Tobi

Do not use tobramycin without first talking to your doctor if you have had an allergic reaction to an aminoglycoside antibiotic such as tobramycin (Nebcin, Tobi), gentamicin (Garamycin, others), amikacin (Amikin), kanamycin (Kantrex), streptomycin, paromomycin, or neomycin.

Talk to your doctor before using tobramycin if you have

• hearing problems;

• a neuromuscular disease such as myasthenia gravis or Parkinson’s disease; or

• kidney disease.

You may not be able to use tobramycin, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Tobramycin is in the FDA pregnancy category D. This means that it is known to be harmful to an unborn baby. Tobramycin is known to cause deafness in the baby when taken during pregnancy. Do not use tobramycin without first talking to your doctor if you are pregnant or could become pregnant during treatment.

It is not known whether tobramycin passes into breast milk. Do not use tobramycin without first talking to your doctor if you are breast-feeding a baby.

Use tobramycin exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.

Tobramycin is inhaled into the lungs with the use of a nebulizer. Do not swallow the solution by mouth.

Wash your hands with soap and water before preparing each treatment.

To use tobramycin inhalation:

• Set up the nebulizer as directed.

• Open one ampule of tobramycin solution for inhalation and squeeze the contents of the ampule into the nebulizer cup. Replace the nebulizer top.

• Turn on the compressor. Check for a steady mist from the mouthpiece. If there is no mist, check all tubing connections and make sure the compressor is working.

• Sit or stand in a position that will allow you to breathe normally. Place the mouthpiece of the nebulizer between your teeth and above your tongue and breathe normally only through your mouth. A noseclip may help you to breathe only through your mouth during a treatment. Continue breathing through the mouthpiece until all of the medicine is gone and no more mist is being produced. You may hear a sputtering sound when the nebulizer cup is empty. The entire treatment should take approximately 15 minutes to complete.

• If you are interrupted or need to cough or rest during a treatment, turn the compressor off to save the medication. Turn the compressor back on when you are ready to resume treatment.

To reduce the risk of illness, infection, or injury from contamination, you must thoroughly clean all parts of the nebulizer as directed after each treatment.

If you are using several respiratory medications, the recommended order is bronchodilator first, followed by chest physiotherapy, then other inhaled medications, followed by tobramycin.

Do not use tobramycin that is cloudy or that has particles in it. Tobramycin stored at room temperature may become a darker color of yellow. This does not indicate any change in quality of the medication.

Do not mix tobramycin with dornase alfa (Pulmozyme) or any other medications in the nebulizer.

Do not use tobramycin in bigger doses or more often than prescribed.

Use all of the tobramycin that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.

Store tobramycin in the refrigerator between 36 and 46 degrees Fahrenheit (2 and 8 degrees Celsius). If refrigeration is not available (e.g., when traveling), tobramycin may be stored at room temperature (77 degrees Fahrenheit/25 degrees Celsius) for up to 28 days. Avoid exposing ampules of tobramycin to direct light. Do not use tobramycin beyond the expiration date printed on the ampule.

Use the missed dose as soon as you remember. However, if it is less than six hours until the next scheduled dose, skip the missed dose and use only the next regularly scheduled dose. Do not use a double dose of this medication.

If you experience any of the following serious side effects, stop using tobramycin and seek emergency medical attention or notify your doctor immediately:

• an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);

• ringing in the ears or changes in hearing;

• dizziness;

• new or worsening respiratory problems or difficulty breathing;

• muscle weakness; or

• a rash.

If you experience any of the following less serious side effects, continue using tobramycin and talk to your doctor:

• changes in voice; or

• unpleasant taste or odor of the medication.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Notify your doctor immediately if you develop ringing in the ears, dizziness, or changes in hearing during treatment with tobramycin.

To reduce the risk of illness, infection, or injury from contamination, you must thoroughly clean all parts of the nebulizer as directed after each treatment.

Do not mix tobramycin with dornase alfa (Pulmozyme) in the nebulizer.

Before using tobramycin, tell your doctor if you are taking:

• furosemide (Lasix);

• ethacryinc acid (Edecrin); or

• mannitol (Osmitrol).

You may not be able to use tobramycin, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.

Do not mix tobramycin with dornase alfa (Pulmozyme) in the nebulizer.

Drugs other than those listed here may also interact with tobramycin. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.

Seek emergency medical attention if an overdose is suspected.

Symptoms of a tobramycin overdose may include dizziness, ringing in the ears, loss of hearing, difficulty or decreased breathing, and weakness.