Neomycin, Polymyxin B, and Gramicidin
Medically reviewed by Drugs.com. Last updated on Sep 4, 2019.
(nee oh MYE sin, pol i MIKS in bee, & gram i SYE din)
- Gramicidin, Neomycin, and Polymyxin B
- Polymyxin B, Neomycin, and Gramicidin
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Ophthalmic [drops]:
Neosporin Ophthalmic Solution: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin 0.025 mg per 1 mL (10 mL) [DSC]
Generic: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin 0.025 mg per 1 mL (10 mL)
Brand Names: U.S.
- Neosporin Ophthalmic Solution [DSC]
- Antibiotic, Ophthalmic
Interferes with bacterial protein synthesis by binding to 30S ribosomal subunits; binds to phospholipids, alters permeability, and damages the bacterial cytoplasmic membrane permitting leakage of intracellular constituents
Use: Labeled Indications
Superficial ocular infections: Short-term treatment of superficial external ocular infections caused by susceptible organisms
Hypersensitivity to neomycin, polymyxin B, gramicidin or any component of the formulation
Superficial ocular infections: Ophthalmic: Instill 1-2 drops into affected eye(s) every 4 hours or 2 drops per hour for severe infections for 7 to 10 days
Refer to adult dosing.
Refer to adult dosing.
Acarbose: Neomycin may enhance the adverse/toxic effect of Acarbose. Neomycin may decrease the metabolism of Acarbose. Monitor therapy
Amphotericin B: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Arbekacin: May enhance the nephrotoxic effect of Aminoglycosides. Arbekacin may enhance the ototoxic effect of Aminoglycosides. Monitor therapy
Ataluren: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, an increased risk of nephrotoxicity may occur with the concomitant use of ataluren and aminoglycosides. Avoid combination
Bacitracin (Systemic): Polymyxin B may enhance the nephrotoxic effect of Bacitracin (Systemic). Avoid combination
Bacitracin (Systemic): Neomycin may enhance the nephrotoxic effect of Bacitracin (Systemic). Avoid combination
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy
Bisphosphonate Derivatives: Aminoglycosides may enhance the hypocalcemic effect of Bisphosphonate Derivatives. Monitor therapy
Botulinum Toxin-Containing Products: Aminoglycosides may enhance the neuromuscular-blocking effect of Botulinum Toxin-Containing Products. Monitor therapy
Capreomycin: May enhance the neuromuscular-blocking effect of Polymyxin B. Monitor therapy
CARBOplatin: Aminoglycosides may enhance the ototoxic effect of CARBOplatin. Especially with higher doses of carboplatin. Monitor therapy
Cardiac Glycosides: Aminoglycosides may decrease the serum concentration of Cardiac Glycosides. This effect has only been demonstrated with oral aminoglycoside administration. Monitor therapy
Cefazedone: May enhance the nephrotoxic effect of Polymyxin B. Monitor therapy
Cephalosporins (2nd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Cephalosporins (3rd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Cephalosporins (4th Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Cephalothin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Cephradine: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Avoid combination
CISplatin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Colistimethate: Aminoglycosides may enhance the nephrotoxic effect of Colistimethate. Aminoglycosides may enhance the neuromuscular-blocking effect of Colistimethate. Consider therapy modification
CycloSPORINE (Systemic): Aminoglycosides may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Monitor therapy
Distigmine: Aminoglycosides may diminish the therapeutic effect of Distigmine. Monitor therapy
Foscarnet: May enhance the nephrotoxic effect of Aminoglycosides. Avoid combination
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy
Loop Diuretics: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Monitor therapy
Mannitol (Systemic): May enhance the nephrotoxic effect of Aminoglycosides. Avoid combination
Mecamylamine: Polymyxin B may enhance the neuromuscular-blocking effect of Mecamylamine. Avoid combination
Methoxyflurane: May enhance the nephrotoxic effect of Polymyxin B. Avoid combination
Neuromuscular-Blocking Agents: Polymyxin B may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Consider therapy modification
Nonsteroidal Anti-Inflammatory Agents: May decrease the excretion of Aminoglycosides. Data only in premature infants. Monitor therapy
Oxatomide: May enhance the ototoxic effect of Aminoglycosides. Monitor therapy
Penicillins: May decrease the serum concentration of Aminoglycosides. Primarily associated with extended spectrum penicillins, and patients with renal dysfunction. Exceptions: Amoxicillin; Ampicillin; Bacampicillin; Cloxacillin; Dicloxacillin; Nafcillin; Oxacillin; Penicillin G (Parenteral/Aqueous); Penicillin G Benzathine; Penicillin G Procaine; Penicillin V Benzathine; Penicillin V Potassium. Consider therapy modification
Regorafenib: Neomycin may decrease serum concentrations of the active metabolite(s) of Regorafenib. Monitor therapy
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification
SORAfenib: Neomycin may decrease the serum concentration of SORAfenib. Monitor therapy
Tenofovir Products: Aminoglycosides may increase the serum concentration of Tenofovir Products. Tenofovir Products may increase the serum concentration of Aminoglycosides. Monitor therapy
Vancomycin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
Vitamin K Antagonists (eg, warfarin): Neomycin may enhance the anticoagulant effect of Vitamin K Antagonists. Monitor therapy
Frequency not defined.
Dermatologic: Maculopapular rash, urticaria, vesicular eruption
Ophthalmic: Burning sensation of eyes, eye irritation (transient), eye pruritus, ophthalmic inflammation, stinging of eyes
Concerns related to adverse effects:
• Neomycin sensitization: Symptoms of neomycin sensitization include itching, reddening, edema, and failure to heal.
• Ocular effects (prolonged use): Glaucoma, defects in visual acuity, posterior subcapsular cataract formation, and secondary ocular infections may result from prolonged use.
Pregnancy Risk Factor
Animal reproduction studies have not been conducted with this combination. See individual monographs for Neomycin and Polymyxin B.
What is this drug used for?
• It is used to treat eye infections.
Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:
• Kidney problems like unable to pass urine, blood in the urine, change in amount of urine passed, or weight gain
• Vision changes
• Eye pain
• Severe eye irritation
• Eye discharge
• Noise or ringing in ears
• Hearing loss
• Hearing changes
• Signs of a significant reaction like 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. Talk to your doctor if you have questions.
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