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• Dosage of Neomycin in details
• Neomycin interactions
• Dosage of Nystatin in details
• Nystatin interactions
• Dosage of Prednisolone in details
• Prednisolone interactions
• Neomycin/Nystatin/Prednisolone/Ternidazole reviews

Consists of Neomycin, Nystatin, Prednisolone, Ternidazole

Dosage of Neomycin in details

Neomycin Dosage

Applies to the following strength(s): 125 mg/5 mL; 500 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

• Bowel Preparation
• Hepatic Encephalopathy
• Hepatic Coma
• Diarrhea

Usual Pediatric Dose for:

• Bowel Preparation
• Hepatic Encephalopathy
• Hepatic Coma
• Diarrhea

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Dose Adjustments
• Precautions
• Dialysis

Usual Adult Dose for Bowel Preparation

1 g orally every hour for 4 doses followed by 1 g every 4 hours for 5 doses

Alternate dosing: 6 g/day orally divided every 4 hours for 2 to 3 days

Usual Adult Dose for Hepatic Encephalopathy

4 to 12 g/day orally divided every 4 to 6 hours for 5 to 6 days

Usual Adult Dose for Hepatic Coma

4 to 12 g/day orally divided every 4 to 6 hours for 5 to 6 days

Usual Adult Dose for Diarrhea

3 g/day orally in 4 divided doses

Usual Pediatric Dose for Bowel Preparation

The safety and efficacy of neomycin in children less than 18 years of age has not been established. However, the use of neomycin may be appropriate is some situations.

Less than 1 month: 50 mg/kg/day orally divided every 6 hours

1 year to 18 years: 50 to 100 mg/kg/day orally divided every 6 hours

Usual Pediatric Dose for Hepatic Encephalopathy

The safety and efficacy of neomycin in children less than 18 years of age has not been established. However, the use of neomycin may be appropriate is some situations.

1 month to 18 years: 50 to 100 mg/kg/day orally divided every 6 to 8 hours for 5 to 6 days

Usual Pediatric Dose for Hepatic Coma

The safety and efficacy of neomycin in children less than 18 years of age has not been established. However, the use of neomycin may be appropriate is some situations.

1 month to 18 years: 50 to 100 mg/kg/day orally divided every 6 to 8 hours for 5 to 6 days

Usual Pediatric Dose for Diarrhea

The safety and efficacy of neomycin in children less than 18 years of age has not been established. However, the use of neomycin may be appropriate is some situations.

Less than 1 month: 50 mg/kg/day orally divided every 6 hours

1 year to 18 years: 50 mg/kg/day orally divided every 6 hours for 2 to 3 days

Renal Dose Adjustments

Patients with impaired renal function have a high risk of developing nephrotoxicity and ototoxicity with oral neomycin. Use of a less nephrotoxic medication may be a consideration for this patient.

Liver Dose Adjustments

In chronic hepatic insufficiency, it may be necessary to give neomycin sulfate 4 g daily for an indefinite period, if less toxic drugs cannot be used.

Dose Adjustments

Caution should be used when administering neomycin to patients with renal impairment. Dose reduction should be considered in these patients.

Precautions

To minimize the risk of toxicity use the lowest possible dose and the shortest possible treatment period to control the condition. Treatment periods of longer than 2 weeks are not recommended.

Do not use in patients with intestinal obstruction.

Do not use in patients with inflammatory or ulcerative gastrointestinal disease due to the potential for increased gastrointestinal absorption of the drug.

Patients should be monitored for nephrotoxicity and ototoxicity.

Neomycin should be used with caution in patients with hearing impairment, renal impairment or neuromuscular disorders.

Dialysis

Patients with impaired renal function have a high risk of developing nephrotoxicity and ototoxicity with oral neomycin. Use of a less nephrotoxic medication may be a consideration for this patient.

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• Other brands: Neo-Tab, Neomycin

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Related treatment guides

• Bowel Preparation
• Diarrhea
• Hepatic Coma
• Hepatic Encephalopathy

What other drugs will affect Neomycin?

Neomycin can harm your kidneys, and this effect is increased when you also use certain other medicines harmful to the kidneys. Before using neomycin, tell your doctor about all other medicines you use. Many other drugs (including some over-the-counter medicines) can be harmful to the kidneys.

Before you take neomycin, tell your doctor if you are using any other antibiotics, such as

• amikacin (Amikin)

• amphotericin-B (Amphotec);

• bacitracin (Baci IM);

• colistimethate (Coly Mycin M);

• gentamicin (Garamycin);

• kanamycin (Kantrex);

• paromomycin (Humatin, Paromycin);

• polymyxin B sulfate;

• penicillin V (PC Pen VK);

• streptomycin;

• tobramycin (Nebcin, Tobi); or

• vancomycin (Vancocin, Vancoled).

Tell your doctor about all other medicines you use, especially:

• cisplatin (Platinol);

• digoxin (digitalis, Lanoxin, Lanoxicaps);

• methotrexate (Rheumatrex, Trexall);

• vitamin B-12;

• antiviral medicines such as adefovir (Hepsera), cidofovir (Vistide), or tenofovir (Viread);

• a blood thinner such as warfarin (Coumadin, Jantoven);

• a botulism toxin medication (Botox, Dysport, Myobloc, Xeomin, and others); or

• a diuretic (water pill) such as bumetanide (Bumex), ethacrynic acid (Edecrin), furosemide (Lasix), or torsemide (Demadex).

This list is not complete and other drugs may interact with neomycin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Neomycin interactions

Acarbose: Neomycin may enhance the adverse/toxic effect of Acarbose. Neomycin may decrease the metabolism of Acarbose. Monitor therapy

Amphotericin B: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Arbekacin: May enhance the nephrotoxic effect of Aminoglycosides. Arbekacin may enhance the ototoxic effect of Aminoglycosides. Monitor therapy

Ataluren: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, an increased risk of nephrotoxicity may occur with the concomitant use of ataluren and aminoglycosides. Avoid combination

Bacitracin (Systemic): Neomycin may enhance the nephrotoxic effect of Bacitracin (Systemic). Avoid combination

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy

Bisphosphonate Derivatives: Aminoglycosides may enhance the hypocalcemic effect of Bisphosphonate Derivatives. Monitor therapy

Botulinum Toxin-Containing Products: Aminoglycosides may enhance the neuromuscular-blocking effect of Botulinum Toxin-Containing Products. Monitor therapy

Capreomycin: May enhance the neuromuscular-blocking effect of Aminoglycosides. Monitor therapy

CARBOplatin: Aminoglycosides may enhance the ototoxic effect of CARBOplatin. Especially with higher doses of carboplatin. Monitor therapy

Cardiac Glycosides: Aminoglycosides may decrease the serum concentration of Cardiac Glycosides. This effect has only been demonstrated with oral aminoglycoside administration. Monitor therapy

Cefazedone: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Cephalosporins (2nd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Cephalosporins (3rd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Cephalosporins (4th Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Cephalothin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Cephradine: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

CISplatin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Colistimethate: Aminoglycosides may enhance the nephrotoxic effect of Colistimethate. Aminoglycosides may enhance the neuromuscular-blocking effect of Colistimethate. Management: Avoid coadministration of colistimethate and aminoglycosides whenever possible due to the risk of nephrotoxicity and neuromuscular blockade. If coadministration cannot be avoided, monitor renal and neuromuscular function. Consider therapy modification

CycloSPORINE (Systemic): Aminoglycosides may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Monitor therapy

Distigmine: Aminoglycosides may diminish the therapeutic effect of Distigmine. Monitor therapy

Foscarnet: May enhance the nephrotoxic effect of Aminoglycosides. Avoid combination

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy

Loop Diuretics: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Monitor therapy

Mannitol (Systemic): May enhance the nephrotoxic effect of Aminoglycosides. Avoid combination

Mecamylamine: Aminoglycosides may enhance the neuromuscular-blocking effect of Mecamylamine. Avoid combination

Methoxyflurane: Aminoglycosides may enhance the nephrotoxic effect of Methoxyflurane. Avoid combination

Neuromuscular-Blocking Agents: Aminoglycosides may enhance the therapeutic effect of Neuromuscular-Blocking Agents. Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May decrease the excretion of Aminoglycosides. Data only in premature infants. Monitor therapy

Oxatomide: May enhance the ototoxic effect of Aminoglycosides. Monitor therapy

Penicillins: May decrease the serum concentration of Aminoglycosides. Primarily associated with extended spectrum penicillins, and patients with renal dysfunction. Exceptions: Amoxicillin; Ampicillin; Bacampicillin; Cloxacillin; Dicloxacillin; Nafcillin; Oxacillin; Penicillin G (Parenteral/Aqueous); Penicillin G Benzathine; Penicillin G Procaine; Penicillin V Benzathine; Penicillin V Potassium. Consider therapy modification

Regorafenib: Neomycin may decrease serum concentrations of the active metabolite(s) of Regorafenib. Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification

SORAfenib: Neomycin may decrease the serum concentration of SORAfenib. Monitor therapy

Tenofovir Products: Aminoglycosides may increase the serum concentration of Tenofovir Products. Tenofovir Products may increase the serum concentration of Aminoglycosides. Monitor therapy

Vancomycin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Vitamin K Antagonists (eg, warfarin): Neomycin may enhance the anticoagulant effect of Vitamin K Antagonists. Monitor therapy

Dosage of Nystatin in details

Nystatin Dosage

Generic name: nystatin

Dosage form: Cream USP and

Topical Powder USP

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Very moist lesions are best treated with the topical dusting powder.

Nystatin® Cream

Adults and Pediatric Patients (Neonates and Older):

Apply liberally to affected areas twice daily or as indicated until healing is complete.

Nystatin®

Topical Powder

Adults and Pediatric Patients (Neonates and Older):

Apply to candidal lesions two or three times daily until healing is complete. For fungal infection of the feet caused by Candida species, the powder should be dusted on the feet, as well as, in all foot wear.

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Topical (nystatin topical)

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  Topical (Advanced Reading)

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• Other brands: Nystop, Nyamyc, Pediaderm AF, Pedi-Dri

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Other formulations

• Nystatin

Related treatment guides

• Cutaneous Candidiasis
• Vaginal Yeast Infection

What other drugs will affect Nystatin?

It is not likely that other drugs you take orally or inject will have an effect on topically applied nystatin topical. But many drugs can interact with each other. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Nystatin interactions

Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for it. Do not start, stop or change the dosage of any medicine before checking with them first.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use.

Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

Dosage of Prednisolone in details

Recommended Dosing

Dosage of Prednisolone (prednisolone sodium phosphate) should be individualized according to the severity of the disease and the response of the patient. For pediatric patients, the recommended dosage should be governed by the same considerations rather than strict adherence to the ratio indicated by age or body weight.

Do not break or use partial Prednisolone (prednisolone sodium phosphate) tablets. Use an appropriate formulation of prednisolone if indicated dose cannot be obtained using Prednisolone. This may become important in the treatment of conditions that require tapering doses that cannot be adequately accommodated by Prednisolone (prednisolone sodium phosphate), e.g., tapering the dose below 10 mg.

The initial dose of Prednisolone (prednisolone sodium phosphate) may vary from 10 to 60 mg (prednisolone base) per day, depending on the specific disease entity being treated. In situations of less severity, lower doses will generally suffice while in selected patients higher initial doses may be required. The initial dosage should be maintained or adjusted until a satisfactory response is noted. If after a reasonable period of time, there is a lack of satisfactory clinical response, Orapred should be discontinued and the patient placed on other appropriate therapy. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT. After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage that will maintain an adequate clinical response is reached. It should be kept in mind that constant monitoring is needed in regard to drug dosage. Included in the situations which may make dosage adjustments necessary are changes in clinical status secondary to remissions or exacerbations in the disease process, the patient's individual drug responsiveness, and the effect of patient exposure to stressful situations not directly related to the disease entity under treatment; in this latter situation it may be necessary to increase the dosage of Prednisolone (prednisolone sodium phosphate) for a period of time consistent with the patient's condition. If after long term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly.

Prednisolone (prednisolone sodium phosphate) are packaged in a blister. Patients should be instructed not to remove the tablet from the blister until just prior to dosing. The blister pack should then be peeled open, and the orally disintegrating tablet placed on the tongue, where tablets may be swallowed whole as any conventional tablet, or allowed to dissolve in the mouth, with or without the assistance of water.

Orally disintegrating tablet dosage forms are friable and are not intended to be cut, split, or broken.

Multiple Sclerosis

In the treatment of acute exacerbations of multiple sclerosis, daily doses of 200 mg of prednisolone for a week followed by 80 mg every other day for one month have been shown to be effective.

Pediatric

In pediatric patients, the initial dose of Orapred may vary depending on the specific disease entity being treated. The range of initial doses is 0.14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m/day.

Asthma

The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone or methylprednisolone in children whose asthma is uncontrolled by inhaled corricosteroids and long-acting bronchodilators is 1-2 mg/kg/day in single or divided doses.

It is further recommended that short course, or "burst" therapy, be continued until a child achieves a peak expiratory flow rate of 80% of his or her personal best or symptoms resolve. This usually requires 3 to 10 days of treatment, although it can take longer. There is no evidence that tapering the dose after improvement will prevent a relapse.

Recommended Monitoring

Blood pressure, body weight, routine laboratory studies, including serum potassium and fasting blood glucose, should be obtained at regular intervals during prolonged therapy. Appropriate diagnostic studies should be performed in patients with known or suspected peptic ulcer disease and in patients at risk for reactivation of latent tuberculosis infections.

Corticosteroid Comparison Chart

For the purpose of comparison, one 10 mg Prednisolone tablet (13.4 mg prednisolone sodium phosphate) is equivalent to the following milligram dosage of the various glucocorricoids:

These dose relationships apply only to oral or intravenous administration of these compounds. When these substances or their derivatives are injected intramuscularly or into joint spaces, their relative properties may be greatly altered.

How supplied

Dosage Forms And Strengths

Orally disintegrating tablets:

• 10 mg prednisolone (as 13.4 mg prednisolone sodium phosphate)
• 15 mg prednisolone (as 20.2 mg prednisolone sodium phosphate)
• 30 mg prednisolone (as 40.3 mg prednisolone sodium phosphate)

Prednisolone (prednisolone sodium phosphate orally disintegrating tablets) 13.4 mg prednisolone sodium phosphate (equivalent to 10 mg prednisolone base) are white, flat faced, bevelled tablet, debossed with ORA on one side and 10 on the other. Supplied as:

• NDC 59630-700-48: 48 tablets per carton. Each carton has 8 cards containing 6 tablets.

Prednisolone (prednisolone sodium phosphate orally disintegrating tablets) 20.2 mg prednisolone sodium phosphate (equivalent to 15 mg prednisolone base) are white, flat faced, bevelled tablet, debossed with ORA on one side and 15 on the other. Supplied as:

• NDC 59630-701-48: 48 tablets per carton. Each carton has 8 cards containing 6 tablets.

Prednisolone: (prednisolone sodium phosphate orally disintegrating tablets) 40.3 mg prednisolone sodium phosphate (equivalent to 30 mg prednisolone base) are white, flat faced, beveled tablets, debossed with ORA on one side and 30 on the other. Supplied as:

• NDC 59630-702-48: 48 tablets per carton. Each carton has 8 cards containing 6 tablets.

Store at 20 to 25°C (68 to 77°F); excursions permitted to 15 to 30°C (59 to 86°F).. Protect from moisture.

Do not break or use partial Prednisolone (prednisolone sodium phosphate) tablets. Keep out of the reach of children.

Manufactured for: Shionogi Pharma, Inc. Atlanta, GA 30328. Manufactured by: CIMA® LABS INC., Eden Prairie, MN 55344. Revised 07/2010

What other drugs will affect Prednisolone?

Many drugs can interact with prednisolone. Below is just a partial list. Tell your doctor if you are using:

• aspirin (taken on a daily basis or at high doses);

• a diuretic (water pill);

• a blood thinner such as warfarin (Coumadin, Jantoven);

• cyclosporine (Gengraf, Neoral, Sandimmune);

• insulin or diabetes medications you take by mouth;

• ketoconazole (Nizoral);

• rifampin (Rifadin, Rifater, Rifamate, Rimactane); or

• seizure medications such as phenytoin (Dilantin) or phenobarbital (Solfoton).

This list is not complete and other drugs may interact with prednisolone. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Prednisolone interactions

Aminoglutethimide

May lead to loss of prednisolone-induced adrenal suppression.

Amphotericin B

Coadministration may be followed by cardiac enlargement and CHF.

Anticholinesterase agents

Coadministration may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agent 24 h prior to starting prednisolone.

Antidiabetic agents

Because prednisolone may increase blood glucose concentrations, dose adjustments of antidiabetic agents may be required.

Aspirin and other salicylates, NSAIDs

Risk of GI bleeding may be increased. Salicylate clearance may be increased.

CYP3A4 inducers (eg, barbiturates, carbamazepine, phenytoin, rifampin)

Prednisolone metabolism may be increased, reducing prednisolone plasma levels and necessitating an increase in dosage.

CYP3A4 inhibitors (eg, estrogens [eg, hormonal contraceptives], ketoconazole, macrolide antibiotics [eg, erythromycin])

Prednisolone metabolism may be decreased, increasing prednisolone plasma levels and increasing the risk of adverse reactions.

Cholestyramine

Prednisolone clearance may be increased, reducing plasma levels and decreasing the efficacy.

Cyclosporine

Increased activity of cyclosporine and prednisolone may occur. Convulsions have been reported with coadministration of corticosteroids and cyclosporine.

Digitalis glycosides

Because of possible hypokalemia, the risk of arrhythmias may be increased.

Isoniazid

Isoniazid serum levels may be reduced, decreasing the efficacy.

Potassium-depleting agents (eg, amphotericin B, diuretics)

Risk of hypokalemia may be increased.

Toxoids and live or inactivated vaccines

Because of inhibition of antibody response, patients on prolonged prednisolone therapy may exhibit a diminished response to toxoids and live or inactivated vaccines. Replication of some organisms contained in live attenuated vaccines may be potentiated.

Warfarin

Because data are conflicting, monitor coagulation indices frequently.

References

1. DailyMed. "PREDNISOLONE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
2. DailyMed. "HYDROCORTISONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
3. FDA/SPL Indexing Data. "9PHQ9Y1OLM: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology