Antibiotic + Pain Relief (neomycin sulf/bacitracin zinc/polymyxin B sulf/pramoxine HCl)

No dosing information is available for this tab.

No dosing information is available for this tab.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

Local Anesthetics/Long-Acting Bupivacaine

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Concurrent use of other local anesthetics or use of other local anesthetics within 96 hours following long-acting bupivacaine may result in additive neurologic and cardiovascular effects. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also increase the risk of methemoglobinemia.(1,2) Non-liposomal bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally.(1)

CLINICAL EFFECTS: Concurrent or use of local anesthetics with 96 hours of use of long-acting bupivacaine may result in neurologic and cardiovascular toxicity. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also result in methemoglobinemia.(1,2) Non-liposomal bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally.(1)

PREDISPOSING FACTORS: Use of additional agents that are associated with methemoglobinemia may further increase the risk of methemoglobinemia.(1) Patients who are at increased risk of developing methemoglobinemia include those with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition. If local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia is recommended.(1)

PATIENT MANAGEMENT: Avoid the use of other local anesthetics within 96 hours following the administration of long-acting bupivacaine. In patients for whom use is required, monitor for neurologic and cardiovascular effects. Also monitor for methemoglobinemia with use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine.(1,2) Non-liposomal bupivacaine may be administered in the same syringe as bupivacaine liposomal or injected immediately before bupivacaine liposomal as long as the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Lidocaine may be administered 20 minutes or more prior to bupivacaine. It is unknown if other local anesthetics may be used without compromising the release characteristic of bupivacaine liposomal.(1)

DISCUSSION: Concurrent use of other local anesthetics or use of other local anesthetics within 96 hours following long-acting bupivacaine may result in additive neurologic and cardiovascular effects. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also increase the risk of methemoglobinemia.(1,2) Non-liposome bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally. Lidocaine may be administered 20 minutes or more prior to bupivacaine. It is unknown if other local anesthetics may be used without compromising the release characteristic of bupivacaine liposomal.(1)

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

• Large open wound
• Severe burns

• Large open wound
• No disease contraindications

There is no enhanced messaging for this drug.

More Frequent

• Dermatitis due to topical drug
• Skin rash

Less Frequent

• Dermatitis due to topical drug

Rare or Very Rare

• Acute respiratory failure
• Anaphylaxis
• Anaphylaxis
• Angioedema
• Bradycardia
• Bronchospastic pulmonary disease
• Cardiac arrhythmia
• CNS toxicity
• Cyanosis
• Eyelid edema
• Headache disorder
• Hypotension
• Methemoglobinemia
• Ototoxicity
• Respiratory depression
• Seizure disorder
• Unconsciousness

Less Frequent

• Blanching of skin
• Edema
• Erythema
• Pruritus of skin
• Skin pigmentation enhancement
• Skin rash
• Stinging of skin
• Urticaria

Rare or Very Rare

• Acute cognitive impairment
• Apprehension
• Blurred vision
• Dizziness
• Drowsy
• Euphoria
• Fungal infection of skin
• Muscle fasciculation
• Nervousness
• Sensation of cold
• Sensation of warmth
• Skin rash
• Skin rash
• Tinnitus
• Tremor
• Vomiting

No enhanced messaging available.

No enhanced messaging available.

Bacitracin and bacitracin zinc should be used during pregnancy only if potential benefits justify potential risks to the fetus.

Some manufacturers state that patients who are pregnant should consult a clinician before using topical preparations containing bacitracin or bacitracin zinc.

The topical preparation containing bacitracin zinc, neomycin sulfate, polymyxin B sulfate, and hydrocortisone should be used during pregnancy only if potential benefits justify potential risks to the fetus. Corticosteroids have been teratogenic in mice and rabbits when applied topically.

Aminoglycosides may cause fetal harm following systemic absorption in pregnant women. The drugs cross the placenta and total, irreversible, bilateral, congenital deafness has been reported in some children whose mothers received parenteral streptomycin during pregnancy.

Fixed-combination topical preparations containing neomycin sulfate and a corticosteroid should be used during pregnancy only if potential benefits justify potential risks to the fetus. Corticosteroids have been teratogenic in animals (mice, rabbits) when applied topically.

If the irrigation solution containing neomycin sulfate and polymyxin B sulfate is used for bladder irrigation during pregnancy, the patient should be informed of the potential hazard to the fetus.

It is not known whether topical bacitracin is distributed into milk.

Some experts consider topical bacitracin compatible with nursing.

Some manufacturers state that patients who are breast-feeding should consult a clinician before using topical preparations containing bacitracin or bacitracin zinc.

The topical preparation containing bacitracin zinc, neomycin sulfate, polymyxin B sulfate, and hydrocortisone should be used with caution in nursing women. Hydrocortisone is distributed into human milk following oral administration, and systemic absorption may occur when hydrocortisone is applied topically.

Clinically unimportant amounts of neomycin may distribute into breast milk following systemic absorption of the drug.

Fixed-combination topical preparations containing neomycin sulfate and a corticosteroid should be used with caution in nursing women. Corticosteroids administered systemically (e.g., orally) are distributed into human milk, and systemic absorption may occur when the drugs are applied topically.

No enhanced messaging available.