tobramycin/loteprednol ophthalmic (Rx)

Brand and Other Names:Zylet
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tobramycin/loteprednol

ophthalmic suspension

  • 0.3/0.5%

Ocular Inflammation

Indicated for steroid-responsive ocular inflammations with risk of superficial bacterial infections

Shake vigorously before use

Instill 1-2 gtts in affected eye(s) q4-6hr; may use as frequently as q1-2hr during first 24-48 hr

Decrease frequency of administration as signs and symptoms improve; if use exceeds >20 mL evaluate therapy further

Dosage Forms & Strengths

tobramycin/loteprednol

ophthalmic suspension

  • 0.3/0.5%

Ocular Inflammation

Indicated for steroid-responsive ocular inflammations with risk of superficial bacterial infections

Shake vigorously before use

Instill 1-2 gtts in affected eye(s) q4-6hr; may use as frequently as q1-2hr during first 24-48 hr

Decrease frequency of administration as signs and symptoms improve; if use exceeds >20 mL evaluate therapy further

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Interactions

Interaction Checker

and tobramycin/loteprednol ophthalmic

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            Contraindicated (0)

              Serious - Use Alternative (22)

              • amphotericin B deoxycholate

                amphotericin B deoxycholate and tobramycin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

              • atracurium

                tobramycin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • bacitracin

                tobramycin and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs

              • BCG vaccine live

                tobramycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • bumetanide

                bumetanide, tobramycin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

              • cholera vaccine

                tobramycin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              • cidofovir

                cidofovir and tobramycin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

              • cisatracurium

                tobramycin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • ethacrynic acid

                ethacrynic acid, tobramycin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

              • furosemide

                furosemide, tobramycin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

              • incobotulinumtoxinA

                tobramycin increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • mannitol

                mannitol increases levels of tobramycin by unspecified interaction mechanism. Contraindicated.

              • neomycin PO

                neomycin PO and tobramycin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

              • onabotulinumtoxinA

                tobramycin increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • pancuronium

                tobramycin increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • quinidine

                quinidine will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • rapacuronium

                tobramycin increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • rocuronium

                tobramycin increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • succinylcholine

                tobramycin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • torsemide

                torsemide, tobramycin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

              • typhoid vaccine live

                tobramycin decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • vecuronium

                tobramycin increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              Monitor Closely (66)

              • abobotulinumtoxinA

                tobramycin increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • acyclovir

                acyclovir and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • amikacin

                amikacin and tobramycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • amiodarone

                amiodarone will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • bazedoxifene/conjugated estrogens

                tobramycin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • capreomycin

                capreomycin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • carboplatin

                carboplatin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • cephaloridine

                cephaloridine and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • cisplatin

                cisplatin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • clarithromycin

                clarithromycin will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • clotrimazole

                clotrimazole will decrease the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • colistin

                colistin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • conjugated estrogens

                tobramycin will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • contrast media (iodinated)

                contrast media (iodinated) and tobramycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • cyclosporine

                cyclosporine and tobramycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • daptomycin

                tobramycin, daptomycin. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Tobramycin levels decrease and daptomycin levels increase when coadministered after single a dose.

              • deferasirox

                deferasirox, tobramycin. Other (see comment). Use Caution/Monitor. Comment: Acute renal failure has been reported during treatment with deferasirox. Coadministration of deferasirox with other potentially nephrotoxic drugs, including aminoglycosides, may increase the risk of this toxicity. Monitor serum creatinine and/or creatinine clearance in patients who are receiving deferasirox and nephrotoxic drugs concomitantly.

              • dichlorphenamide

                dichlorphenamide and tobramycin both decrease serum potassium. Use Caution/Monitor.

              • digoxin

                tobramycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • dronedarone

                dronedarone will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                tobramycin and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • erythromycin base

                erythromycin base will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • erythromycin lactobionate

                erythromycin lactobionate will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • erythromycin stearate

                erythromycin stearate will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • estradiol

                tobramycin will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estrogens conjugated synthetic

                tobramycin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estropipate

                tobramycin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • felodipine

                felodipine will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • fosphenytoin

                fosphenytoin will decrease the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • gentamicin

                gentamicin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • indinavir

                indinavir will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • ioversol

                ioversol and tobramycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • ketoconazole

                ketoconazole will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • loratadine

                loratadine will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • magnesium supplement

                magnesium supplement, tobramycin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Each enhance the neuromuscular blocking effect of the other; may have negative respiratory effects.

              • mestranol

                tobramycin will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • nefazodone

                nefazodone will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nicardipine

                nicardipine will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nifedipine

                nifedipine will decrease the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nilotinib

                nilotinib will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • oxaliplatin

                oxaliplatin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • peramivir

                tobramycin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • phenobarbital

                phenobarbital will decrease the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • phenytoin

                phenytoin will decrease the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • polymyxin B

                polymyxin B and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • prabotulinumtoxinA

                tobramycin increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • quercetin

                quercetin will decrease the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • rifampin

                rifampin will decrease the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • rimabotulinumtoxinB

                tobramycin, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • ritonavir

                ritonavir will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • sirolimus

                sirolimus will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                tobramycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              • sodium sulfate/?magnesium sulfate/potassium chloride

                sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of tobramycin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              • sodium sulfate/potassium sulfate/magnesium sulfate

                sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of tobramycin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              • St John's Wort

                St John's Wort will decrease the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • streptozocin

                streptozocin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • tacrolimus

                tacrolimus will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                tacrolimus and tobramycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • teicoplanin

                teicoplanin and tobramycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • tenofovir DF

                tenofovir DF and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

                tobramycin increases levels of tenofovir DF by decreasing elimination. Use Caution/Monitor.

              • tolvaptan

                tolvaptan will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • trazodone

                trazodone will decrease the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • trimagnesium citrate anhydrous

                tobramycin, trimagnesium citrate anhydrous. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration of aminoglycosides with magnesium may increase risk of neuromuscular weakness and paralysis.

              • verapamil

                verapamil will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • voclosporin

                voclosporin, tobramycin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

              • warfarin

                tobramycin increases effects of warfarin by unknown mechanism. Use Caution/Monitor.

              Minor (70)

              • aceclofenac

                aceclofenac increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • acemetacin

                acemetacin increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • adefovir

                adefovir and tobramycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • aspirin

                aspirin increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • aspirin rectal

                aspirin rectal increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • aztreonam

                aztreonam, tobramycin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Pseudomonas spp. and Enterobacteriaceae.

              • balsalazide

                tobramycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • biotin

                tobramycin will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium acetate

                tobramycin decreases levels of calcium acetate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium carbonate

                tobramycin decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium chloride

                tobramycin decreases levels of calcium chloride by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium citrate

                tobramycin decreases levels of calcium citrate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium gluconate

                tobramycin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • celecoxib

                celecoxib increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • clotrimazole

                clotrimazole decreases levels of tobramycin by unknown mechanism. Minor/Significance Unknown.

              • cordyceps

                cordyceps decreases toxicity of tobramycin by unspecified interaction mechanism. Minor/Significance Unknown.

              • cyanocobalamin

                tobramycin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • diclofenac

                diclofenac increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • diflunisal

                diflunisal increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • entecavir

                tobramycin, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

              • etodolac

                etodolac increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • fenoprofen

                fenoprofen increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • fluconazole

                fluconazole decreases levels of tobramycin by unknown mechanism. Minor/Significance Unknown.

              • flurbiprofen

                flurbiprofen increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • foscarnet

                foscarnet and tobramycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • ibuprofen

                ibuprofen increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • ibuprofen IV

                ibuprofen IV increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • indomethacin

                indomethacin increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • ketoconazole

                ketoconazole decreases levels of tobramycin by unknown mechanism. Minor/Significance Unknown.

              • ketoprofen

                ketoprofen increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • ketorolac

                ketorolac increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • ketorolac intranasal

                ketorolac intranasal increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • lornoxicam

                lornoxicam increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • magnesium chloride

                tobramycin decreases levels of magnesium chloride by increasing renal clearance. Minor/Significance Unknown.

              • magnesium citrate

                tobramycin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

              • magnesium hydroxide

                tobramycin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

              • magnesium oxide

                tobramycin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

              • magnesium sulfate

                tobramycin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • meclizine

                meclizine, tobramycin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Ototoxicity of aminoglycoside may be masked.

              • meclofenamate

                meclofenamate increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • mefenamic acid

                mefenamic acid increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • meloxicam

                meloxicam increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • methoxyflurane

                methoxyflurane and tobramycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • miconazole vaginal

                miconazole vaginal decreases levels of tobramycin by unknown mechanism. Minor/Significance Unknown.

              • nabumetone

                nabumetone increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • naproxen

                naproxen increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • oxaprozin

                oxaprozin increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • pantothenic acid

                tobramycin will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • parecoxib

                parecoxib increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • paromomycin

                paromomycin and tobramycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • pentamidine

                pentamidine and tobramycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • piperacillin

                piperacillin increases effects of tobramycin by pharmacodynamic synergism. Minor/Significance Unknown.

              • piroxicam

                piroxicam increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • posaconazole

                posaconazole decreases levels of tobramycin by unknown mechanism. Minor/Significance Unknown.

              • pyridoxine

                tobramycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pyridoxine (Antidote)

                tobramycin will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • salicylates (non-asa)

                salicylates (non-asa) increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • salsalate

                salsalate increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • streptomycin

                streptomycin and tobramycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • sulfasalazine

                sulfasalazine increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • sulindac

                sulindac increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • thiamine

                tobramycin will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ticarcillin

                ticarcillin decreases effects of tobramycin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.

              • tolfenamic acid

                tolfenamic acid increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • tolmetin

                tolmetin increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • vancomycin

                tobramycin and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • voriconazole

                voriconazole decreases levels of tobramycin by unknown mechanism. Minor/Significance Unknown.

              • zoledronic acid

                tobramycin, zoledronic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypocalcemia.

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              Warnings

              Contraindications

              Hypersensitivity to any component of the formulation or to other corticosteroids

              Viral, mycobacterial & fungal eye infections

              Cautions

              History of herpes simplex infections

              May exacerbate infections by nonsusceptible organisms

              Monitor IOP if used >10 d

              Bacterial keratitis reported from inadvertent contamination of multiple dose ophthalmic solution

              Immunosuppression resulting from prolonged use of steroid use may result in secondary bacterial and fungal infections; steroids may also mask symptoms of infections and enhance existing ocular infections

              Ocular hypertension and/or glaucoma reported with prolonged corticosteroid use

              Discontinue use if sensitivity reaction to tobramycin develops

              Corticosteroid use following cataract surgery may delay healing

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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: Excretion in milk unknown; use caution

              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

              Loteprednol: Prevents/reduces irritation & swelling by suppressing normal immune response, decreasing inflammatory mediators and reverses capillary permeability

              Tobramycin: Alters bacterial cell membrane integrity by binding to 30S and 50S ribosomal subunits, which in turn interferes with bacterial protein synthesis

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              Images

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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              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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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.