Bacterial infections:

Indications for: TOBI

Management of cystic fibrosis patients with P. aeruginosa.

Adults and Children:

<6yrs: not established. Use the correct nebulizer/compressor. Administer by oral inhalation over a 15-minute period. Give in alternate 28-day cycles (28 days on, 28 days off). ≥6yrs: 300mg (1 amp) twice daily, as close to every 12hrs as possible (must be at least 6hrs apart). Give last when using multiple inhalation therapies.

TOBI Warnings/Precautions:

Safety and efficacy have not been demonstrated in patients <6yrs, in those with FEV1 <25% or >75% predicted, or patients colonized with B. cepacia. Auditory/vestibular dysfunction; monitor closely; if ototoxicity occurs, manage and discontinue if appropriate. Risk for ototoxicity (known maternal history of ototoxicity due to aminoglycoside use or mitochondrial DNA variants); consider alternative therapies. Consider obtaining audiometric evaluations at baseline (esp. at risk of auditory dysfunction). Monitor for high frequency hearing loss if tinnitus occurs. Renal dysfunction or neuromuscular disorders (eg, myasthenia gravis, Parkinson's disease); monitor closely. Monitor serum tobramycin levels in renal dysfunction patients or if treated with concomitant IV aminoglycosides. Consider discontinuing if nephrotoxicity occurs. Elderly. Embryo-fetal toxicity. Pregnancy. Nursing mothers: monitor infant.

TOBI Classification:


TOBI Interactions:

Concomitant ethacrynic acid, furosemide, urea, IV mannitol: not recommended. Diuretics may increase toxicity. Avoid concurrent or sequential use with other oto-, neuro-, or nephrotoxic drugs. Monitor with concomitant systemic aminoglycosides. Do not mix in nebulizer with dornase alfa.

Adverse Reactions:

Increased cough, pharyngitis, increased sputum, dyspnea, hemoptysis, decreased lung function, voice alteration, taste perversion, rash; tinnitus (monitor if occurs), bronchospasm.

Drug Elimination:

Renal. Half-life: 2–3 hours.

Generic Drug Availability:


How Supplied:

Single-dose amps (5mL)—56