polymyxin B (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Systemic Infections

IV: 15,000-25,000 units/kg/day divided q12hr; not to exceed 25,000 units/kg/day

IM: 25,000-30,000 units/kg/day divided q4-6hr

Intrathecal: 50,000 qDay for 3-4 days; then qDay or qODay for at least 2 weeks after CSF cultures are negative and normal for glucose content

Total daily dose not to exceed 2,000,000 units/day

Renal Impairment

CrCl >20 mL/minute: give 75-100% usual dose/day divided q12hr

CrCl 5-20 mL/minute: give 50% usual dose/day divided q12hr

CrCl <5 mL/minute: give 15% usual dose/day q12hr

Other Information

Monitor: renal function

Other Indications & Uses

Bacterial Septicemia due to P. aeruginosa, E. aerogenes, & K. pneumoniae, H. Influenzae Meningitis, UTI due to E. coli

Systemic Infections

Infants

  • IM: May receive up to 40,000 units/kg/day divided q6hr if renal function healthy
  • IV: May receive up to 40,000 units/kg/day divided q12hr;
  • Intrathecal: 20,000 units/day for 3-4 days; follow with 25,000 units qODay for at least 2 weeks after CSF cultures are negative and CSF (glucose) has returned to normal

Children

  • IM: 25,000-30,000 units/kg/day divided q12hr
  • IV: 15,000-25,000 units/kg/day divided q12hr; not to exceed 25,000 units/kg/day
  • Intrathecal: 50,000 qDay for 3-4 days; then qDay or qODay for at least 2 weeks after CSF cultures are negative and normal for glucose content

Renal Impairment

CrCl >20 mL/min: give 75-100% usual dose/day divided q12hr

CrCl 5-20 mL/min: give 50% usual dose/day divided q12hr

CrCl <5 mL/min: give 15% usual dose/day q12hr

Other Information

Monitor: renal function

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Interactions

Interaction Checker

and polymyxin B

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (1)

            • allogeneic cultured keratinocytes/fibroblasts in bovine collagen

              polymyxin B decreases effects of allogeneic cultured keratinocytes/fibroblasts in bovine collagen by Other (see comment). Contraindicated. Comment: Exposure to topical antibiotics has been antibiotics shown to degrade Gintuit; if exposed, irrigate the wound thoroughly with saline and allow a suitable wash-out period to elapse before applying Gintuit.

            Serious - Use Alternative (14)

            • amphotericin B deoxycholate

              amphotericin B deoxycholate and polymyxin B both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • atracurium

              polymyxin B increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.

            • bacitracin

              polymyxin B and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs

            • cholera vaccine

              polymyxin B, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

            • cidofovir

              cidofovir and polymyxin B both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • cisatracurium

              polymyxin B increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.

            • incobotulinumtoxinA

              polymyxin B increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.

            • neomycin PO

              neomycin PO and polymyxin B both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • onabotulinumtoxinA

              polymyxin B increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.

            • pancuronium

              polymyxin B increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.

            • rapacuronium

              polymyxin B increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.

            • rocuronium

              polymyxin B increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.

            • succinylcholine

              polymyxin B increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.

            • vecuronium

              polymyxin B increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.

            Monitor Closely (19)

            • acyclovir

              acyclovir and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • amikacin

              amikacin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • capreomycin

              capreomycin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • carboplatin

              carboplatin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • cephaloridine

              cephaloridine and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • cisplatin

              cisplatin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • colistin

              colistin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • contrast media (iodinated)

              contrast media (iodinated) and polymyxin B both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • cyclosporine

              cyclosporine and polymyxin B both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              polymyxin B and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • gentamicin

              gentamicin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • ioversol

              ioversol and polymyxin B both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • oxaliplatin

              oxaliplatin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • sodium picosulfate/magnesium oxide/anhydrous citric acid

              polymyxin B decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

            • streptozocin

              polymyxin B and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • tacrolimus

              polymyxin B and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • teicoplanin

              polymyxin B and teicoplanin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • tobramycin

              polymyxin B and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • voclosporin

              voclosporin, polymyxin B. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            Minor (9)

            • adefovir

              adefovir and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • entecavir

              polymyxin B, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

            • foscarnet

              foscarnet and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • methoxyflurane

              methoxyflurane and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • paromomycin

              paromomycin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • pentamidine

              pentamidine and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • streptomycin

              polymyxin B and streptomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • vancomycin

              polymyxin B and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • verteporfin

              polymyxin B increases levels of verteporfin by pharmacodynamic synergism. Minor/Significance Unknown.

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            Adverse Effects

            Frequency Not Defined

            Anaphylactoid reactions with dyspnea and tachycardia

            Eosinophilia

            Fever

            Nephrotoxicity

            Neurotoxicity

            Skin exanthemata

            Urticaria

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Oliguria, myasthenia gravis, pregnancy, renal disease

            Potential risk of nephrotoxicity and neurotoxicity

            May inhibit neuromuscular transmission

            Inactivated by strong acidic or alkaline solution

            Discontinue if diminished urine output, rise in SCr or BUN, or signs of respiratory paralysis appear

            Do not use IM routinely, particularly in peds, because of severe inj site pain

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            Pregnancy & Lactation

            Pregnancy Category: B: use when benefits outweigh risks

            Lactation: use caution; no data

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Distribution: wide, does not cross placenta or aqueous humor of eye; does not appear in CSF or synovial fluid

            Peak Plasma

            Time: IM: 2 hr

            Concentration: 20-40 KU IM dose: 1-8 mcg/mL

            Other Information

            Protein Bound: 79-92%

            Half-life elimination: 4.3-6 hr with normal renal function

            Metabolism: N/A

            Excretion: urine 60% (<1% as unchanged drug)

            Dialyzable: HD; no; PD: no

            Mechanism of Action

            Bactericidal; causes leakage of bacterial membrane by binding to phospholipids.

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            Administration

            IV Incompatibilities

            Additive: amphotericin B, chloramphenicol Na succinate, chlorothiazide, heparin, MgSO4

            Syringe: ampicillin(?)

            IV Compatibilities

            Additive: amikacin, ascorbic acid, colistimethate, diphenhyramine, erythromycin lactobionate, hydrocortisone Na succinate, kanamycin, pencillin G potassium, penicillin G Na, phenobarbital, ranitidine, vit B/C

            Syringe: penicillin G Na

            Y-site: esmolol

            IV/IM/IT Preparation

            IV: dilute 500,000 U in 300-500 mL D5W

            IM: reconstitute vial with 2 mL SWI , NS, or procaine HCl 1% solution

            Intrathecal (IT): reconstitute vial with10 mL NS; DO NOT use procaine HCl for IT

            IV/IM Administration

            IV: infuse over 60-90 min

            IM: give deep into upper outer quadrant of gluteal muscles

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            polymyxin B sulfate injection
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            500,000 unit vial
            polymyxin B sulfate injection
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            polymyxin B sulfate injection
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            500,000 unit vial
            polymyxin B sulfate injection
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            500,000 unit vial
            polymyxin B sulfate injection
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            500,000 unit vial
            polymyxin B sulfate injection
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            500,000 unit vial
            polymyxin B sulfate injection
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            500,000 unit vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            polymyxin B sulfate injection

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

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

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.