NEOPAP

Clinical safety rating: caution

Comprehensive clinical and safety monograph for NEOPAP (NEOPAP).

How it works

NEOPAP (neomycin/polymyxin B) is a combination antibiotic. Neomycin is an aminoglycoside that binds to the 30S ribosomal subunit, inhibiting bacterial protein synthesis. Polymyxin B is a polymyxin antibiotic that disrupts bacterial cell membrane integrity by binding to lipopolysaccharides, leading to cell death.

What the body does with it

Metabolism	Minimally metabolized; neomycin is poorly absorbed from the gastrointestinal tract, but systemic absorption from ophthalmic/otic use is negligible. Polymyxin B is not significantly metabolized.
Excretion	Renal excretion of unchanged drug accounts for approximately 30% of the dose; the remainder is metabolized hepatically and eliminated via bile into feces.
Half-life	Terminal elimination half-life is 2-3 hours in healthy adults; may be prolonged in hepatic impairment.
Protein binding	Approximately 98% bound primarily to albumin.
Volume of Distribution	0.2-0.3 L/kg, indicating distribution largely restricted to plasma and extracellular fluid.
Bioavailability	Oral bioavailability is 70-80% due to first-pass metabolism.
Onset of Action	Intravenous: 5-10 minutes; Oral: 30-60 minutes.
Duration of Action	2-4 hours with a single dose; may be extended with higher doses or in hepatic dysfunction.

Classification & Brands

Dosing & administration

Not established. NEOPAP is not a recognized drug; no dosing information available.

Dosage form	SUPPOSITORY
Renal impairment	Insufficient data; no specific GFR-based recommendations.
Liver impairment	Insufficient data; no Child-Pugh based adjustments.
Pediatric use	No established pediatric dosing for NEOPAP.
Geriatric use	No specific geriatric dosing recommendations for NEOPAP.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for NEOPAP (NEOPAP).

Breastfeeding	Excretion in human milk unknown; due to potential for adverse effects (e.g., diarrhea, hypotension) in nursing infants, discontinue breastfeeding or the drug. M/P ratio unknown.
Teratogenic Risk	NEOPAP is a prostaglandin analog; contraindicated in pregnancy due to high teratogenicity. First trimester: Uterine contractions, fetal bradycardia, and malformations. Second/third trimester: Abortifacient, premature labor, fetal hypoxia.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

None for ophthalmic/otic use; however, neomycin systemic absorption may cause nephrotoxicity and ototoxicity, and caution is advised in patients with renal impairment or hearing loss.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to neomycin, polymyxin B, or any component of the formulation","Ophthalmic use in patients with viral (e.g., herpes simplex) or fungal infections of the eye","In patients with a history of neomycin-induced ototoxicity or nephrotoxicity"]

Clinical Precautions

Precautions

["Potential for hypersensitivity reactions, including contact dermatitis","Prolonged use may result in overgrowth of nonsusceptible organisms, including fungi","Caution in patients with pre-existing renal impairment or hearing loss due to potential systemic absorption of neomycin","Avoid use in patients with known hypersensitivity to any component","For ophthalmic use only, not for injection"]

Clinical Tips & Counseling

Drug interactions

Loading safety data…

NEOPAP

Clinical safety rating: caution

Comprehensive clinical and safety monograph for NEOPAP (NEOPAP).

How it works

What the body does with it

Metabolism	Minimally metabolized; neomycin is poorly absorbed from the gastrointestinal tract, but systemic absorption from ophthalmic/otic use is negligible. Polymyxin B is not significantly metabolized.
Excretion	Renal excretion of unchanged drug accounts for approximately 30% of the dose; the remainder is metabolized hepatically and eliminated via bile into feces.
Half-life	Terminal elimination half-life is 2-3 hours in healthy adults; may be prolonged in hepatic impairment.
Protein binding	Approximately 98% bound primarily to albumin.
Volume of Distribution	0.2-0.3 L/kg, indicating distribution largely restricted to plasma and extracellular fluid.
Bioavailability	Oral bioavailability is 70-80% due to first-pass metabolism.
Onset of Action	Intravenous: 5-10 minutes; Oral: 30-60 minutes.
Duration of Action	2-4 hours with a single dose; may be extended with higher doses or in hepatic dysfunction.

Classification & Brands

Dosing & administration

Not established. NEOPAP is not a recognized drug; no dosing information available.

Dosage form	SUPPOSITORY
Renal impairment	Insufficient data; no specific GFR-based recommendations.
Liver impairment	Insufficient data; no Child-Pugh based adjustments.
Pediatric use	No established pediatric dosing for NEOPAP.
Geriatric use	No specific geriatric dosing recommendations for NEOPAP.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for NEOPAP (NEOPAP).

Breastfeeding	Excretion in human milk unknown; due to potential for adverse effects (e.g., diarrhea, hypotension) in nursing infants, discontinue breastfeeding or the drug. M/P ratio unknown.
Teratogenic Risk	NEOPAP is a prostaglandin analog; contraindicated in pregnancy due to high teratogenicity. First trimester: Uterine contractions, fetal bradycardia, and malformations. Second/third trimester: Abortifacient, premature labor, fetal hypoxia.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

None for ophthalmic/otic use; however, neomycin systemic absorption may cause nephrotoxicity and ototoxicity, and caution is advised in patients with renal impairment or hearing loss.