop taking Neomycin suddenly without consulting your healthcare provider, particularly if you are using it for hepatic encephalopathy. Stopping the medication abruptly can cause a rapid increase in ammonia levels, leading to a recurrence of confusion or even a hepatic coma. For bowel preparation, the course is very short and must be completed exactly as scheduled for a safe surgery. If you experience severe side effects like hearing changes or decreased urination, contact your doctor immediately. They will provide a safe plan for discontinuing the medication.
If you miss a dose of Neomycin, take it as soon as you remember. However, if it is nearly time for your next scheduled dose, skip the missed dose and continue with your regular schedule. Never take two doses at once to make up for a missed one, as this significantly increases the risk of toxic side effects like kidney damage. For patients preparing for surgery, missing a dose can be critical, so you should call your surgeon's office for specific instructions. Keeping a consistent schedule is the best way to ensure the medication works effectively.
Neomycin is not typically associated with weight gain. In fact, long-term use is more likely to cause weight loss because it can interfere with how your intestines absorb fats and nutrients, a condition known as malabsorption syndrome. If you notice sudden weight gain or swelling in your ankles and feet, this could be a sign of kidney problems (nephrotoxicity) rather than fat gain. This requires immediate medical evaluation. Always report significant changes in your weight to your healthcare provider while taking this medication.
Neomycin has several serious drug interactions that your doctor must monitor. It should not be taken with other drugs that can damage the ears or kidneys, such as certain diuretics (water pills) or other aminoglycoside antibiotics. It can also increase the effect of blood thinners like Warfarin, which might lead to easier bruising or bleeding. Additionally, it can interfere with the absorption of heart medications like Digoxin and certain vitamins. Always provide your doctor with a complete list of all prescriptions, over-the-counter drugs, and herbal supplements you are currently taking.
Yes, Neomycin sulfate is available as a generic medication in several forms, including oral tablets and various topical ointments. Generic versions are required by the FDA to have the same quality, strength, and purity as brand-name versions. Using the generic version can often be more cost-effective for patients and is widely stocked in most pharmacies. Your healthcare provider will prescribe the specific form and strength that is appropriate for your medical condition. Check with your pharmacist to ensure you are receiving the correct generic equivalent prescribed.
Other drugs with the same active ingredient (Neomycin)