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      Drugs & Diseases

      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

      Next:

      Interactions

      Interaction Checker

      and tobramycin/loteprednol ophthalmic

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                Contraindicated (0)

                  Serious - Use Alternative (23)

                  • 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.

                  • microbiota oral

                    tobramycin decreases effects of microbiota oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Microbiota oral contains bacterial spores. Antibacterial agents may decrease efficacy if coadministered. Complete antibiotic regimens 2-4 days before initiating microbiota oral. .

                  • 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.

                  • levoketoconazole

                    levoketoconazole 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.

                  Minor (71)

                  • 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.

                  • levoketoconazole

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

                  • 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

                  Do not allow the dropper tip to touch any surface, as this may contaminate the suspension

                  As with all ophthalmic preparations containing benzalkonium chloride, patients should be advised not to wear soft contact lenses while receiving therapy

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                  Pregnancy & Lactation

                  Pregnancy

                  There are no adequate and well-controlled studies with loteprednol etabonate or tobramycin in pregnant women.

                  Animal data

                  • Loteprednol etabonate produced teratogenicity at clinically relevant doses in the rabbit and rat when administered orally during pregnancy; loteprednol etabonate produced malformations when administered orally to pregnant rabbits at doses ≥0.54 times the recommended human ophthalmic dose (RHOD) and to pregnant rats at doses ≥ 13 times the RHOD
                  • In pregnant rats receiving oral doses of loteprednol etabonate during the period equivalent to the last trimester of pregnancy through lactation in humans, survival of offspring was reduced at doses ≥ 1.3 times the RHOD
                  • Maternal toxicity was observed in rats at doses ≥ 135 times the RHOD, and a maternal no observed adverse effect level (NOAEL) was established at 13 times the RHOD
                  • Abortions were observed in pregnant rabbits administered tobramycin via subcutaneous injection at 180 times the RHOD; tobramycin did not affect fetal development when administered by subcutaneous injection to pregnant rats at doses 450 times the RHOD

                  Lactation

                  There are no data on presence of loteprednol etabonate or tobramycin in human milk, effects on breastfed infants, or on milk production; the developmental and health benefits of breastfeeding should be considered, along with the mother’s clinical need for therapy and any potential adverse effects on the breastfed infant from the drug

                  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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                  Patient Handout

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                  Formulary

                  FormularyPatient Discounts

                  Adding plans allows you to compare formulary status to other drugs in the same class.

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

                  Create Your List of Plans

                  Adding plans allows you to:

                  • View the formulary and any restrictions for each plan.
                  • Manage and view all your plans together – even plans in different states.
                  • 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.

                  View explanations for tiers and restrictions
                  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.
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