Polymyxin B

Table of contents

  • Brand Names
  • Drug Combinations
  • Chemistry
  • Pharmacologic Category
  • Mechanism of Action
  • Therapeutic Use
  • Pregnancy and Lactation Implications
  • Contraindications
  • Warnings and Precautions
  • Adverse Reactions
  • Drug Interactions
  • Genes that may be involved
  • Dosage
  • Pharmacokinetics and Pharmacodynamics
  • Special Considerations

Brand Names


Hungary: Polysor.

North America

USA: Polymyxine B, Poly-Rx.

Latin America

Brazil: Polimixina B.


Japan: Metamyxin, Polymyxin B.

Drug combinations

Polymyxin B and Bacitracin

Polymyxin B and Dexamethasone

Polymyxin B and Neomycin

Polymyxin B and Oxytetracycline

Polymyxin B and Trimethoprim

Polymyxin B, Bacitracin, and Hydrocortisone

Polymyxin B, Bacitracin, and Neomycin

Polymyxin B, Dexamethasone, and Neomycin

Polymyxin B, Dexamethasone, and Trimethoprim

Polymyxin B, Dipyrone, and Prednisolone

Polymyxin B, Fluocinolone, and Neomycin

Polymyxin B, Gramicidin and Neomycin

Polymyxin B, Hydrocortisone, and Neomycin

Polymyxin B, Hydrocortisone, and Oxytetracycline

Polymyxin B, Miconazole, and Prednisolone

Polymyxin B, Neomycin, and Nystatin

Polymyxin B, Neomycin, and Phenylephrine

Polymyxin B, Neomycin, and Prednisolone

Polymyxin B, Bacitracin, Hydrocortisone, and Neomycin

Polymyxin B, Bacitracin, Neomycin, and Pramoxine

Polymyxin B, Dexamethasone, Neomycin, and Lidocaine

Polymyxin B, Fludrocortisone, Lidocaine, and Neomycin

Polymyxin B, Metronidazole, Miconazole, and Neomycin

Polymyxin B, Gotu Kola, Hydrocortisone, Metronidazole, Miconazole, and Neomycin

Other Polymyxin B combinations: Lactic Acid; Gelatin; Glycerin; Mineral Oil; Paraben; Titanium; Witepsol


Polymyxin B Sulfate: C~48~H~84~N~16~O~17~S. Mw: 1189.3426. N-2-[4-amino-2-(formylamino)butanoyl]-N-(3-amino-1-{[6,9,18-tris(2-aminoethyl)-15-benzyl-3-(2-hydroxyethyl)-12-(2-methylpropyl)-2,5,8,11,14,17,20-heptaoxo-1,4,7,10,13,16,19-heptaazacyclotricosan-21-yl]carbamoyl}propyl)homoserinamide sulfate. CAS-1405-20-5; CAS-1404-26-8 (polymyxin B).

Pharmacologic Category

Antibacterials; Polymyxins. Skin and Mucous Membrane Agents; Antibacterials. EENT Preparations; Antibacterials. Irrigation Antibiotic. (ATC-Code: A07AA05; J01XB02; S01AA18; S02AA11; S03AA03).

Mechanism of action

Binds to phospholipids, alters permeability, and damages bacterial cytoplasmic membrane permitting leakage of intracellular constituents.

Therapeutic use

Used in fixed combination with other anti-infectives (e.g. bacitracin, neomycin, gramicidin, trimethoprim) for treatment of superficial eye infections caused by susceptible bacteria. Used in fixed combination with corticosteroids and other anti-infectives in certain bacterial ocular infections. Used in fixed combination with corticosteroids (with or without other anti-infectives) for treatment of otitis externa caused by susceptible bacteria.

Pregnancy and lactiation implications

Safety in pregnant women not established. Excretion in breast milk unknown (use caution).

Unlabeled use


Hypersensitivity to polymyxin B or any component of the formulation. Concurrent use of neuromuscular blockers.

Warnings and precautions

May cause nephrotoxicity (avoid concurrent or sequential use of other nephrotoxic drugs (e.g. aminoglycosides)). May cause neurotoxicity, which can also result in respiratory paralysis from neuromuscular blockade, especially when drug is given soon after anesthesia or muscle relaxants (avoid concurrent or sequential use of other neurotoxic drugs). Neurotoxic reactions usually associated with high serum levels, often in renal dysfunction. Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea and pseudomembranous colitis. Use with caution in impaired renal function. I.M./intrathecal administration only to hospitalized patients. Polymyxin B most toxic when given parenterally (avoid parenteral use whenever possible).



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