Neomycin, Polymyxin B, and Dexamethasone
Medically reviewed by Drugs.com. Last updated on Jan 6, 2019.
(nee oh MYE sin, pol i MIKS in bee, & deks a METH a sone)
- Dexamethasone, Neomycin, and Polymyxin B
- Neo/Polymyx B Sulf/Dexameth
- Polymyxin B, Neomycin, and Dexamethasone
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment, ophthalmic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexamethasone 0.1% per g (3.5 g)
Maxitrol: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexamethasone 0.1% per g (3.5 g)
Suspension, ophthalmic [drops]: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexamethasone 0.1% per 1 mL (5 mL)
Maxitrol: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexamethasone 0.1% per 1 mL (5 mL) [contains benzalkonium chloride]
Brand Names: U.S.
- Antibiotic/Corticosteroid, Ophthalmic
See individual agents.
Use: Labeled Indications
Inflammatory ocular conditions: Management of corticosteroid-responsive inflammatory ocular conditions where bacterial infection or a risk of bacterial infection exists
Hypersensitivity to neomycin, polymyxin B, dexamethasone, or any component of the formulation; viral disease of the cornea and conjunctiva (including epithelial herpes simplex keratitis [dendritic keratitis], vaccinia, varicella); mycobacterial ophthalmic infection; fungal diseases of ocular structures
Canadian labeling: Additional contraindications (not in US labeling): Untreated parasitic ophthalmic infection
Inflammatory ocular conditions: Ophthalmic:
Suspension: Instill 1 to 2 drops into the conjunctival sac of the affected eye(s) 4 to 6 times daily. In severe disease, drops may be used hourly; frequency should decrease as signs and symptoms improve.
Ointment: Place ~1/2” ribbon in the conjunctival sac of the affected eye(s) 3 to 4 times daily
Note: If signs and symptoms do not improve after 2 days of treatment, the patient should be reevaluated.
Refer to adult dosing.
Inflammatory ocular conditions: Ophthalmic: Suspension: Children ≥2 years and Adolescents: Instill 1 to 2 drops into the conjunctival sac of the affected eye(s) 4 to 6 times daily; in severe disease, drops may be used hourly and tapered to discontinuation
Ophthalmic: Note: Contact lenses should not be worn during therapy.
Ointment: Apply into pocket between eyeball and lower lid; patient should look downward before closing eye. To avoid contamination, do not touch tip of tube to eye or any other surface.
Suspension: Shake well before using. Tilt head back, instill suspension into the conjunctival sac, and close eye(s). Apply light finger pressure on lacrimal sac for 1 minute following instillation. To avoid contamination, do not touch dropper to eye or any other surface.
Ointment: Store between 2°C to 25°C (36°F to 77°F).
Suspension: Store between 8°C to 27°C (46°F to 80°F).
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Dexamethasone (Ophthalmic). Monitor therapy
Nonsteroidal Anti-Inflammatory Agents (Ophthalmic): May enhance the adverse/toxic effect of Corticosteroids (Ophthalmic). Healing of ophthalmic tissue during concomitant administration of ophthalmic products may be delayed. Monitor therapy
Ritodrine: Corticosteroids may enhance the adverse/toxic effect of Ritodrine. Monitor therapy
Also see individual agents.
Frequency not defined:
Hypersensitivity: Hypersensitivity reaction
Infection: Secondary infection
Ophthalmic: Glaucoma, increased intraocular pressure, optic nerve damage (infrequent), subcapsular posterior cataract
Miscellaneous: Wound healing impairment
<1%, postmarketing, and/or case reports: Headache, keratitis (ulcerative), Stevens-Johnson syndrome
Concerns related to adverse effects:
• Immunosuppression: Prolonged use of corticosteroids (including ophthalmic preparations) may increase the incidence of secondary ocular infections (including fungal infections). Acute purulent ocular infections may be masked or exacerbated with use. Fungal infection should be suspected in any patient with persistent corneal ulceration who has received corticosteroids.
• Neomycin sensitization: Neomycin may cause cutaneous sensitization. Discontinue use if hypersensitivity occurs. Cross-sensitivity to other topical or systemic aminoglycosides may occur.
• Ocular effects: Prolonged use of corticosteroids may result in glaucoma; damage to the optic nerve, defects in visual acuity and fields of vision, corneal and scleral thinning (leading to perforation), and posterior subcapsular cataract formation may occur. Use following cataract surgery may delay healing or increase the incidence of bleb formation.
• Glaucoma: Use with caution in patients with glaucoma.
• Ocular herpes simplex: Use with extreme caution in patients with a history of ocular herpes simplex; frequent slit lamp microscopy is recommended.
Dosage-forms specific issues:
• Ophthalmic suspension: May contain benzalkonium chloride, which may be absorbed by soft contact lenses; contact lenses should not be worn during treatment of ophthalmologic infections.
• Appropriate use: Never directly introduce (eg, inject) into the anterior chamber. A maximum of 8 g of ointment or 20 mL of suspension should be prescribed initially; reevaluate patients (eg, intraocular pressure and exams using magnification and fluorescein staining, where appropriate) prior to additional refills. Use >10 days should include routine monitoring of intraocular pressure. Inadvertent contamination of multiple-dose ophthalmic bottle dropper and tips has caused bacterial keratitis.
Monitor intraocular pressure with use >10 days and in patients with glaucoma; reevaluate if signs and symptoms persist beyond 2 days.
Adverse events have been observed with topical corticosteroids in animal reproduction studies. If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctual occlusion to decrease potential exposure to the fetus (Samples 1988). Refer to individual agents.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Have patient report immediately to prescriber vision changes, eye pain, or severe eye irritation (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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