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Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic)

Medically reviewed by Drugs.com. Last updated on June 6, 2020.

Pronunciation

(nee oh MYE sin, pol i MIKS in bee, & hye droe KOR ti sone)

Index Terms

  • Hydrocortisone, Neomycin, and Polymyxin B
  • Neomycin/Polymyxin B Sulf/Hc
  • Polymyxin B, Neomycin, and Hydrocortisone

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Suspension, Ophthalmic:

Generic: Neomycin sulfate 3.5 mg/mL, polymyxin B 10,000 units/mL, and hydrocortisone 1% (7.5 mL)

Pharmacologic Category

  • Antibiotic, Ophthalmic
  • Antibiotic/Corticosteroid, Ophthalmic
  • Corticosteroid, Ophthalmic

Pharmacology

See individual agents.

Use: Labeled Indications

Ocular inflammatory conditions: Management of steroid-responsive inflammatory ocular conditions where bacterial infection or a risk of bacterial infection exists

Contraindications

Hypersensitivity to neomycin, polymyxin B, hydrocortisone, 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

Dosing: Adult

Ocular inflammatory conditions: Ophthalmic: Instill 1 to 2 drops into affected eye(s) every 3 to 4 hours, or more frequently as required for severe infections Reevaluate patient if improvement not observed after 2 days of therapy. Monitor IOP if therapy exceeds 10 days

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Ocular inflammation/infection: Limited data available: Children and Adolescents: Ophthalmic: 1 to 2 drops in the affected eye(s) every 3 to 4 hours has been used by some centers; dosing based on experience with other combination ophthalmic products with similar ingredients

Administration

Ophthalmic: 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.

Storage

Store at 20°C to 25°C (68°F to 77°F).

Drug Interactions

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

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

Ophthalmic: Eye irritation

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: Systemic absorption of topical corticosteroids may cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.

• 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.

• Kaposi sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi sarcoma (case reports); if noted, discontinuation of therapy should be considered (Goedert 2002).

• Neomycin sensitization: Neomycin may cause cutaneous sensitization. Symptoms of neomycin sensitization include itching, reddening, edema, and failure to heal. Discontinuation of product and avoidance of similar products should be considered.

• Ocular effects: Prolonged use of corticosteroids may result in ocular hypertension and/or 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.

• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing's syndrome, hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas.

Disease-related concerns:

• 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.

Special populations:

• Pediatric: Children may absorb proportionally larger amounts of corticosteroids after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing's syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients.

Dosage form specific issues:

• Sulfites: Some formulations may contain sulfites, which may cause allergic-type reactions in susceptible individuals.

Other warnings/precautions:

• Appropriate use: Ophthalmic suspension: Never directly introduce (eg, inject) into the anterior chamber. A maximum of 20 mL of suspension should be prescribed initially; re-evaluate 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 tip has caused bacterial keratitis.

Monitoring Parameters

Monitor intraocular pressure with use longer than 10 days and in patients with glaucoma

Pregnancy Risk Factor

C

Pregnancy Considerations

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 punctal occlusion to decrease potential exposure to the fetus (Samples 1988). Refer to individual agents.

Patient Education

What is this drug used for?

• It is used to treat or prevent eye infections.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Vision changes

• Eye pain

• Severe eye irritation

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

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