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Overview: Inhaled tobramycin is an antibiotic that is used to treat certain infections caused by the bacterium Pseudomonas aeruginosa in people with cystic fibrosis. Common side effects include cough, sore throat, increased sputum, voice or taste changes, and rash. Serious side effects may include breathing problems and hearing loss. Tell your health care provider right away if you have trouble breathing, hearing loss, or hear a ringing or roaring sound.

Uses

What is inhaled tobramycin used for?

Inhaled tobramycin is an antibiotic that is commonly used to treat certain infections caused by the bacteria Pseudomonas aeruginosa in people with cystic fibrosis.

Inhaled tobramycin may also be used for other conditions as determined by your health care provider.

Other forms of tobramycin are available. See Tobramycin and Tobramycin ophthalmic for more information.

Inhaled tobramycin may not be appropriate for all Pseudomonas aeruginosa infections. Bacteria in some locations may have developed resistance to inhaled tobramycin, which will make it not work as well.

How does inhaled tobramycin work (mechanism of action)?

Inhaled tobramycin kills certain types of bacteria by preventing them from making proteins.

How is inhaled tobramycin supplied (dosage forms)?

Brands and other names

  • Bethkis
  • Kitabis Pak
  • Tobi
  • Tobi Podhaler

Dosage forms and strengths

  • 28 mg per capsule inhalation powder
  • 300 mg/4 mL per ampule inhalation solution
  • 300 mg/5 mL per ampule inhalation solution

How should I store inhaled tobramycin?

Inhalation Solution. Inhaled tobramycin liquid should be stored in a refrigerator, between 36 F to 46 F (2 C to 8 C). If needed it can be stored at room temperature, up to 77 F (25 C) for up to 28 days. Protect inhaled tobramycin liquid from light. 

Inhalation Powder. Inhaled tobramycin powder in a capsule should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). The capsules can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. Do not remove the capsules from the blister pack until you are ready to use it. 

Side Effects

What are the most common side effects of inhaled tobramycin?

The most common side effects of inhaled tobramycin are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Cough
  • Sore throat
  • Increased sputum (phlegm)
  • Breathing problems (see below)
  • Coughing up blood
  • Headache
  • Voice changes
  • Change in how things taste
  • Rash
  • Crackles (rales)

There may be other side effects of inhaled tobramycin that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of inhaled tobramycin?

While less common, the most serious side effects of inhaled tobramycin are described below, along with what to do if they happen.

Severe Allergic Reactions. Inhaled tobramycin may cause allergic reactions, which can be serious. Stop using inhaled tobramycin and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Breathing Problems. Inhaled tobramycin may cause the muscles around the airways to tighten (bronchospasm) instead of relaxing, which can be serious. Stop using inhaled tobramycin and contact your health care provider right away if you have trouble breathing.

Hearing Loss. Inhaled tobramycin may be associated with hearing loss, which is also called ototoxicity. You may be at higher risk of hearing loss if your mother has a history of hearing loss with inhaled tobramycin or any similar medicines. Hearing loss may be permanent. Tell your health care provider right away if you have hearing loss or dizziness, are feeling off balance, or hear a ringing or roaring sound.

Warnings & Precautions

Who should not use inhaled tobramycin?

Allergies to Ingredients. People who are allergic to any of the following should not use inhaled tobramycin.

  • Bethkis
  • Kitabis Pak
  • Tobi
  • Tobi Podhaler
  • Tobramycin
  • Any other medicine known as an aminoglycoside
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific inhaled tobramycin products they stock.

What should I know about inhaled tobramycin before using it?

Do not use inhaled tobramycin unless it has been prescribed to you by a health care provider. Use it as prescribed.

Do not share inhaled tobramycin with other people, even if they have the same condition as you. It may harm them.

Keep inhaled tobramycin out of the reach of children. Since some inhaled tobramycin products may be kept in a refrigerator, take special precautions to keep them away from children who also use the refrigerator. 

Each inhaled tobramycin product should only be used with the specific inhaler device or nebulizer and compressor products listed in the product’s Instructions for Use. Make sure that you or a caregiver understands how to properly prepare and use the inhaled tobramycin product dispensed to you. If you have any questions, talk to your health care provider.

If you are using inhaled tobramycin with a nebulizer, do not mix or dilute inhaled tobramycin with other medicines in the nebulizer.

If you are using tobramycin capsule inhalation powder, do not swallow the capsules. Ask your pharmacist if you have any questions about how to use them. 

If you are using other inhaled medicines and/or chest physical therapy, your health care provider may tell you to use your inhaled medicines and chest physical therapy in a specific order. Follow all instructions given to you by your health care provider.

What should I tell my health care provider before using inhaled tobramycin?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if inhaled tobramycin is right for you.

In particular, make sure that you discuss any of the following.

Other Medicines and Supplements. Inhaled tobramycin may interact with other medicines and supplements. Before using inhaled tobramycin, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Kidney problems
  • Hearing problems, including noises in your ears
  • Breathing problems, including wheezing, coughing, and chest tightness
  • Muscle or nerve problems, such as myasthenia gravis or Parkinson’s disease

Family History. Certain genetic factors can increase your chance of developing hearing loss with inhaled tobramycin. For example, if your mother had hearing problems from inhaled tobramycin, or a similar medicine, you may be at higher risk for this side effect. Tell your health care provider about any family history of side effects to this type of antibiotic that you know about.

Pregnancy. Inhaled tobramycin may cause harm to an unborn baby. Tell your health care provider if you are or plan to become pregnant. Your health care provider will advise you if you should use inhaled tobramycin while you are pregnant or trying to get pregnant.

Breastfeeding. It is not known if inhaled tobramycin passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will advise you if you should use inhaled tobramycin while breastfeeding. If you breastfeed while using inhaled tobramycin, monitor your baby for diarrhea or poop with blood in it. If you notice either of these things, tell your health care provider right away.

Interactions

Does inhaled tobramycin interact with foods or drinks?

There are no known interactions between inhaled tobramycin and foods or drinks.

It is unknown if drinking alcohol will affect inhaled tobramycin, but heavy drinking can slow your immune response and make it harder for your body to fight infection. 

Does inhaled tobramycin interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using inhaled tobramycin.

  • A nonsteroidal anti-inflammatory drug (NSAID), such as aspirin, ibuprofen, naproxen, and others, which is in many prescription and OTC products for pain, swelling, and fever
  • An aminoglycoside antibiotic, such as amikacin, gentamicin, or neomycin, which is a medicine to treat infections
  • A diuretic (also called a water pill), such as ethacrynic acid or furosemide, which is a medicine used to reduce edema (fluid retention) and blood pressure

This may not be a complete list of medicines that can interact with inhaled tobramycin. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much inhaled tobramycin?

If you or someone else has used too much inhaled tobramycin, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of inhaled tobramycin?

If you miss a dose, use it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only use the next dose. Some inhaled tobramycin products may have instructions to only take the missed dose if there are at least six hours left until the next dose. Follow any instructions provided with your inhaled tobramycin. Do not take double or extra doses. Ask your pharmacist if you have any questions about what to do if you miss a dose. 

It is important to complete your prescribed course of inhaled tobramycin, even if your symptoms get better or go away. This will reduce the risk of future infections being resistant to inhaled tobramycin or other similar medicines.