Drug General Information (ID: DDIAC5MIVO)
Drug Name			Neomycin		Drug Info		Colistimethate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antibiotics				Antibiotics
Structure

Mechanism of Neomycin-Colistimethate Interaction (Severity Level: Major)
Additive neuromuscular blocking effects Click to Show/Hide Mechanism Graph
Drug Name		Neomycin				Colistimethate
Mechanism 1		Neuromuscular blocking effects				Neuromuscular blocking effects
Key Mechanism Factor 1
		Factor Name		Neuromuscular blocking effects
		Factor Description		Neuromuscular blocking agents cause paralysis of affected skeletal muscles by blocking postsynaptic acetylcholine (Nm) receptors, thereby blocking neuromuscular signaling at the neuromuscular junction. Neuromuscular blocking agents can cause the following side effects: muscle paralysis, jaw stiffness, and shortness of breath. Concomitant use of drugs with neuromuscular blocking activity may result in severe and/or prolonged respiratory depression.
Mechanism Description		Additive neuromuscular blocking effects by the combination of Neomycin and Colistimethate
Increased risk of nephrotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Neomycin				Colistimethate
Mechanism 2		Nephrotoxicity				Nephrotoxicity
Key Mechanism Factor 2
		Factor Name		Nephrotoxicity
		Factor Description		The combination of drugs that can induce nephrotoxicity may increase the risk of kidney injury. When kidney injury occurs, the inability to remove excess urine and waste from the body can lead to high levels of urea nitrogen, creatinine, and electrolytes (such as potassium and magnesium) in the blood.
Mechanism Description		Increased risk of nephrotoxicity by the combination of Neomycin and Colistimethate

Recommended Action
Management		This combination should be avoided concurrently or sequentially. If coadministration is medically necessary, patients should be closely monitored for development of toxicity, including renal function tests, respiratory function, and vestibular and audiometric tests.

References
1	Product Information. Arikayce (amikacin liposome). Insmed Incorporated, Bridgewater, NJ.
2	Product Information. Garamycin (gentamicin). Schering-Plough Corporation, Kenilworth, NJ.
3	Lindesmith LA, Baines RD Jr, Bigelow DB, Petty TL "Reversible respiratory paralysis associated with polymyxin therapy." Ann Intern Med 68 (1968): 318-27.[PMID: 4306125]