NEO-RX

Clinical safety rating: caution

Comprehensive clinical and safety monograph for NEO-RX (NEO-RX).

How it works

Aminoglycoside antibiotic that binds to the 30S ribosomal subunit, causing misreading of mRNA and inhibition of protein synthesis in susceptible bacteria.

What the body does with it

Metabolism	Not significantly metabolized; primarily eliminated unchanged by glomerular filtration.
Excretion	Renal excretion accounts for 90-100% of elimination, primarily as the parent drug via glomerular filtration and tubular secretion. Urinary excretion: 90-100% unchanged. Fecal/biliary: negligible (<2%).
Half-life	Terminal elimination half-life is 2.5-3 hours in adults with normal renal function; increased to up to 10-15 hours in severe renal impairment (CrCl <30 mL/min). Clinically, this supports 8-hourly dosing intervals in normal renal function, with extended intervals in renal impairment.
Protein binding	10-20% bound to serum proteins (primarily albumin).
Volume of Distribution	Volume of distribution (Vd) is 0.2-0.3 L/kg in adults, indicating primarily extracellular fluid distribution. Higher Vd (0.3-0.5 L/kg) in neonates and critically ill patients with fluid overload.
Bioavailability	Intravenous: 100%. Intramuscular: 90-95% (rapid and complete absorption). Subcutaneous: 75-90%. Oral: <1% (not administered orally).
Onset of Action	Intravenous: immediate (within 5-10 minutes for peak plasma concentration). Intramuscular: 30-60 minutes. Subcutaneous: 1-2 hours.
Duration of Action	Duration is 8-12 hours for therapeutic effect; extends to 12-18 hours in renal impairment. Clinical notes: Prolonged duration in renal failure necessitates monitoring for toxicity (ototoxicity, nephrotoxicity).

Classification & Brands

Dosing & administration

100 mg intravenously every 12 hours.

Dosage form	POWDER
Renal impairment	CrCl >50 mL/min: no adjustment; CrCl 10-50 mL/min: 50 mg every 12 hours; CrCl <10 mL/min: 50 mg every 24 hours.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: 50 mg every 12 hours; Child-Pugh C: 50 mg every 24 hours.
Pediatric use	2 mg/kg intravenously every 12 hours; maximum 100 mg per dose.
Geriatric use	Initial dose reduction to 50 mg intravenously every 12 hours; titrate based on renal function and tolerance.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for NEO-RX (NEO-RX).

Breastfeeding	NEO-RX is excreted into breast milk; M/P ratio unknown. Use with caution in lactating women due to potential for infant side effects such as sedation and respiratory depression. Consider alternative breastfeeding method if high maternal doses are required.
Teratogenic Risk	First trimester: No evidence of teratogenicity in human studies; animal studies show no fetal harm. Second and third trimesters: Increased risk of fetal bradycardia and hypoglycemia with late pregnancy exposure. Avoid use near term due to potential neonatal withdrawal syndrome.

Warnings & precautions

■ FDA Black Box Warning

WARNING: Nephrotoxicity, ototoxicity (vestibular and cochlear), and neuromuscular blockade. Risk increases with prolonged use, high doses, renal impairment, and concurrent use of other nephrotoxic/ototoxic drugs. Monitoring of renal function and drug levels required.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to aminoglycosides","Myasthenia gravis (risk of neuromuscular blockade)","Severe renal impairment (unless benefit outweighs risk and dose adjustment is possible)","Pregnancy (risk of fetal ototoxicity)"]

Clinical Precautions

Precautions

["Monitor renal function, audiometric tests, and drug serum concentrations (peak and trough) to reduce toxicity.","Adjust dose based on renal function; avoid prolonged use.","Caution in elderly, dehydrated patients, and those with pre-existing renal impairment."]

Clinical Tips & Counseling

Drug interactions

Loading safety data…

NEO-RX

Clinical safety rating: caution

Comprehensive clinical and safety monograph for NEO-RX (NEO-RX).

How it works

Aminoglycoside antibiotic that binds to the 30S ribosomal subunit, causing misreading of mRNA and inhibition of protein synthesis in susceptible bacteria.

What the body does with it

Metabolism	Not significantly metabolized; primarily eliminated unchanged by glomerular filtration.
Excretion	Renal excretion accounts for 90-100% of elimination, primarily as the parent drug via glomerular filtration and tubular secretion. Urinary excretion: 90-100% unchanged. Fecal/biliary: negligible (<2%).
Half-life	Terminal elimination half-life is 2.5-3 hours in adults with normal renal function; increased to up to 10-15 hours in severe renal impairment (CrCl <30 mL/min). Clinically, this supports 8-hourly dosing intervals in normal renal function, with extended intervals in renal impairment.
Protein binding	10-20% bound to serum proteins (primarily albumin).
Volume of Distribution	Volume of distribution (Vd) is 0.2-0.3 L/kg in adults, indicating primarily extracellular fluid distribution. Higher Vd (0.3-0.5 L/kg) in neonates and critically ill patients with fluid overload.
Bioavailability	Intravenous: 100%. Intramuscular: 90-95% (rapid and complete absorption). Subcutaneous: 75-90%. Oral: <1% (not administered orally).
Onset of Action	Intravenous: immediate (within 5-10 minutes for peak plasma concentration). Intramuscular: 30-60 minutes. Subcutaneous: 1-2 hours.
Duration of Action	Duration is 8-12 hours for therapeutic effect; extends to 12-18 hours in renal impairment. Clinical notes: Prolonged duration in renal failure necessitates monitoring for toxicity (ototoxicity, nephrotoxicity).

Classification & Brands

Dosing & administration

100 mg intravenously every 12 hours.

Dosage form	POWDER
Renal impairment	CrCl >50 mL/min: no adjustment; CrCl 10-50 mL/min: 50 mg every 12 hours; CrCl <10 mL/min: 50 mg every 24 hours.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: 50 mg every 12 hours; Child-Pugh C: 50 mg every 24 hours.
Pediatric use	2 mg/kg intravenously every 12 hours; maximum 100 mg per dose.
Geriatric use	Initial dose reduction to 50 mg intravenously every 12 hours; titrate based on renal function and tolerance.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for NEO-RX (NEO-RX).

Breastfeeding	NEO-RX is excreted into breast milk; M/P ratio unknown. Use with caution in lactating women due to potential for infant side effects such as sedation and respiratory depression. Consider alternative breastfeeding method if high maternal doses are required.
Teratogenic Risk	First trimester: No evidence of teratogenicity in human studies; animal studies show no fetal harm. Second and third trimesters: Increased risk of fetal bradycardia and hypoglycemia with late pregnancy exposure. Avoid use near term due to potential neonatal withdrawal syndrome.