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Neomycin, Polymyxin B, and Hydrocortisone (Topical)

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.

Cream, External:

Cortisporin: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone 0.5% per g (7.5 g) [contains methylparaben, propylene glycol]

Brand Names: U.S.

  • Cortisporin

Pharmacologic Category

  • Antibiotic, Topical
  • Antibiotic/Corticosteroid, Topical
  • Corticosteroid, Topical

Pharmacology

See individual agents.

Use: Labeled Indications

Corticosteroid-responsive dermatoses with secondary infection: Treatment of corticosteroid-responsive dermatoses with secondary infection.

Contraindications

Hypersensitivity to neomycin, polymyxin B, hydrocortisone, or any component of the formulation; tuberculous, fungal, or viral lesions of the skin (herpes simplex, vaccinia, and varicella); application to external ear canal if eardrum is perforated; ophthalmic administration

Dosing: Adult

Corticosteroid-responsive dermatoses with secondary infection: Topical: Apply a thin layer 2 to 4 times daily. Therapy should be discontinued when control is achieved; if no improvement is seen, reassessment of diagnosis may be necessary

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Corticosteroid-responsive dermatoses with secondary infection:Topical: Children and Adolescents (off-label use): Some centers have used one application (a thin layer to affected areas) 2 to 4 times daily for up to 7 days. Therapy should be discontinued when control is achieved or after 7 days.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.

Administration

Topical: For external use only. Rub gently into affected area, as condition permits

Storage

Store at 15°C to 25°C (59°F to 77°F).

Drug Interactions

Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Avoid combination

Ceritinib: Corticosteroids may enhance the hyperglycemic effect of Ceritinib. Monitor therapy

Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Monitor therapy

Deferasirox: Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Monitor therapy

Hyaluronidase: Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Consider therapy modification

Adverse Reactions

For additional information, see hydrocortisone (topical).

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: Systemic absorption of topical corticosteroids may cause hypercorticism 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 may also increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines.

• 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.

• 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.

Special populations:

• Elderly: Because of the risk of adverse effects associated with systemic absorption, topical corticosteroids should be used cautiously in the elderly in the smallest possible effective dose for the shortest duration.

• 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.

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted with this combination. See individual agents.

Patient Education

• 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 signs of high blood sugar (confusion, feeling sleepy, more thirst, hunger, passing urine more often, flushing, fast breathing, or breath that smells like fruit), signs of skin changes (pimples, stretch marks, slow healing, or hair growth), edema, pain, or severe skin 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.

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