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Neomycin, Polymyxin B, and Dexamethasone


Pronunciation

 (nee oh MYE sin, pol i MIKS in bee, & deks a METH a sone)


U.S. Brand Names

 AK-Trol®; Dexacidin® [DSC]; Dexacine™ [DSC]; Dexasporin; Maxitrol®; Methadex


Synonyms

 Dexamethasone, Neomycin, and Polymyxin B; Polymyxin B, Neomycin, and Dexamethasone


Generic Available

 Yes


Canadian Brand Names

 Dioptrol®; Maxitrol®


Use

 Steroid-responsive inflammatory ocular conditions in which a corticosteroid is indicated and where bacterial infection or a risk of bacterial infection exists


Pregnancy Risk Factor

 C


Pregnancy Implications

 See individual agents.


Lactation

 Excretion in breast milk unknown/use caution


Contraindications

 Hypersensitivity to neomycin, polymyxin B, dexamethasone, or any component of the formulation; viral, fungal, or tuberculosis diseases of the eye


Warnings/Precautions

 Sensitivity to neomycin may develop; discontinue if sensitivity reaction occurs. Prolonged use of corticosteroids may result in glaucoma; damage to the optic nerve, defects in visual acuity and fields of vision, and posterior subcapsular cataract formation may occur. Prolonged use of corticosteroids may increase the incidence of secondary ocular infection or mask acute infection (including fungal infections); may prolong or exacerbate ocular viral infections; use following cataract surgery may delay healing or increase the incidence of bleb formation. A maximum of 8 g of ointment or 20 mL of suspension should be prescribed initially; patients should be evaluated prior to additional refills. Suspension contains benzalkonium chloride which may be adsorbed by contact lenses; contact lenses should not be worn during treatment of ophthalmic infections.


Adverse Reactions

 Frequency not defined: Ocular: Allergic sensitivity, cutaneous sensitization, eye pain, development of glaucoma, cataract, increased intraocular pressure, optic nerve damage, wound healing delayed


Drug Interactions

 Dexamethasone: Substrate of CYP3A4 (minor); Induces CYP2A6 (weak), 2B6 (weak), 2C8/9 (weak), 3A4 (weak)

Also see individual agents.


Mechanism of Action

 See individual agents.


Pharmacodynamics/Kinetics

 See individual agents.


Dosage

 Children and Adults: Ophthalmic:

Ointment: Place a small amount (~ 1 /2") in the affected eye 3-4 times/day or apply at bedtime as an adjunct with drops

Suspension: Instill 1-2 drops into affected eye(s) every 3-4 hours; in severe disease, drops may be used hourly and tapered to discontinuation


Administration

 Contact lenses should not be worn during therapy.

Ointment: Do not touch tip of tube to eye. Instill ointment into pocket between eyeball and lower lid; patient should look downward before closing eye.

Suspension: Shake suspension before use. Tilt head back, instill suspension in conjunctival sac and close eye(s). Do not touch dropper to eye. Apply light finger pressure on lacrimal sac for 1 minute following instillation.


Monitoring Parameters

 Monitor intraocular pressure with use longer than 10 days


Patient Education

 Notify prescriber if condition worsens or does not improve in 3-4 days


Dental Health: Effects on Dental Treatment

 No significant effects or complications reported


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 No information available to require special precautions


Mental Health: Effects on Mental Status

 None reported


Mental Health: Effects on Psychiatric Treatment

 None reported


Dosage Forms

 [DSC] = Discontinued product

Ointment, ophthalmic (Dexacine™ [DSC], Maxitrol®): Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexamethasone 0.1% per g (3.5 g)

Suspension, ophthalmic (AK-Trol®, Dexacidin® [DSC], Dexasporin, Maxitrol®, Methadex): Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexamethasone 0.1% per mL (5 mL) [contains benzalkonium chloride]


International Brand Names

 Dioptrol® (CA); Maxitrol® (CA)


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