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Neomycin Dosage

Medically reviewed on March 5, 2018.

Applies to the following strengths: 125 mg/5 mL; 500 mg

Usual Adult Dose for Bowel Preparation

1 g orally every hour for 4 doses followed by 1 g every 4 hours for 5 doses

Alternate dosing: 6 g/day orally divided every 4 hours for 2 to 3 days

Usual Adult Dose for Hepatic Encephalopathy

4 to 12 g/day orally divided every 4 to 6 hours for 5 to 6 days

Usual Adult Dose for Hepatic Coma

4 to 12 g/day orally divided every 4 to 6 hours for 5 to 6 days

Usual Adult Dose for Diarrhea

3 g/day orally in 4 divided doses

Usual Pediatric Dose for Bowel Preparation

The safety and efficacy of neomycin in children less than 18 years of age has not been established. However, the use of neomycin may be appropriate is some situations.

Less than 1 month: 50 mg/kg/day orally divided every 6 hours
1 year to 18 years: 50 to 100 mg/kg/day orally divided every 6 hours

Usual Pediatric Dose for Hepatic Encephalopathy

The safety and efficacy of neomycin in children less than 18 years of age has not been established. However, the use of neomycin may be appropriate is some situations.

1 month to 18 years: 50 to 100 mg/kg/day orally divided every 6 to 8 hours for 5 to 6 days

Usual Pediatric Dose for Hepatic Coma

The safety and efficacy of neomycin in children less than 18 years of age has not been established. However, the use of neomycin may be appropriate is some situations.

1 month to 18 years: 50 to 100 mg/kg/day orally divided every 6 to 8 hours for 5 to 6 days

Usual Pediatric Dose for Diarrhea

The safety and efficacy of neomycin in children less than 18 years of age has not been established. However, the use of neomycin may be appropriate is some situations.

Less than 1 month: 50 mg/kg/day orally divided every 6 hours
1 year to 18 years: 50 mg/kg/day orally divided every 6 hours for 2 to 3 days

Renal Dose Adjustments

Patients with impaired renal function have a high risk of developing nephrotoxicity and ototoxicity with oral neomycin. Use of a less nephrotoxic medication may be a consideration for this patient.

Liver Dose Adjustments

In chronic hepatic insufficiency, it may be necessary to give neomycin sulfate 4 g daily for an indefinite period, if less toxic drugs cannot be used.

Dose Adjustments

Caution should be used when administering neomycin to patients with renal impairment. Dose reduction should be considered in these patients.

Precautions

US BOXED WARNING:
-TOXICITY: Neurotoxicity (including ototoxicity and nephrotoxicity) following the oral use of this drug has been reported, even when used in recommended doses. The potential for nephrotoxicity, permanent bilateral auditory ototoxicity, and sometimes vestibular toxicity are present in patients with normal renal function when treated with higher doses of this drug and/or for longer periods than recommended. The risk of nephrotoxicity and ototoxicity is greater in patients with impaired renal function. Other factors which increase the risk of toxicity are advanced age and dehydration.
-OTOTOXICITY: This adverse effect is often delayed in onset and patients developing cochlear damage will not have symptoms during therapy to warn them of developing eighth nerve destruction. Total or partial deafness may occur long after this drug has been discontinued.
-NEUROMUSCULAR BLOCKAGE AND RESPIRATORY PARALYSIS: These adverse effects have been reported following the oral use of this drug. Consider the possibility of these adverse effects occurring, especially to patients receiving anesthetics; neuromuscular blocking agents such as tubocurarine, succinylcholine, decamethonium; or in patients receiving massive transfusions of citrate anticoagulated blood. If blockage occurs, calcium salts may reverse these phenomena but mechanical respiratory assistance may be necessary.
-MONITORING: Closely observe patients because of the potential toxicity associated with the use of this drug. Perform serial, vestibular, and audiometric tests, as well as tests of renal function.
-CONCURRENT THERAPY: Avoid concurrent and/or sequential systemic, oral, or topical use of other aminoglycosides, including paromomycin and other potentially nephrotoxic and/or neurotoxic drugs such as bacitracin, cisplatin, vancomycin, amphotericin B, polymyxin B, colistin, and viomycin because the toxicity may be additive. Also avoid concomitant use with potent diuretics (ethacrynic acid or furosemide) since diuretics by themselves may cause ototoxicity, and when administered intravenously, they may enhance toxicity by altering antibiotic concentrations in serum and tissue.

Consult WARNINGS section for additional precautions.

Dialysis

Patients with impaired renal function have a high risk of developing nephrotoxicity and ototoxicity with oral neomycin. Use of a less nephrotoxic medication may be a consideration for this patient.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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