What are the side effects of inhaled tobramycin (Tobi)?

Side effects from inhaled tobramycin (Tobi) mostly affect the mouth, throat, and lungs. Common side effects include cough, shortness of breath, wheezing, "rattling" lung sounds, hoarseness, and pain. Since tobramycin (Tobi) mostly stays in the lungs, this medication rarely affects other parts of the body, though it is still possible in some cases. Serious side effects also include hearing loss and kidney injury.

tobramycin

Generic Tobi

Used for Cystic Fibrosis

Tobramycin (Tobi) helps people with cystic fibrosis (CF) breathe better by controlling their Pseudomonas aeruginosa bacterial infection long term. It's inhaled through your mouth using a device (either a nebulizer or inhaler), and it can cause irritation in the mouth, throat, and lungs.

Reviewed by:

Aileen Chu, PharmD, BCPS

Michelle Nguyen, PharmD

Last reviewed on August 30, 2021

What is Tobramycin (Tobi)?

What is Tobramycin (Tobi) used for?

Cystic fibrosis (CF) with Pseudomonas aeruginosa bacterial infection

How Tobramycin (Tobi) works

Tobramycin (Tobi) is an aminoglycoside antibiotic. It kills bacteria by blocking their ability to make proteins that are necessary for their protective covering. By getting rid of the Pseudomonas aeruginosa bacteria in the lungs, tobramycin (Tobi) helps people with CF breathe better.

Are you looking for information on tobramycin eye ointment or drops (Tobrex) instead?

Drug facts

Common Brands	Tobi, Tobi Podhaler, Bethkis, Kitabis Pak
Drug Class	Aminoglycoside antibiotic
Controlled Substance Classification	Not a controlled medication
Generic Status	No lower-cost generic available
Availability	Prescription only

Common Brands

Tobi, Tobi Podhaler, Bethkis, Kitabis Pak

Drug Class

Aminoglycoside antibiotic

Controlled Substance Classification

Not a controlled medication

Generic Status

No lower-cost generic available

Availability

Prescription only

Side effects of Tobramycin (Tobi)

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Lung reactions, including cough, shortness of breath, wheezing, "rattling" lung sounds
Hoarseness
Mouth or throat pain

Less Common Side Effects

Stuffy nose
Throat or airway irritation
Pain in the chest muscles
Change in taste
Nausea, vomiting, and diarrhea
Bleeding
Change in blood cell counts
High blood sugar
Headache
Infection
Fever
Rash

Tobramycin (Tobi) serious side effects

Contact your healthcare provider immediately if you experience any of the following.

Difficulty breathing or wheezing
Hearing loss, dizziness, or ringing in the ears
Muscle weakness
Kidney injury: less urine, swollen feet or legs

Source: FDA

The following Tobramycin (Tobi) side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

Itching, redness, swelling, or other sign of eye or eyelid irritation not present before use of this medicine

Symptoms of overdose

Increased watering of the eyes

itching, redness, or swelling of the eyes or eyelids

painful irritation of the clear front part of the eye

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Burning or stinging of the eyes

Eye ointments usually cause your vision to blur for a few minutes after application.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Pros and cons of Tobramycin (Tobi)

Pros

Works directly in the area where the bacterial infection is
Fewer serious side effects than oral or intravenous (IV) antibiotics
Can be given to children older than 6 years of age

Cons

Requires correct inhalation technique to get the full effect
Can cause hearing loss, so you may need regular hearing tests
Need to remember to start and stop taking the medication every 28 days

Pharmacist tips for Tobramycin (Tobi)

Make sure that you are using the right technique for inhaling tobramycin (Tobi) by reading the step-by-step instructions included with your medication and by reviewing your technique with your provider. If you aren't sure how to take your dose, check with your provider or pharmacist. Parents or caregivers should supervise children who are using this medication.
The dose is the same for adults and children over 6 years of age.
Take your doses 12 hours apart. It's okay if your timing is off by a little bit, but don't take them less than 6 hours apart. So if you miss a dose and it's less than 6 hours until the next dose, skip the missed dose and take the regular dose according to your usual schedule.
Use tobramycin (Tobi) in 4-week cycles. Take it for 28 days, then stop for 28 days, then repeat the cycle. It may help to mark your calendar so you know where you're at in the treatment cycle.
If you're feeling better after a few doses of this medication, you should continue to take tobramycin (Tobi) for the full 28-day cycle. Stopping this antibiotic too early can lead to bacterial resistance (tobramycin (Tobi) may not work anymore). Antibiotic-resistant bacterial infections are very difficult to treat and are especially problematic in people who have CF.
If you are getting chest physiotherapy or using other inhaled medications, take your dose of tobramycin (Tobi) last.
Tips for the Tobi Podhaler: The capsules should only be used with the Podhaler device for inhalation. Do not swallow the capsules, since the medication only works if it's inhaled directly into the lungs where you have the infection. After each dose, check to make sure that the capsule is empty; if there's still some powder inside, keep inhaling until it's empty. Use a new Podhaler every 7 days.
Tips for the inhalation solution: Store the solution in the refrigerator or at room temperature. If it's out of the refrigerator for a while, the solution may become a darker yellow color; this is normal, and you can use the medication as long as it has been out of the refrigerator and at room temperature for fewer than 28 days. The medication breaks down if exposed to light, so also make sure to keep unopened ampules in the foil pouch until right before you're ready to use it. Once the medication is in the nebulizer machine, breathe it in through your mouth until the solution is completely gone (this can take up to 15 minutes). Make sure to clean and disinfect your nebulizer machine regularly to prevent contamination.
It's normal to feel a little throat or lung irritation from tobramycin (Tobi), but talk to your provider if side effects are bothersome or if you experience significant difficulty breathing.
Tobramycin (Tobi) can interact with other medications. Make sure to tell your provider and pharmacist all the medications that you take, including supplements and over-the-counter medications, so that they can help you watch out for interactions and side effects.
Tobramycin (Tobi) mostly stays in the lungs and doesn't reach other parts of the body. In certain situations, your provider may check blood tests just to be safe.

Common questions about Tobi

Tobi solution can be nebulized, meaning that you use a special machine to turn the liquid into a mist that you inhale. For many years, nebulization was the only way for CF patients to inhale tobramycin into the lungs. More recently, tobramycin became available as a powder for inhalation (Tobi Podhaler), but it can't be nebulized and must be administered using the Podhaler device.

Side effects from inhaled Tobi mostly affect the mouth, throat, and lungs. Common side effects include cough, shortness of breath, wheezing, "rattling" lung sounds, hoarseness, and pain. Since Tobi mostly stays in the lungs, this medication rarely affects other parts of the body, though it is still possible in some cases. Serious side effects also include hearing loss and kidney injury.

Tobi inhalation is used specifically to kill Pseudomonas aeruginosa in the lungs of people with CF. It can work against some other bacteria as well, but the inhalation form is not used for those infections. Tobi doesn't work as well against Burkholderia cepacia, which is why it cannot be given to people who have that bacteria in their lungs.

Do not mix Tobi with any other medications. If you are getting nebulized albuterol at the same time as your dose of Tobi, take Tobi after the albuterol.

Risks and warnings for Tobramycin (Tobi)

Tobramycin (Tobi) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Difficulty breathing

Tobramycin (Tobi) can cause tight airways (bronchospasm), making it difficult to breathe. If this medication causes difficulty breathing or wheezing, talk to your provider. If you have a rescue inhaler, it's a good idea to keep it handy, especially when you first start taking tobramycin (Tobi).

Hearing loss

Risk factors: History of ear problems, including difficulty with hearing and balance (vestibular dysfunction)

Aminoglycoside antibiotics like tobramycin (Tobi) can cause hearing loss, dizziness, and vertigo (spinning sensation). Some people may first notice ringing in the ears. If you experience any of these symptoms, talk to your provider as soon as possible. Your provider will monitor your hearing, and if necessary, may check to make sure your tobramycin blood level isn't too high.

Kidney injury

Risk factors: Kidney problems | Taking other medications that can cause kidney injury

Aminoglycoside antibiotics like tobramycin (Tobi) can cause kidney injury, especially if medication blood levels get too high. This rarely happens with tobramycin (Tobi), because it mostly stays in the lungs, but if you have kidney problems, your provider may check kidney tests and tobramycin blood levels to be safe. Let your provider know if you are making less urine than normal or if you notice fluid buildup in your legs and feet, since these are potential symptoms of kidney injury.

Muscle weakness

Risk factors: Myasthenia gravis | Parkinson's disease | Other neuromuscular conditions

Aminoglycoside antibiotics like tobramycin (Tobi) can cause muscle weakness, especially in people who have neuromuscular conditions, such as myasthenia gravis and Parkinson's disease. In severe cases, this can be paralyzing and affect your ability to breathe. Let your provider know immediately if you experience any kind of muscle weakness while you're taking this medication.

Harm to unborn baby

Aminoglycoside antibiotics like tobramycin (Tobi) can cause harm to your unborn baby if you take it while pregnant. This rarely happens with tobramycin (Tobi), because it mostly stays in the lungs, but if you are pregnant or plan to become pregnant, talk to your provider about the risks and benefits of using this medication.

Tobramycin (Tobi) dosage

Typical dosage for Tobramycin (Tobi)

The typical dose is 1 inhalation by mouth every 12 hours. Use this medication for 28 days, then stop for 28 days, then repeat the 28-day cycle.

Solution form (Tobi, Bethkis, and Kitabis Pak): Each dose (1 ampule) contains 300 mg of tobramycin.
Capsule form (Tobi Podhaler): Each dose (4 capsules) contains a total of 112 mg of tobramycin.

Interactions between Tobramycin (Tobi) and other drugs

Tobramycin (Tobi) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Tobramycin (Tobi). Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Ataluren

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Alcuronium
Atracurium
Cholera Vaccine, Live
Cidofovir
Cisatracurium
Colistimethate Sodium
Decamethonium
Doxacurium
Ethacrynic Acid
Fazadinium
Foscarnet
Furosemide
Gallamine
Hexafluorenium
Lysine
Mannitol
Metocurine
Mivacurium
Pancuronium
Pipecuronium
Rapacuronium
Rocuronium
Succinylcholine
Tubocurarine
Vancomycin
Vecuronium

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.