Neomycin Side Effects

For the Consumer

Applies to neomycin: oral solution, oral tablet

As well as its needed effects, neomycin may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking neomycin, check with your doctor immediately:

• Any loss of hearing
• clumsiness
• diarrhea
• difficulty in breathing
• dizziness
• drowsiness
• greatly decreased frequency of urination or amount of urine
• increased amount of gas
• increased thirst
• light-colored, frothy, fatty-appearing stools
• ringing or buzzing or a feeling of fullness in the ears
• skin rash
• unsteadiness
• weakness

Minor Side Effects

Some neomycin side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

• Irritation or soreness of the mouth or rectal area
• nausea or vomiting

For Healthcare Professionals

Applies to neomycin: compounding powder, oral solution, oral tablet

General

Since oral neomycin is absorbed systemically after oral administration, its use may result in nephrotoxicity, neurotoxicity and/or ototoxicity, even at recommended doses and in patients with normal renal function.^[Ref]

Renal

The major renal side effect of oral neomycin is nephrotoxicity, which has occurred even at recommended doses and in patients with normal renal function.^[Ref]

Early signs of nephropathy include mild proteinuria, sloughing of renal tubular epithelial cells, formation of cellular casts, and decreases in creatinine clearance. Often there is a high output renal failure where daily urine volume may appear unchanged until significant increases in serum creatinine and BUN levels occur.

Neomycin damages renal tubules by causing tubular epithelial cell necrosis. It is considered the most nephrotoxic aminoglycoside.^[Ref]

Nervous system

Early symptoms of neomycin-induced auditory toxicity may manifest as high tone hearing loss, tinnitus, or a feeling of fullness in the ear, or its onset may be asymptomatic. If ototoxicity occurs, the onset of hearing loss is between several days to 6 weeks after therapy begins; however, it may not occur for months or years after neomycin has been discontinued. Symptoms of vestibulotoxicity may include tinnitus, vertigo and ataxia.

Neomycin is considered more ototoxic than vestibulotoxic. It progressively accumulates in the inner ear and which leads to sensory hair cell loss in the in the cochlea and damage to the stria vascularis. In an animal study, neomycin was found to be more ototoxic than gentamicin, kanamycin and dihydrostreptomycin.

One case report series describes 5 cases of hearing impairment associated with long-term oral neomycin therapy for hepatic encephalopathy. Doses ranged from 2 to 12 g/day and were administered for 8 to 28 months; in 2 cases paromomycin was also administered. Renal failure did not occur.^[Ref]

Nervous system side effects associated with oral neomycin therapy have included neuromuscular blockade, respiratory paralysis, and eighth cranial nerve damage with hearing loss, even at recommended doses and in patients with normal renal function. Symptoms of neurotoxicity include numbness, tingling, muscle twitching, and convulsions.^[Ref]

Other

Oral neomycin therapy may result in overgrowth of nonsusceptible organisms, especially fungi.^[Ref]

A case of fatal Candida albicans pyelonephritis and septicemia following preoperative bowel preparation with oral neomycin and bacitracin has been reported.^[Ref]

Gastrointestinal

Gastrointestinal side effects most commonly include nausea, vomiting and diarrhea. Clostridium difficile colitis has also been reported with oral neomycin therapy.^[Ref]

It is possible that some side effects of neomycin may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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