Tobramycin is an antibiotic. It is used to treat a bacterial lung infections in patients with cystic fibrosis (a disease that causes thick, sticky mucus build up in the lungs) who are 6 years old and above.
Use this medicine exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.
Tobramycin is to be orally inhaled. It is available as a capsule or as a solution.
If you have been give a capsule for oral inhalation, an inhaler will be used. To take a dose, follow these steps:
- Wash your hands thoroughly with soap and water.
- Take the capsule out from the blister pack (remove capsule only before use). Do not leave the capsule exposed to air for too long.
- Place the capsule inside the chamber of the inhaler. Close the mouthpiece firmly until you hear a click sound.
- Hold the inhaler with the mouthpiece facing upwards.
- Press and release the piercing button once.
- Breathe out completely.
- Place the inhaler to your mouth and close your lips firmly around the mouthpiece.
- Breathe in slowly and deeply until your lungs are full. As you breathe in, you should hear or feel the capsule vibrate.
- Hold your breath for as long as you can. At the same time, remove the inhaler from your mouth.
- Repeat steps 5-8. This will ensure you receive the full dose.
If you are using a solution for oral inhalation, a nebuliser will be used. To take a dose, follow these steps:
- Wash your hands thoroughly with soap and water.
- Take an ampoule of Tobramycin from the foil pouch and keep the rest of the medicine refrigerated in the original packaging.
- Check all the pieces of the nebuliser, and make sure that you have the suitable compressor and tubing to connect the nebuliser and compressor.
- Remove the nebuliser top from the nebuliser by twisting the top anticlockwise and then lifting it. Set the top aside on a clean, dry surface.
- Connect one end of the tubing to the compressor air outlet. Make sure that the tubing fits well. Plug the compressor into the electrical outlet.
- Open the ampoule by holding the bottom tab with one hand and twisting off the top with your other hand. Squeeze all the contents of the ampoule into the nebuliser chamber.
- Replace the nebuliser top. Put the mouthpiece and the inspiratory valve cap in place on the nebuliser, and connect the compressor.
- Turn on the compressor. You should see a steady mist coming from the mouthpiece. If there is no mist, check if all tubings are connected and if the compressor is working properly.
- Sit or stand in an upright position so that you can breathe normally.
- Place the mouthpiece between your teeth and on top of your tongue. Breathe normally through your mouth.
- Continue breathing until you have received your full dose and if there is no longer any mist being produced. It should take about 15 minutes to take all the treatment. You will hear a "spluttering noise" coming from the mouthpiece when the nebuliser cup is empty.
- Clean and disinfect your nebuliser.
If you have problems or do not understand the instructions, ask your doctor or pharmacist to show you how to use it.
Do not share your inhaler or nebuliser with others as it could spread infection.
The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on the type and severity of your infection.
If you miss a dose and it is 6 hours or more before the next dose is due, take the missed dose and return to your normal dosing schedule.
If it is less than 6 hours before the next dose is due, skip the missed dose and return to your normal dosing schedule.
DO NOT double a dose under any circumstances.
If you often forget to take your medicine, let your doctor and pharmacist know.
Do not use Tobramycin if you ever had an allergic reaction (e.g. rashes, breathlessness, swollen eyes) to this medicine and its ingredients, or any similar antibiotics such as amikacin, gentamicin, streptomycin.
Inform your doctor if you have the following conditions:
- hearing problems
- myasthenia gravis (muscle weakness disorder)
- Parkinson's disease (disorder that affects movement causing symptoms such as tremors, muscle stiffness, slowed movement and impaired balance or walking)
- kidney disease
- haemoptysis (coughing out blood)
Let your doctor know if you are pregnant or breastfeeding.
For as long as you are being treated with this medicine, routine blood tests may be done to monitor your condition and check your response to the medication regularly. It is also important to monitor any hearing problems that you may experience while you are being treated with this medicine.
Tobramycin may cause any of the following side effects: cough, discolouration of the substance you cough, inflammation of the throat, runny or stuffy nose, fever, difficulty in speaking, hoarseness, alteration or loss of voice, decreased appetite, nausea, vomiting, altered taste, muscle pain, and feeling unwell.
Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
- rashes, breathlessness, swelling of the face, eyes or mouth
- ringing, buzzing, or roaring noise in the ears, loss of hearing
- chest pain, tightness, or discomfort
- coughing out blood
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Inform your doctor and pharmacist if you are taking any of these medicines:
- certain antibiotics e.g. cefalotin, polymyxin, amikacin, gentamicin, streptomycin
- amphotericin B (medicine used to treat fungal infection)
- water pills e.g. furosemide, ethacrynic acid, or other similar medicines e.g. urea, intravenous mannitol
- medicines for muscle weakness e.g. neostigmine, pyridostigmine
- medicines used in organ transplant or certain immune disorders e.g. ciclosporin, tacrolimus
- medicines for cancer e.g. cisplatin, carboplatin
This list does not include all medicines that may interact with Tobramycin.
Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements and medicines that you buy without a prescription.
Avoid alcohol.
Store Tobramycin inhalation solution in the refrigerator, between 2-8°C. Do not freeze, otherwise it will no longer be effective and should not be used.
You may also store Tobramycin inhalation solution in the foil pouches (opened or unopened) at room temperature for up to 28 days.
Tobramycin inhalation solution is normally slightly yellow. It may get darker if unrefrigerated. The colour change does not affect how the medicine works.
Do not use if the solution is cloudy, has particles in it, or if it has been stored at a room temperature for more than 28 days.
Protect from light.
Once opened, use medicine immediately. Throw away any unused solution.
Capsules for oral inhalation must always be stored in the blister to protect it from moisture. Remove only before use.
Medicines must not be used past the expiry date.
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