POLY-PRED

Clinical safety rating: caution

Comprehensive clinical and safety monograph for POLY-PRED (POLY-PRED).

How it works

Poly-Pred is a combination of neomycin (aminoglycoside antibiotic) and polymyxin B (polypeptide antibiotic) with prednisolone (corticosteroid). Neomycin inhibits bacterial protein synthesis by binding to 30S ribosomal subunit; polymyxin B disrupts bacterial cell membrane permeability; prednisolone suppresses inflammation by inhibiting phospholipase A2, reducing prostaglandin and leukotriene synthesis, and decreasing cytokine production.

What the body does with it

Metabolism	Prednisolone is primarily metabolized in the liver via CYP3A4; neomycin and polymyxin B are not significantly metabolized and are excreted mostly unchanged in urine after systemic absorption.
Excretion	Prednisolone acetate is metabolized hepatically and excreted renally (approximately 70% as metabolites and 20% unchanged) and in feces (<10%). Neomycin sulfate and polymyxin B sulfate are minimally absorbed and excreted unchanged in feces.
Half-life	Prednisolone acetate has a terminal half-life of 2.1–3.5 hours. Neomycin and polymyxin B have negligible systemic absorption; their local half-life is not clinically relevant.
Protein binding	Prednisolone acetate: 70–90% bound to corticosteroid-binding globulin (CBG) and albumin. Neomycin: minimal binding. Polymyxin B: limited binding.
Volume of Distribution	Prednisolone acetate: Vd approximately 0.6–1.1 L/kg, indicating distribution into total body water. Neomycin and polymyxin B: negligible Vd due to lack of systemic absorption.
Bioavailability	Base: Topical ophthalmic (eye drops) — the systemic bioavailability of prednisolone acetate from ocular administration is low (<1%). Neomycin and polymyxin B are essentially non-absorbed systemically via this route.
Onset of Action	Topical ophthalmic: Onset of anti-inflammatory effect within 24–48 hours; antibacterial effect begins within 1–2 hours after instillation.
Duration of Action	Topical ophthalmic: Duration of anti-inflammatory effect is 12–24 hours; antibacterial effect persists for 6–12 hours. Dosing typically every 3–4 hours for initial therapy.

Classification & Brands

Dosing & administration

1-2 drops into the affected eye(s) every 3-4 hours, or more frequently as directed by physician. Do not use more than 6 times daily.

Dosage form	SUSPENSION/DROPS
Renal impairment	No adjustment required. Systemic absorption is minimal.
Liver impairment	No adjustment required. Systemic absorption is minimal.
Pediatric use	1 drop into the affected eye(s) every 4-6 hours, as needed. Do not exceed 4 times daily.
Geriatric use	Use lowest effective dose to avoid intraocular pressure elevation. Monitor intraocular pressure closely.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for POLY-PRED (POLY-PRED).

Breastfeeding	Prednisolone excreted in breast milk (M/P ratio ~0.5-1.0). Sulfacetamide minimal excretion. Topical ophthalmic use unlikely to cause systemic effects. Use with caution; monitor infant for adrenal suppression.
Teratogenic Risk	Category C: Prednisolone and sulfacetamide cross placenta. First trimester: Increased risk of cleft palate (OR 3.4). Second/third trimesters: Adrenal suppression, intrauterine growth restriction, premature rupture of membranes. Sulfacetamide: Risk of kernicterus if used near term.

Warnings & precautions

■ FDA Black Box Warning

None explicitly assigned by FDA.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to any component","Epithelial herpes simplex keratitis (dendritic keratitis)","Viral diseases of the cornea and conjunctiva (e.g., vaccinia, varicella)","Fungal diseases of ocular structures","Mycobacterial infections of the eye","Uncomplicated conjunctival or corneal foreign body removal"]

Clinical Precautions

Precautions

["Prolonged use may lead to ocular hypertension/glaucoma, cataract formation, secondary ocular infections, and delayed wound healing","Neomycin may cause sensitization and allergic reactions; cross-sensitivity with other aminoglycosides","Systemic absorption of neomycin and polymyxin B may cause nephrotoxicity and ototoxicity, especially with prolonged use or in patients with renal impairment","Use with caution in patients with herpes simplex keratitis","Prolonged use may suppress host immune response and increase risk of secondary fungal infections"]

Clinical Tips & Counseling

Drug interactions

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POLY-PRED

Clinical safety rating: caution

Comprehensive clinical and safety monograph for POLY-PRED (POLY-PRED).

How it works

What the body does with it

Metabolism	Prednisolone is primarily metabolized in the liver via CYP3A4; neomycin and polymyxin B are not significantly metabolized and are excreted mostly unchanged in urine after systemic absorption.
Excretion	Prednisolone acetate is metabolized hepatically and excreted renally (approximately 70% as metabolites and 20% unchanged) and in feces (<10%). Neomycin sulfate and polymyxin B sulfate are minimally absorbed and excreted unchanged in feces.
Half-life	Prednisolone acetate has a terminal half-life of 2.1–3.5 hours. Neomycin and polymyxin B have negligible systemic absorption; their local half-life is not clinically relevant.
Protein binding	Prednisolone acetate: 70–90% bound to corticosteroid-binding globulin (CBG) and albumin. Neomycin: minimal binding. Polymyxin B: limited binding.
Volume of Distribution	Prednisolone acetate: Vd approximately 0.6–1.1 L/kg, indicating distribution into total body water. Neomycin and polymyxin B: negligible Vd due to lack of systemic absorption.
Bioavailability	Base: Topical ophthalmic (eye drops) — the systemic bioavailability of prednisolone acetate from ocular administration is low (<1%). Neomycin and polymyxin B are essentially non-absorbed systemically via this route.
Onset of Action	Topical ophthalmic: Onset of anti-inflammatory effect within 24–48 hours; antibacterial effect begins within 1–2 hours after instillation.
Duration of Action	Topical ophthalmic: Duration of anti-inflammatory effect is 12–24 hours; antibacterial effect persists for 6–12 hours. Dosing typically every 3–4 hours for initial therapy.

Classification & Brands

Dosing & administration

1-2 drops into the affected eye(s) every 3-4 hours, or more frequently as directed by physician. Do not use more than 6 times daily.

Dosage form	SUSPENSION/DROPS
Renal impairment	No adjustment required. Systemic absorption is minimal.
Liver impairment	No adjustment required. Systemic absorption is minimal.
Pediatric use	1 drop into the affected eye(s) every 4-6 hours, as needed. Do not exceed 4 times daily.
Geriatric use	Use lowest effective dose to avoid intraocular pressure elevation. Monitor intraocular pressure closely.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for POLY-PRED (POLY-PRED).

Breastfeeding	Prednisolone excreted in breast milk (M/P ratio ~0.5-1.0). Sulfacetamide minimal excretion. Topical ophthalmic use unlikely to cause systemic effects. Use with caution; monitor infant for adrenal suppression.
Teratogenic Risk	Category C: Prednisolone and sulfacetamide cross placenta. First trimester: Increased risk of cleft palate (OR 3.4). Second/third trimesters: Adrenal suppression, intrauterine growth restriction, premature rupture of membranes. Sulfacetamide: Risk of kernicterus if used near term.

Warnings & precautions

■ FDA Black Box Warning

None explicitly assigned by FDA.

Side Effect Profile

Serious Effects

Absolute Contraindications

Clinical Precautions

Precautions

Clinical Tips & Counseling

Drug interactions

Loading safety data…