Tobi Podhaler (tobramycin)
Inhaled Aminoglycosides Inhalation Capsule, With Inhalation Device
Last reviewed · Source: First Databank (FDB) drug data
Overview
USES: This medication is used to treat people with cystic fibrosis who have an ongoing lung infection with a certain bacteria (Pseudomonas aeruginosa). People with cystic fibrosis produce thick, sticky mucus that can plug up the tubes, ducts and passageways in the lungs. This can result in serious breathing problems and infections in the lungs.
Tobramycin belongs to a class of drugs known as aminoglycoside antibiotics. Tobramycin works by stopping the growth of bacteria, including Pseudomonas aeruginosa, that commonly infect the lungs of people with cystic fibrosis. This effect decreases lung infections and damage, and helps to improve breathing.
Generic name: tobramycin
Pronunciation: (TOE-bra-MYE-sin)
Drug class: Inhaled Aminoglycosides
Therapeutic class: Respiratory Therapy Agents
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Tobi Podhaler
Indications
The following indications are listed for Tobi Podhaler:
- Respiratory Cystic Fibrosis With Pseudomonas Aeruginosa Colonization
- Synergy For P. Aeruginosa Infection In Cystic Fibrosis
Dosing
No dosing information is available for this tab.
No dosing information is available for this tab.
| Drug label | Dosing type | Instructions |
|---|---|---|
| Tobi Podhaler 28 Mg Inhale Cap | Maintenance | Inhale the contents of 4 capsules (112 mg) by inhalation route every 12 hours for 28 days. |
No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
Antibiotics/Fecal Microbiota
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Fecal microbiota is a suspension of live bacteria, which may be compromised by concurrent use of antibiotics.(1)
CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota. Antibacterial treatment should be completed for 24 to 72 hours before initiating treatment with fecal microbiota. Do not use antibiotics for up to 8 weeks after fecal microbiota.(1)
DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota.
Antibiotics/Fecal Microbiota Spores
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Fecal microbiota spores is a suspension of live bacterial spores, which may be compromised by concurrent use of antibiotics.(1)
CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota spores.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota spores. Antibacterial treatment should be completed for 2 to 4 days before initiating treatment with fecal microbiota spores.(1)
DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota spores.
Antimicrobials/Live Typhoid Vaccine
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1)
CLINICAL EFFECTS: Vaccination may be ineffective.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3)
DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3)
Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
Aminoglycosides/Anesthetics
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: The neuromuscular blocking activity of aminoglycosides results from a decreased sensitivity at the postjunctional membrane and interfere with transmitter release.(1) These actions produce a synergistic effect with anesthetic agents that produce neuromuscular blockade.(2,3) Some anesthetics cause renal failure due to release of fluoride ion. Aminoglycosides cause nephrotoxicity when high doses are given.(4,5)
CLINICAL EFFECTS: Increased neuromuscular blockade activity, profound sedation, respiratory depression, coma, and/or death. Circulatory collapse may also occur secondary to the neuromuscular blockade.(6-10) Decreased urinary output and increased BUN and serum creatinine may indicate renal impairment.
PREDISPOSING FACTORS: Patients in respiratory distress, history of renal impairment and high doses of aminoglycosides and anesthetics.
PATIENT MANAGEMENT: Monitor neuromuscular blockade with train-of-four stimulus. Monitor vital signs, and respiratory rate. Intravenous neostigmine (0.2 to 2.5 mg), calcium (1 G), and possibly sodium bicarbonate (dose not reported) may be beneficial in reversal of neuromuscular blockade and respiratory depression.(6-10) Supportive care and ventilation should be utilized until the neuromuscular blockade is resolved. Volume replacement may be necessary for circulatory collapse.(6-10) Monitor BUN, serum creatinine, and urinary output and adjust aminoglycoside and anesthetic doses according to renal function.
DISCUSSION: Aminoglycosides including kanamycin(6,11), streptomycin(6,13), amikacin(13), gentamicin(7,13-15), neomycin, and tobramycin(13) have been documented to have neuromuscular blocking activity. There is no documentation with netilmicin and paromomycin, though it is assumed that they produce the same effects as the other members of this class. Neomycin has been shown to interact with cyclopropane(8,9), halothane(6), methoxyflurane(6), and nitrous oxide(6). Enflurane, ethylene, and isoflurane share similar properties to the previous inhalation anesthetics and would likely interact with neomycin. Kanamycin(6,11) and streptomycin (6,12) are known to interact with ether. Gentamicin has been reported to potentiate atracurium.(16) Therefore it is hypothesized that all aminoglycosides interact with the inhaled anesthetics. One study evaluating gentamicin and halothane in animals did not exhibit a decrease in muscle strength.(17) Aminoglycosides have been proven to be nephrotoxic at high doses. Anesthetics containing fluoride also produce renal dysfunction. Nephrotoxicity occurred more often when gentamicin or tobramycin were given with enflurane than when enflurane was given alone or in patients who received nitrous oxide and opioid anesthesia.(4)
Misc Antibiotics/Neuromuscular Blocking Agents
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Aminoglycosides, bacitracin, clindamycin, lincomycin, and polymyxins may enhance the pharmacologic effects of neuromuscular blocking agents.
CLINICAL EFFECTS: May see an increase in the pharmacologic effects of neuromuscular blocking agents, including prolonged respiratory depression and apnea.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: If it is necessary to administer these drugs concurrently, do so with extreme caution. Monitor neuromuscular function and adjust the dose of the neuromuscular blocking agent accordingly.
DISCUSSION: Concomitant administration of aminoglycosides, bacitracin, clindamycin, lincomycin, and polymixins with neuromuscular blocking agents has been shown to produce synergism of the effects on skeletal muscles. Concurrent administration of these drugs has been associated with prolonged respiratory depression, respiratory paralysis, and fatal apnea. The interaction usually occurs when the antibiotic is given prior to or concurrently with the neuromuscular blocking drug, but it may also occur when given after administration. Any antibiotic dosage or route of administration may produce respiratory depression.
Moderate Interaction: Assess the risk to the patient and take action as needed.
Tobramycin Inhalation/Selected Diuretics
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: The combination may have additive or synergistic risks for ototoxicity and/or nephrotoxicity.(1,2)
CLINICAL EFFECTS: Concurrent use may result in an increased risk of aminoglycoside toxicity.(1)
PREDISPOSING FACTORS: Severe renal impairment, sepsis, or concomitant use of additional ototoxic or nephrotoxic agents may further increase the risk for toxicity. Patients carrying certain variants in the MT-RNR1 gene (m.1555A>G, m.1095T>C, and m.1494C>T) are at greatly increased risk of developing ototoxicity. An additional risk factor includes patients with a maternal relative known to have a clinically relevant MT-RNR1 variant. The risk of ototoxicity can occur at standard recommended doses of aminoglycosides.(3)
PATIENT MANAGEMENT: Instruct patients to contact their provider for new onset or worsening tinnitus. Tinnitus may be a sentinel symptom of ototoxicity. In clinical trials of tobramycin inhalation 8 patients (3%) receiving tobramycin reported tinnitus while no patients in the placebo group reported this symptom.(1) For renally impaired patients receiving long term tobramycin inhalation therapy, consider measurement of serum tobramycin to assure low systemic levels. The manufacturer of tobramycin for inhalation states that the product should not be administered concurrently with ethacrynic acid, furosemide, intravenous mannitol, or urea.(1)
DISCUSSION: Although systemic absorption of inhaled tobramycin is limited, the manufacturer states that because these diuretics may enhance the risk for aminoglycoside toxicity, they should not be administered concurrently with inhaled tobramycin.(1)
Contraindications
There is no enhanced messaging for this drug.
- Mt-RNr1 increased risk of aminoglycoside-induced hearing loss
- Kidney disease with reduction in glomerular filtration rate (GFr)
- Myasthenia gravis
- Asthma
- Chronic obstructive pulmonary disease
- Disorder of the vestibulocochlear nerve
- Hemoptysis
- Parkinsonism
- Tinnitus
- Vertigo
Adverse reactions
There is no enhanced messaging for this drug.
Rare or Very Rare
- Aphonia
- Auditory neurotoxicity
- Bronchospastic pulmonary disease
- Nephrotoxicity
- Neuromuscular blockade
- Ototoxicity
More Frequent
- Cough
- Diarrhea
- Dysgeusia
- Dyspnea
- Fever
- Headache disorder
- Hemoptysis
- Increased sputum
- Pain in oropharynx
- Pharyngitis
- Skin rash
- Voice change
Less Frequent
- Laryngitis
- Myalgia
- Nausea
- Non-cardiac chest pain
- Vomiting
- Weight loss
Rare or Very Rare
- Anorexia
- Ataxia
- Dizziness
- Malaise
- Pruritus of skin
- Sputum discoloration
- Tinnitus
- Urticaria
- Vertigo
- Wheezing
Precautions
No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
ICD codes
| Code | Type | Description |
|---|---|---|
| Respiratory cystic fibrosis with pseudomonas aeruginosa colonization | ||
| B96.5 | ICD10CM | Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere |
| E84.0 | ICD10CM | Cystic fibrosis with pulmonary manifestations |
| Synergy for p. aeruginosa infection in cystic fibrosis | ||
| B96.5 | ICD10CM | Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere |
| E84.0 | ICD10CM | Cystic fibrosis with pulmonary manifestations |
ICD code information from First Databank (FDB).
Formulary status
Search health-plan coverage for this drug by ZIP code.
Choose the first character of a health plan name.
Last reviewed · Source: First Databank (FDB) drug data
On this page
Actions
Sign in to save favorites
Saving this drug requires a free Physicians Office Resource account.