Home Drug Guide Paromomycin sulfate

Drug Guide

Generic Name

Paromomycin sulfate

Brand Names Humatin

Classification

Therapeutic: Antiparasitic, Antibacterial

Pharmacological: Aminoglycoside antibiotic

FDA Approved Indications

Amebiasis caused by Entamoeba histolytica
Liver abscesses due to E. histolytica (as adjunctive therapy)
Infections caused by certain intestinal parasites

Mechanism of Action

Paromomycin binds to 30S subunit of bacterial ribosomes, inhibiting protein synthesis, leading to the death of susceptible organisms. It is poorly absorbed from the gastrointestinal tract, primarily acting locally.

Dosage and Administration

Adult: Largely depends on the indication; for amebiasis, commonly 25-35 mg/kg/day divided into 3 doses for 7-10 days.

Pediatric: Same as adults, dosing based on weight (usually 25-35 mg/kg/day) divided into three doses. Adjustments based on clinical response and tolerance.

Geriatric: No specific dosage adjustments are usually necessary; monitor renal function.

Renal Impairment: Use with caution; dose adjustments may be necessary as accumulation increases risk of toxicity.

Hepatic Impairment: No specific adjustments necessary.

Pharmacokinetics

Absorption: Poorly absorbed from gastrointestinal tract, providing localized action in the gut.

Distribution: Limited systemic distribution due to poor absorption.

Metabolism: Not metabolized significantly.

Excretion: Primarily excreted unchanged via the kidneys.

Half Life: Approximately 2-3 hours in individuals with normal renal function.

Contraindications

Hypersensitivity to aminoglycosides.
Pregnancy (category C, risk-benefit should be assessed).

Precautions

Renal impairment: Use cautiously due to risk of accumulation and nephrotoxicity.
Hearing impairment: Use with caution in patients with pre-existing hearing loss.

Adverse Reactions - Common

Gastrointestinal disturbances such as nausea or diarrhea. (Common)

Adverse Reactions - Serious

Nephrotoxicity (kidney damage). (Rare)
Ototoxicity (hearing loss or balance issues). (Rare)
Neuromuscular blockade leading to respiratory paralysis (especially with rapid IV administration). (Rare)

Drug-Drug Interactions

Potentially enhances neuromuscular blockade when used with muscle relaxants.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor renal function: BUN, serum creatinine.

Diagnoses:

Risk for nephrotoxicity.
Risk for ototoxicity.

Implementation: Administer as prescribed, hydrate well, monitor hearing and renal function.

Evaluation: Assess for resolution of parasitic infection, monitor for adverse effects.

Patient/Family Teaching

Complete full course of therapy.
Report any hearing changes, dizziness, or signs of kidney problems.
Maintain adequate hydration.

Special Considerations

Black Box Warnings:

Potential for ototoxicity and nephrotoxicity, especially with high doses or prolonged therapy.

Genetic Factors: N/A

Lab Test Interference: May interfere with certain lab tests such as urine glucose, but generally no significant interference reported.

Overdose Management

Signs/Symptoms: Hearing loss, balance difficulties, nephrotoxicity.

Treatment: Discontinuation of drug, supportive care, and in severe cases, renal replacement therapy or audiologic intervention.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable under recommended storage conditions.