WARNINGS
NOT FOR INJECTION INTO THE EYE. If a sensitivity reaction to POLYTRIM® occurs, discontinue
use. POLYTRIM® Ophthalmic Solution is not indicated for the prophylaxis or treatment of ophthalmia
neonatorum.
PRECAUTIONS
General
As with other antimicrobial preparations, prolonged use may result in overgrowth of nonsusceptible
organisms, including fungi. If superinfection occurs, appropriate therapy should be initiated.
Carcinogenesis, Mutagenesis, Impairment Of Fertility
Carcinogenesis
Long-term studies in animals to evaluate carcinogenic potential have not been
conducted with polymyxin B sulfate or trimethoprim.
Mutagenesis
Trimethoprim was demonstrated to be non-mutagenic in the Ames assay. In studies at two
laboratories no chromosomal damage was detected in cultured Chinese hamster ovary cells at
concentrations approximately 500 times human plasma levels after oral administration; at concentrations
approximately 1,000 times human plasma levels after oral administration in these same cells, a low level
of chromosomal damage was induced at one of the laboratories. Studies to evaluate mutagenic potential
have not been conducted with polymyxin B sulfate.
Impairment Of Fertility
Polymyxin B sulfate has been reported to impair the motility of equine sperm,
but its effects on male or female fertility are unknown.
No adverse effects on fertility or general reproductive performance were observed in rats given
trimethoprim in oral dosages as high as 70 mg/kg/day for males and 14 mg/kg/day for females.
Pregnancy
Teratogenic Effects
Animal reproduction studies have not been conducted with polymyxin B sulfate. It is not known whether
polymyxin B sulfate can cause fetal harm when administered to a pregnant woman or can affect
reproduction capacity.
Trimethoprim has been shown to be teratogenic in the rat when given in oral doses 40 times the human
dose. In some rabbit studies, the overall increase in fetal loss (dead and resorbed and malformed
conceptuses) was associated with oral doses 6 times the human therapeutic dose.
While there are no large well-controlled studies on the use of trimethoprim in pregnant women,
Brumfitt and Pursell, in a retrospective study, reported the outcome of 186 pregnancies during which
the mother received either placebo or oral trimethoprim in combination with sulfamethoxazole. The
incidence of congenital abnormalities was 4.5% (3 of 66) in those who received placebo and 3.3% (4 of
120) in those receiving trimethoprim and sulfamethoxazole. There were no abnormalities in the 10
children whose mothers received the drug during the first trimester. In a separate survey, Brumfitt and
Pursell also found no congenital abnormalities in 35 children whose mothers had received oral
trimethoprim and sulfamethoxazole at the time of conception or shortly thereafter.
Because trimethoprim may interfere with folic acid metabolism, trimethoprim should be used during
pregnancy only if the potential benefit justifies the potential risk to the fetus.
Nonteratogenic Effects
The oral administration of trimethoprim to rats at a dose of 70 mg/kg/day
commencing with the last third of gestation and continuing through parturition and lactation caused no
deleterious effects on gestation or pup growth and survival.
Nursing Mothers
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human
milk, caution should be exercised when POLYTRIM® Ophthalmic Solution is administered to a nursing
woman.
Pediatric Use
Safety and effectiveness in children below the age of 2 months have not been established (see
WARNINGS).
Geriatric Use
No overall differences in safety or effectiveness have been observed between elderly and other adult
patients.