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Tobramycin Sulfate Nebulizer solution

It is used to treat or prevent certain kinds of bacterial infections in the lungs

Generic Name: tobramycin inhalation  |  Brand Name: Tobi

Brand Names: Tobi

There is an FDA Alert for this drug. Click here to view it.

    Neurotoxicity and Ototoxicity
  • Neurotoxicity (manifested as both auditory and vestibular ototoxicity) can occur. Other neurotoxicity manifestations include numbness, skin tingling, muscle twitching, and seizures.
  • Eighth-cranial nerve impairment develops principally in patients with preexisting renal damage and in those with normal renal function who receive doses higher or treatment longer than recommended.
  • Aminoglycoside-induced ototoxicity is irreversible, usually bilateral, and may be partial or total.
  • Risk of hearing loss increases with degree of exposure to either high peak or high trough serum concentrations.
  • Patients developing cochlear damage may not have symptoms during aminoglycoside treatment to warn them of eighth-cranial nerve toxicity and total or partial, irreversible, bilateral deafness may occur after drug discontinued.
    Nephrotoxicity
  • Potentially nephrotoxic.
  • Aminoglycoside-induced nephrotoxicity usually is reversible.
  • Nephrotoxicity develops principally in patients with preexisting renal damage and in those with normal renal function who receive doses higher or treatment longer than recommended.
  • Rarely, nephrotoxicity may become apparent several days after discontinuance.
    Patient Monitoring
  • Patients should be under close clinical observation because of potential ototoxicity and nephrotoxicity.
  • Closely monitor renal and eighth-cranial nerve function, especially in patients with known or suspected renal impairment at start of treatment and also in those whose renal function is initially normal but who develop renal dysfunction during treatment.
  • Monitor serum tobramycin concentrations periodically to ensure adequate concentrations and avoid potentially toxic and prolonged peak concentrations (>12 mcg/mL).
  • Rising trough concentrations (>2 mcg/mL) may indicate tissue accumulation.
  • Tissue accumulation, excessive peak concentrations, cumulative dose, advanced age, and dehydration may contribute to ototoxicity and nephrotoxicity.
  • Evaluate urine for decreased specific gravity and increased excretion of protein, cells, and casts; periodically determine BUN, Scr, and Clcr.
  • When feasible, perform serial audiograms in patients old enough to be tested, particularly high-risk patients.
  • Discontinue tobramycin or adjust dosage if there is evidence of impaired renal, vestibular, or auditory function.
  • Use with caution in neonates and premature infants because of their renal immaturity and prolonged tobramycin serum half-life.
    Interactions
  • Avoid concurrent and/or sequential use of other neurotoxic or nephrotoxic drugs, particularly other aminoglycosides, cephaloridine (no longer available in US), viomycin, polymyxin B, colistin, cisplatin, and vancomycin.
  • Avoid concurrent use of potent diuretics (e.g., ethacrynic acid, furosemide) since diuretics themselves may cause ototoxicity and IV diuretics enhance toxicity by altering serum and tissue aminoglycoside concentrations.
    Pregnancy
  • Aminoglycosides can cause fetal harm when administered to a pregnant woman.

What is this medicine?

TOBRAMYCIN (toe bra MYE sin) is an aminoglycoside antibiotic. It is used to treat or prevent certain kinds of bacterial infections in the lungs. It will not work for colds, flu, or other viral infections.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
  • balance problems
  • hearing problems
  • kidney disease
  • myasthenia gravis
  • Parkinson's disease
  • an unusual or allergic reaction to tobramycin, other aminoglycosides or medicines, sulfites, foods, dyes or preservatives
  • pregnant or trying to get pregnant
  • breast-feeding

How should I use this medicine?

This medicine is for inhalation using a nebulizer. Nebulizers make a liquid into an aerosol that you breathe in through your mouth or your mouth and nose and into your lungs. You will be taught how to use your nebulizer. Follow the directions on your prescription label. Do not use more often than directed.

You will get an information sheet with each prescription and refill. Read this sheet carefully each time. This sheet may change.

Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for children as young as 6 years old for selected conditions, precautions do apply.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Take your doses at least 6 hours apart. Do not take double or extra doses.

What may interact with this medicine?

Do not take this medicine with any of the following medications:
  • cidofovir
  • cisplatin
  • colistin
  • ethacrynic acid
  • furosemide
  • mannitol
  • other aminoglycoside antibiotics
  • polymyxin
  • urea
  • vancomycin
  • viomycin

This medicine may also interact with the following medications:

  • diuretics

What should I watch for while using this medicine?

Visit your doctor or health care professional as directed. Tell your doctor or healthcare professional if your symptoms do not start to get better or if they get worse.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
  • allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
  • breathing problems
  • change in amount or color of urine
  • change in hearing
  • dizziness
  • fever or infection
  • loss of balance
  • redness, blistering, peeling or loosening of the skin, including inside the mouth
  • unusual bleeding or bruising
  • unusually weak or tired

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • diarrhea
  • changes in voice
  • cough
  • headache
  • nausea, vomiting
  • runny nose

Where should I keep my medicine?

Keep out of the reach of children.

Store in the refrigerator between 2 and 8 degrees C (36 and 46 degrees F). You can also store this medicine at room temperature, up to 25 degrees C (77 degrees F) and throw away any unused medicine after 28 days. Protect from light. Do not use if the medicine is cloudy. Throw away any unused medicine after the expiration date.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.


Last Updated: September 02, 2009
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