Paromomycin Sulfate (paromomycin sulfate)
Amebicides, Systemic Oral Capsule
Last reviewed · Source: First Databank (FDB) drug data
Overview
Paromomycin sulfate is an aminoglycoside antibiotic with antibacterial and antiprotozoal activity.
Paromomycin is an aminoglycoside antibiotic obtained from Streptomyces rimosus var. paromomycinus. The drug is structurally related to neomycin, streptomycin, and kanamycin. Paromomycin is considered a luminal or contact amebicide since it acts principally in the intestinal lumen.
Like other aminoglycosides, paromomycin is bactericidal and appears to inhibit protein synthesis in susceptible bacteria at the 30S segment of the ribosome. Paromomycin has a broad spectrum of activity similar to that of neomycin. Paromomycin is active against protozoa, especially Entamoeba histolytica.
Limited in vitro studies indicate that paromomycin concentrations of 5 mcg/mL may be amebistatic and concentrations of 10 mcg/mL may be amebicidal against Acanthamoeba. In one study, several strains of Blastocystis hominis were not susceptible to the drug in vitro. Paromomycin also is active against Cryptosporidium.
Paromomycin inhibits protein synthesis by binding to the prokaryotic ribosomes of Cryptosporidium.
Paromomycin sulfate is poorly absorbed from the GI tract. Lesions or ulcerations of the intestine may facilitate absorption of the drug. Paromomycin is rapidly absorbed following IM+ injection, and peak plasma concentrations are attained within 1 hour.
Almost 100% of an oral dose is eliminated unchanged in feces.
USES: This medication is used to treat a certain parasite infection of the intestines (amebiasis). This medication is known as an aminoglycoside antibiotic. It works by stopping the growth of parasites in the intestines.
This medication is poorly absorbed into the blood so it will not work for infections outside of the intestines. Paromomycin may also be used along with a special diet to treat a certain serious brain problem (hepatic encephalopathy). This condition occurs in people with liver disease and is caused by too much of a certain natural substance (ammonia) in the body.
Normally the liver gets rid of the ammonia. Paromomycin helps to treat hepatic encephalopathy by stopping the growth of certain bacteria in your intestines that make ammonia. This antibiotic treats only parasitic and bacterial infections.
It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.
Generic name: paromomycin sulfate
Pronunciation: (PAIR-oh-mow-MY-sin)
Drug class: Amebicides, Systemic
Therapeutic class: Anti-Infective Agents
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Paromomycin Sulfate
Indications
The following indications are listed for Paromomycin Sulfate:
- Acute Intestinal Amebiasis
- Chronic Intestinal Amebiasis
- Hepatic Coma
Also known as: Acute Amebic Dysentery.
Dosing
Dosage of paromomycin sulfate is expressed in terms of paromomycin.
Paromomycin sulfate is administered orally with a meal.
Paromomycin sulfate has been administered topically+ for the treatment of cutaneous leishmaniasis+ as a preparation containing paromomycin 15% and methylbenzethonium chloride 12% in white petrolatum. Topical preparations of the drug are not commercially available in the US.
Paromomycin sulfate has been administered IM+ for the treatment of visceral leishmaniasis (kala azar)+. Parenteral preparations of the drug are not commercially available in the US.
Store paromomycin sulfate capsules in a tight container at 20-25degreesC; protect capsules from moisture.
| Drug label | Dosing type | Instructions |
|---|---|---|
| Paromomycin 250 Mg Capsule | Maintenance | Take 1 capsule (250 mg) by oral route 3 times per day. |
No dosing information is available for this tab.
Drug interactions
No formal drug interaction studies have been conducted to date.
There are no contraindication interactions for this drug.
Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
Misc Antibiotics/Neuromuscular Blocking Agents
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Aminoglycosides, bacitracin, clindamycin, lincomycin, and polymyxins may enhance the pharmacologic effects of neuromuscular blocking agents.
CLINICAL EFFECTS: May see an increase in the pharmacologic effects of neuromuscular blocking agents, including prolonged respiratory depression and apnea.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: If it is necessary to administer these drugs concurrently, do so with extreme caution. Monitor neuromuscular function and adjust the dose of the neuromuscular blocking agent accordingly.
DISCUSSION: Concomitant administration of aminoglycosides, bacitracin, clindamycin, lincomycin, and polymixins with neuromuscular blocking agents has been shown to produce synergism of the effects on skeletal muscles. Concurrent administration of these drugs has been associated with prolonged respiratory depression, respiratory paralysis, and fatal apnea. The interaction usually occurs when the antibiotic is given prior to or concurrently with the neuromuscular blocking drug, but it may also occur when given after administration. Any antibiotic dosage or route of administration may produce respiratory depression.
Moderate Interaction: Assess the risk to the patient and take action as needed.
Aminoglycosides, Oral/Digoxin, Oral
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Aminoglycosides appears to inhibit gastrointestinal absorption of digoxin but the precise mechanism is unknown.
CLINICAL EFFECTS: Therapeutic effects of digoxin may be decreased. However, in a minority of patients (10%) gut flora inactivates digoxin. In these patients, due to an aminoglycoside-induced reduction in GI bacteria, serum digoxin concentrations may be increased. Symptoms of digoxin toxicity can include anorexia, nausea, vomiting, headache, fatigue, malaise, drowsiness, generalized muscle weakness, disorientation, hallucinations, visual disturbances, and arrhythmias.
PREDISPOSING FACTORS: None Determined.
PATIENT MANAGEMENT: If both drugs are administered, monitor serum digoxin levels when initiating, discontinuing or changing the dose of the aminoglycoside. Measure serum digoxin concentrations before initiating gentamicin. Reduce digoxin concentrations by decreasing dose by approximately 30-50% or by modifying the dosing frequency and continue monitoring. (3)
DISCUSSION: Separating the administration times of digoxin and the aminoglycoside is not likely to prevent this interaction. Digoxin levels were found to be decreased when neomycin was taken 3 or 6 hours before digoxin. Additionally, serum digoxin concentrations may increase when the aminoglycoside is stopped. Concomitant administration of gentamicin and digoxin caused an increase in digoxin serum concentration of 129-212%. (3)
Aminoglycosides/Select Cephalosporins
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Unknown.
CLINICAL EFFECTS: Nephrotoxicity may occur.
PREDISPOSING FACTORS: Preexisting renal impairment, older age, and large doses of either drug.
PATIENT MANAGEMENT: Try to avoid this combination in patients at risk of developing nephrotoxicity. Elderly patients, patients receiving large doses of either drug, and renal patients should be considered at risk. Monitor renal function if this combination is used.
DISCUSSION: This interaction is likely to occur in some patients, but clinical documentation is limited. This interaction is usually not a problem in patients with normal renal function.
Contraindications
*Known hypersensitivity to the drug.
*Intestinal obstruction.
- Gastrointestinal obstruction
- Mt-RNr1 increased risk of aminoglycoside-induced hearing loss
- Disorder of the vestibulocochlear nerve
- Gastrointestinal ulcer
- Kidney disease with reduction in glomerular filtration rate (GFr)
Adverse reactions
Adverse effects reported following oral administration of paromomycin at doses >3 g daily include nausea, abdominal cramps, and diarrhea.
Adverse effects following topical+ administration of paromomycin (combined with topical methylbenzethonium chloride) include local reactions such as burning, pruritus, erythema, pain, edema, and blisters.
Adverse effects following IM+ administration of paromomycin include injection site pain, fever, elevated liver enzymes, and reversible ototoxicity.
There are no severe adverse reactions for this drug.
Less Frequent
- Abdominal pain with cramps
- Diarrhea
- Nausea
Precautions
No enhanced messaging available.
No enhanced messaging available.
Because oral paromomycin is minimally absorbed from the GI tract, it may be a drug of choice for treatment of amebiasis or giardiasis+ in pregnant women.
No specific precautions are recommended for use of paromomycin in breast-feeding women.
No enhanced messaging available.
ICD codes
| Code | Type | Description |
|---|---|---|
| Acute intestinal amebiasis | ||
| A06.0 | ICD10CM | Acute amebic dysentery |
| A06.2 | ICD10CM | Amebic nondysenteric colitis |
| Chronic intestinal amebiasis | ||
| A06.1 | ICD10CM | Chronic intestinal amebiasis |
| Hepatic coma | ||
| B15.0 | ICD10CM | Hepatitis A with hepatic coma |
| B16.0 | ICD10CM | Acute hepatitis B with delta-agent with hepatic coma |
| B16.2 | ICD10CM | Acute hepatitis B without delta-agent with hepatic coma |
| B17.11 | ICD10CM | Acute hepatitis C with hepatic coma |
| B19.0 | ICD10CM | Unspecified viral hepatitis with hepatic coma |
| B19.11 | ICD10CM | Unspecified viral hepatitis B with hepatic coma |
| B19.21 | ICD10CM | Unspecified viral hepatitis C with hepatic coma |
| K70.41 | ICD10CM | Alcoholic hepatic failure with coma |
| K71.11 | ICD10CM | Toxic liver disease with hepatic necrosis, with coma |
| K72.01 | ICD10CM | Acute and subacute hepatic failure with coma |
| K72.11 | ICD10CM | Chronic hepatic failure with coma |
| K72.91 | ICD10CM | Hepatic failure, unspecified with coma |
| K76.82 | ICD10CM | Hepatic encephalopathy |
ICD code information from First Databank (FDB).
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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