Drug Interactions between Neo-Polycin and netilmicin

MONITOR: Aminoglycosides administered via the ophthalmic route have the potential to be absorbed systemically, which could lead to additive effects when used simultaneously with systemic aminoglycosides. In general, poor administration technique may be associated with increased systemic exposure of ophthalmic products by enhanced absorption via the nasolacrimal duct to the nasopharyngeal mucosa, or from the skin surrounding the eye. Patient specific factors such as age (young or advanced) and other comorbidities such as existing renal dysfunction may also contribute. Theoretically, the risk of additive ototoxicity, nephrotoxicity, and/or other adverse effects associated with aminoglycosides may be increased, particularly in patients on systemic aminoglycosides for a longer duration of time and/or at larger doses. Clinical data are not available.

MANAGEMENT: Caution and increased monitoring are advised if systemic aminoglycosides are coadministered with ophthalmic aminoglycoside preparations. Renal function and aminoglycoside levels should be more closely monitored, particularly in circumstances where systemic absorption may be increased and/or in patients at an increased risk of adverse effects from aminoglycoside toxicity. For example, patients with preexisting-existing renal dysfunction, ototoxicity-enhancing risk factors (e.g., neonates, use of other ototoxic agents, otitis media, genetic susceptibility), young or advanced age, and/or barriers to proper ophthalmic administration may all benefit from closer monitoring. Patients should be counseled on the correct use of the ophthalmic preparation to help reduce the amount of drug available to be systemically absorbed.