Paromomycin Sulfate (pair-oh-moe-my-sin) Humatin Oral Aminoglycoside Antiparasitic

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PRESCRIBER HIGHLIGHTS
Aminoglycoside used primarily as an alternative for PO treatment of cryptosporidiosis in small animals Not appreciably absorbed when gut is intact when dosed orally in humans & dogs Some state that the drug is contraindicated in cats secondary to toxicity Adverse effects are usually limited to GI effects (N,V,D); cats may be susceptible to renal & ophthalmic toxicity Use with caution in patients with intestinal ulceration

USES/INDICATIONS
Paromomycin may be useful as a secondary treatment for cryptosporidiosis in dogs and cats. It has also been used topically to treat cutaneous Leishmaniasis. In humans, it has been used as an alternative treatment for giardiasis, Dientamoeba fragilis, and hepatic coma.

PHARMACOLOGY/ACTIONS
Paromomycin has an antimicrobial spectrum of activity similar to neomycin, but its primary therapeutic uses are for the treatment of protozoa, including Leishmania spp., Entamoeba histolytica, and Cryptosporidium spp. It also has activity against a variety of tapeworms, but there are better choices available for clinical use.

PHARMACOKINETICS
Like neomycin, paromomycin is very poorly absorbed when given orally. Potentially systemic toxicity (nephrotoxicity, ototoxicity, pancreatitis) could occur if used in patients with significant ulcerative intestinal lesions or for a prolonged period at high dosages.

CONTRAINDICATIONS/PRECAUTIONS/WARNINGS
Paromomycin is contraindicated in patients with known hypersensitivity to the drug, ileus or intestinal obstruction, and GI ulceration. Use with caution in cats. Because of potential toxicity, some clinicians recommend not using the drug in this species. Do not use in animals with blood in the stool as this may signal that the drug could be absorbed and cause nephrotoxicity.

ADVERSE EFFECTS
Gastrointestinal effects (nausea, inappetence, vomiting, diarrhea) are the most likely adverse effects to be noted with therapy. Because paromomycin can affect gut flora, nonsusceptible bacterial or fungal overgrowths are a possibility. In patients with significant gut ulceration, paromomycin may be absorbed systemically with resultant nephrotoxicity, ototoxicity, or pancreatitis. Use in cats has been associated with renal dysfunction, ototoxicity and blindness.

REPRODUCTIVE/NURSING SAFETY
Because minimal amounts are absorbed when administered orally, paromomycin should be safe to use during pregnancy. It should not be used parenterally during pregnancy.

When used orally, paromomycin should be safe to use during lactation.

OVERDOSAGE/ACUTE TOXICITY
Because paromomycin is not absorbed orally, acute overdose adverse effects should be limited to gastrointestinal distress in patients with an intact GI system. Chronic overdoses may lead to systemic toxicity.

DRUG INTERACTIONS
The following drug interactions have either been reported or are theoretical in humans or animals receiving paromomycin and may be of significance in veterinary patients: Digoxin: Paromomycin may reduce digoxin absorption Methotrexate: Paromomycin may reduce methotrexate absorption

LABORATORY CONSIDERATIONS
None were noted

DOSES
Dogs: For treatment of cryptosporidiosis: 1. 125165 mg/kg PO twice daily for 5 days (Blagburn 2003) 2. 150 mg/kg PO once a day for 5 days. Caution: nephrotoxicity. (Tams 2003) Cats: For treatment of cryptosporidiosis: Note: Higher dosages of paromomycin have caused renal or otic toxicity and/or blindness in some treated cats. Consider using an alternate treatment first (e.g., azithromycin) or paromomycin at an initially reduced dosage level. 1. 125165 mg/kg PO twice daily for 5 days. (Blagburn 2003) 2. 150 mg/kg PO once a day for 5 days. Caution: nephrotoxicity. (Tams 2003) 3. 150 mg/kg PO q1224hr. Paromomycin can be nephrotoxic if absorbed. If the cat is responding to the first 7 days of therapy and toxicity has not been noted, continue treatment for 1 week past clinical resolution of diarrhea. (Lappin 2008) Camelids (NWC): 1. For treatment of cryptosporidiosis in crias: 50 mg/kg PO (dosing interval not specified, assume once per day - Plumb) for 510 days. (Walker 2009) Reptiles: 1. For treatment of cryptosporidiosis: 300800 mg/kg PO q2448h for 714 days or as needed (de la Navarre 2003)

MONITORING
Efficacy GI adverse effects If used in cats, monitor renal function

CLIENT INFORMATION
Unless otherwise instructed, give with food

CHEMISTRY/SYNONYMS

An aminoglycoside antibiotic, paromomycin sulfate occurs as an odorless, creamy white to light yellow, hygroscopic, amorphous powder having a saline taste. Paromomycin is very soluble in water (> 1 gram/mL). Paromomycin may also be known as: aminosidin sulphate, aminosidine sulphate, catenulin sulphate, crestomycin sulphate; estomycin sulphate, hydroxymycin sulphate, monomycin A sulphate, neomycin E sulphate, paucimycin sulphate, Gabbromicina, Gabbroral, Gabroral, Humagel, Humatin, Kaman, and Sinosid.

STORAGE/STABILITY
Paromomycin capsules should be stored at room temperature (1530C; 5986F) in tight containers.

DOSAGE FORMS/REGULATORY STATUS

Veterinary-Labeled Products: None Human-Labeled Products: Paromomycin Sulfate Oral Capsules: 250 mg; Humatin (Parke-Davis); generic; (Rx)
References
1. Blagburn, B. (2003). Current recognition, control and prevention of protozoan parasites affecting dogs and cats. Proceedings: Western Veterinary Conference. Accessed via: Veterinary Information Network. http://goo.gl/QsVOr 2. de la Navarre, B. (2003). Common parasitic diseases of reptiles and amphibians. Proceedings: Western Veterinary Conf. Accessed via: Veterinary Information Network. http://goo.gl/ZafJD 3. Lappin, M.R. (2008). Giardia and Cryptosporidium spp. infections of cats: clinical and zoonotic aspects. Proceedings: ECVIM. Accessed via: Veterinary Information Network. http://goo.gl/ZyO3e 4. Tams, T. (2003). Giardiasis, Clostridium perfringens enterotoxicosis, and Cryptosporidiosis. Proc: Atlantic Coast Veterinary Conf. 5. Walker, P. (2009). Differential diagnosis of diarrhea in camelid crias. Proceedings: ACVIM. Accessed via: Veterinary Information Network. http://goo.gl/0C6AM

January 1, 2005 (published) | January 1, 2011 (revised)

URL: http://www.vin.com/doc/?id=4692413