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tobramycin (Rx)Brand and Other Names:Nebcin injection

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
  • 40mg/mL
more...

Bacterial Infections

3-6 mg/kg/day IV/IM divided q8hr OR 

4-7 mg/kg/dose IV/IM qDay

Renal Impairment

Clcr >60 mL/min: q8hr

Clcr 40-60 mL/min: q12hr

Clcr 20-40 mL/min: q24hr

Clcr 10-20 mL/min: q48hr

Clcr <10 mL/min: q72hr

Following dialysis in ESRD

Monitor

Peak and trough concentrations, renal and auditory function

Life-threatening infection: 8-10 mcg/mL

Serious infection: 6-8 mcg/mL

UTIs: 4-6 mcg/mL

Synergy for infections caused by gram-positive organisms: 3-5 mcg/mL

Other Indications & Uses

May have increase activity against resistant Gram negatives

Citrobacter spp., E. coli, P. aeruginosa, Proteus spp. (indole-positive and negative), Providencia spp. (including Klebsiella-Enterobacter-Serratia), S. aureus (coagulase-positive and negative)

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
  • 40mg/mL
more...

Cystic Fibrosis

IV/IM: 2.5-3.3 mg/kg q6-8hr 

Neonates

<30 week gestation

  • <28 days old: 2.5 mg/kg IV/IM qDay
  • ≥28 days old: 3 mg/kg IV/IM qDay

30-36 week gestation

  • <14 days old: 3 mg/kg IV/IM qDay
  • ≥14 days old: 5 mg/kg/day IV/IM divided q12hr

>37 week gestation

  • <7 days old: 5 mg/kg/day IV/IM divided q12hr
  • ≥7 days old: 7.5 mg/kg/day IV/IM divided q8hr

Bacterial Infection

<5 years old: 2.5 mg/kg/dose IV/IM q8hr 

≥5 years old: 2-2.5 mg/kg/dose IV/IM q8hr

Hemodialysis: 1.25-1.75 mg/kg/dose postdialysis

Monitor

Peak and trough concentrations, renal and auditory function

Life-threatening infection: 8-10 mcg/mL

Serious infection: 6-8 mcg/mL

UTIs: 4-6 mcg/mL

Synergy for infections caused by gram-positive organisms: 3-5 mcg/mL

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Interactions

Interaction Checker

tobramycin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Ototoxicity

            Nephrotoxicity

            Neurotoxicity (neuromuscular blockade)

            <1%

            Hypotension

            Drug fever

            Drowsiness

            Headache

            Paresthesia

            Tremor

            Rash

            Nausea

            Vomiting

            Anemia

            Eosinophilia

            Arthralgia

            Weakness

            Eyelid edema

            Itching eyes

            Keratitis

            Lacrimation

            Dyspnea

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            Warnings

            Black Box Warnings

            Neurotoxicity, manifested as both bilateral auditory and vestibular ototoxicity, can occur in patients with preexisting renal damage and in patients with normal renal function treated at higher doses and/or for periods longer than those recommended. High-frequency deafness usually occurs first and can be detected only by audiometric testing. Vertigo may occur and may be evidence of vestibular injury

            Aminoglycosides are potentially nephrotoxic. Risk is greater in patients with impaired renal function and in those who receive high doses or prolonged therapy. Rarely, nephrotoxicity may not become apparent until the first few days after cessation of therapy

            Use with caution in premature infants and neonates because of renal immaturity and the resulting prolongation of serum half-life of the drug

            Neuromuscular blockade and respiratory paralysis have been reported following parenteral injection, topical instillation (as in orthopedic and abdominal irrigation or in local treatment of empyema), and oral use of aminoglycosides, especially when given soon after anesthesia or muscle relaxants. If blockage occurs, calcium salts may reverse these phenomena, but mechanical respiratory assistance may be necessary

            Avoid concurrent or sequential use of neurotoxic and/or nephrotoxic drugs including other aminoglycosides (eg, amikacin, streptomycin, neomycin, kanamycin, gentamicin, paromomycin

            Cumulative listing of drugs to avoid from all aminoglycoside package inserts includes amphotericin B, bacitracin, cephaloridine, cisplatin, colistin, polymyxin B, vancomycin, and viomycin. Avoid potent diuretics (eg, ethacrynic acid, furosemide) because they increase risk of ototoxicity. When administered intravenously, diuretics may enhance aminoglycoside toxicity by altering antibiotic concentrations in serum and tissue

            Contraindications

            Documented hypersensitivity

            Cautions

            Concurrency with neuromuscular blockers

            Aminoglycosides are associated with nephrotoxicity and ototoxicity

            Renal impairment

            Auditory or vestibular impairment

            May cause irreversible hearing loss

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: enters breast milk

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits protein synthesis by irreversibly binding to bacterial 30S and 50S ribosomes

            Absorption

            Absorption: IM: rapid and complete

            Peak Plasma Time: IM: 30-60 min; IV: ~30 min

            Distribution

            Distribution: to extracellular fluid including serum, abscesses, ascitic, pericardial, pleural, synovial, lymphatic, and peritoneal fluids; crosses placenta; poor penetration into CSF, eye, bone, prostate

            Protein Bound: <30%

            Vd: 0.2-0.3 L/kg; pediatrics: 0.2-0.7 L/kg

            Elimination

            Half-Life: 2-3 hr (normal renal function)

            Excretion: ~90%-95% in urine within 24 hr (normal renal function)

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            Administration

            IV Incompatibilities

            Additive: cefamandole, cefepime, cefotaxime, cefotetan, floxacillin, heparin, penicillins

            Syringe: cefamandole, clindamycin, heparin

            Y-site: allopurinol, amphotericin B cholesteryl sulfate, cefoperazone, heparin, hetastarch, indomethacin, propofol, sargramostim

            IV Preparation

            Standard diluent: 50-100 mL of D5W or NS

            IV Administration

            Infuse over 30-60 min

            Give penicillins or cephalosporins at least 1 hr apart from tobramycin

            Storage

            Stable at room temp both as the clear, colorless solution & as the dry powder

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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