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Pronunciation:

(par oh moe MYE sin)

U.S. Brand Names:

Humatin®

Synonyms:

Paromomycin Sulfate

Generic Available:

Yes

Canadian Brand Names:

Humatin®

Use:

Treatment of acute and chronic intestinal amebiasis; hepatic coma

Use - Unlabeled/Investigational:

Treatment of cryptosporidiosis

Pregnancy Risk Factor:

Lactation:

Does not enter breast milk/compatible

Contraindications:

Hypersensitivity to paromomycin or any component of the formulation; intestinal obstruction, renal failure

Warnings/Precautions:

Use with caution in patients with impaired renal function or possible or proven ulcerative bowel lesions

Adverse Reactions:

1% to 10%: Gastrointestinal: Diarrhea, abdominal cramps, nausea, vomiting, heartburn

<1%: Headache, vertigo, exanthema, rash, pruritus, steatorrhea, secondary enterocolitis, eosinophilia, ototoxicity

Overdosage/Toxicology:

Symptoms of overdose include nausea, vomiting, diarrhea

Following GI decontamination, if possible; care is supportive and symptomatic

Drug Interactions:

Decreased effect of digoxin, vitamin A, and methotrexate

Increased effect of oral anticoagulants, neuromuscular blockers, and polypeptide antibiotics

Ethanol/Nutrition/Herb Interactions:

Food: Paromomycin may cause malabsorption of xylose, sucrose, and fats.

Mechanism of Action:

Acts directly on ameba; has antibacterial activity against normal and pathogenic organisms in the GI tract; interferes with bacterial protein synthesis by binding to 30S ribosomal subunits

Pharmacodynamics/Kinetics:

Absorption: None

Excretion: Feces (100% as unchanged drug)

Dosage:

Oral:

Intestinal amebiasis: Children and Adults: 25-35 mg/kg/day in 3 divided doses for 5-10 days

Dientamoeba fragilis: Children and Adults: 25-30 mg/kg/day in 3 divided doses for 7 days

Cryptosporidium (unlabeled use): Adults with AIDS: 1.5-2.25 g/day in 3-6 divided doses for 10-14 days (occasionally courses of up to 4-8 weeks may be needed)

Tapeworm (fish, dog, bovine, porcine):

Children: 11 mg/kg every 15 minutes for 4 doses

Adults: 1 g every 15 minutes for 4 doses

Hepatic coma: Adults: 4 g/day in 2-4 divided doses for 5-6 days

Dwarf tapeworm: Children and Adults: 45 mg/kg/dose every day for 5-7 days

Patient Education:

Take as directed, for full course of therapy. Do not skip doses. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake, and nutrition. If GI upset occurs, small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help. Report unresolved or severe nausea or vomiting, dizziness, ringing in ears, or loss of hearing. Pregnancy precaution: Inform prescriber if you are pregnant.

Nursing Implications:

Monitor hearing loss before and during therapy

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:

May cause dizziness

Mental Health: Effects on Psychiatric Treatment:

None reported

Dosage Forms:

Capsule: 250 mg

International Brand Names:

Dediacol® (GT, SV); Gabbromicina® (HK); Gabbroral® (BE, ID, IT, LU); Gabroral® (BG); Humatin® (AT, CA, CH, DE, ES, IT); Humatin-Pulvis® (AT); Kaman® (IT); Paramox® (DO)

References

Danziger LH, Kanyok TP, and Novak RM, "Treatment of Cryptosporidial Diarrhea in an AIDS Patient With Paromomycin,"Ann Pharmacother, 1993, 27(12):1460-2.

"Drugs for Parasitic Infections,"Med Lett Drugs Ther, 1998, 40(1017):1-12.

Liu LX and Weller PF, "Antiparasitic Drugs,"N Engl J Med, 1996, 334(18):1178-84.

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