Paromomycin Sulfate

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Paromomycin Sulfate

Pronouncation: (par-oh-moe-MY-sin SULL-fate)
Class: Amebicide, Aminoglycoside

Trade Names:
Humatin
- Capsules 250 mg

Mechanism of Action

Pharmacology

Inhibits production of protein in bacteria, causing bacterial cell death.

Pharmacokinetics

Absorption

Poorly absorbed orally.

Elimination

Feces (100% unchanged).

Indications and Usage

Treatment of acute and chronic intestinal amebiasis. Adjunctive therapy in management of hepatic coma.

Unlabeled Uses

Treatment of other parasitic infections.

Contraindications

Intestinal obstruction; extraintestinal amebiasis; hypersensitivity to aminoglycosides.

Dosage and Administration

Intestinal Amebiasis
Adults and Children

PO 25 to 35 mg/kg/day in 3 divided doses with meals for 5 to 10 days.

Hepatic Coma
Adults

PO 4 g/day in divided doses at regular intervals for 5 to 6 days.

Storage/Stability

Store at room temperature in a tight container.

Drug Interactions

Digoxin

May reduce rate and extent of digoxin absorption; this may be offset by decreased digoxin metabolism.

Methotrexate

Decreased absorption of methotrexate.

Neuromuscular blockers

Increased action of both depolarizing and nondepolarizing neuromuscular blocking agents, may prolong need for respiratory support.

Neurotoxic, nephrotoxic, or ototoxic medications (eg, polypeptide antibiotics)

Additive adverse effects may occur with concurrent or sequential administration of medications with similar toxic profiles.

Laboratory Test Interactions

None well documented.

Adverse Reactions

GI

Nausea; vomiting; abdominal cramps; anorexia; epigastric burning; pruritus ani; diarrhea.

Miscellaneous

Malabsorption syndrome.

Precautions

Warnings

Neurotoxicity

Manifests as both auditory and vestibular ototoxicity, and primarily occurs in patients with pre-existing renal damage or with prolonged therapy. Partial or total irreversible deafness may continue to develop after drug is stopped. Other features of neurotoxicity include paresthesias, twitching, and seizures.

Nephrotoxicity

Usually reversible.

Paromomycin is teratogenic in pregnancy. Closely monitor renal and eighth nerve function in patients with suspected renal dysfunction. Monitor peak and trough concentrations. Renal impairment requires dosage adjustments.


Pregnancy

Category D .

Lactation

Excreted in breast milk.

Superinfection

Prolonged or repeated therapy may result in bacterial or fungal overgrowth of nonsusceptible organisms and secondary infections.

Muscular disorders

Patients with muscular disorders such as myasthenia gravis or parkinsonism may have worsening of their disease because of potential effect of aminoglycosides on neuromuscular junction.

Overdosage

Symptoms

Neurotoxicity, nephrotoxicity, ototoxicity.

Patient Information

  • Stress to patient the importance of taking full course of therapy.
  • Emphasize to patient the importance of personal hygiene, especially handwashing.
  • Explain to patient the symptoms of superinfection and ask patient to watch for symptoms if on prolonged therapy.
  • Instruct patient to report the following symptoms to health care provider: ringing in ears, hearing impairment, or dizziness.




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