tobramycin

Therapeutic Classification: anti-infectives

Pharmacologic Classification: aminoglycosides

REMS

Treatment of serious Gram-negative bacterial infections and infections caused by staphylococci when penicillins or other less toxic drugs are contraindicated.
Inhaln: Management of cystic fibrosis patients with Pseudomonas aeruginosa.

Inhibits protein synthesis in bacteria at level of 30S ribosome.

Therapeutic effects:

Bactericidal action.

Spectrum:

Most aminoglycosides notable for activity against:
- Pseudomonas aeruginosa,
- Klebsiella pneumoniae,
- Escherichia coli,
- Proteus,
- Serratia,
- Acinetobacter,
- Staphylococcus aureus.
In treatment of enterococcal infections, synergy with a penicillin is required.

Absorption: Well absorbed after IM administration. IV administration results in complete bioavailability. Low absorption follows administration by inhalation.

Distribution: Widely distributed throughout extracellular fluid; crosses the placenta; small amounts enter breast milk. Poor penetration into CSF.

Metabolism/Excretion: Excretion is >90% renal.

Half-Life: Neonates: 2–11 hr; Infants: 3–5 hr; Children: 1–3 hr; Adolescents: 0.5–2.5 hr; Adults: 2–4 hr (↑ in renal impairment to 5–70 hr).

(blood levels‡)

ROUTE	ONSET	PEAK	DURATION
IM	rapid	30–90 min	6–24 hr
IV	rapid	end of infusion‡	6–24 hr

‡All parenterally administered aminoglycosides.

‡Postdistribution peak occurs 30 min after the end of a 30-min infusion and 15 min after the end of a 1-hr infusion.

Contraindicated in:

Hypersensitivity;
Most parenteral products contain bisulfites and should be avoided in patients with known intolerance;
Cross-sensitivity among aminoglycosides may occur.

Use Cautiously in:

Renal impairment (dose adjustments necessary; blood level monitoring useful in preventing ototoxicity and nephrotoxicity);
Hearing impairment;
Geri: Difficulty in assessing auditory and vestibular function; age-related renal impairment;;
Pedi: Neonates (↑ risk of neuromuscular blockade; difficulty in assessing auditory and vestibular function; immature renal function);
Neuromuscular diseases such as myasthenia gravis;
Obese patients (dosage should be based on ideal body weight);
OB: May cause congenital deafness;
Lactation: Lactation.

EENT: ototoxicity (vestibular and cochlear), Inhalation onlytinnitus, voice alteration

GI: CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA (CDAD)

GU: nephrotoxicity

F and E: hypomagnesemia

MS: muscle paralysis (high parenteral doses)

Resp: Inhalation onlybronchospasm, wheezing

Misc: hypersensitivity reactions

Drug-drug:

Inactivated by penicillins and cephalosporins when coadministered to patients with renal insufficiency.
Possible respiratory paralysis after inhalation anesthetics or neuromuscular blockers.
↑risk of ototoxicity with loop diuretics or mannitol (IV).
↑risk of nephrotoxicity with othernephrotoxic drugs.

IM IV (Adults ): 3–6 mg/kg/day in 3 divided doses, or 4–6.6 mg/kg once daily.
IM IV (Children >5 yr): 6–7.5 mg/kg/day divided q 8 hr, up to 13 mg/kg/day divided q 6–8 hr in cystic fibrosis patients (dosing interval may vary from q 6 hr–q 24 hr, depending on clinical situation).
IM IV (Children 1 mo-5 yr): 7.5 mg/kg/day divided q 8 hr, up to 13 mg/kg/day divided q 6–8 hr in cystic fibrosis.
IM IV (Neonates ): Preterm <1000 g—3.5 mg/kg/dose q 24 hr; 0–4 wk, <1200 g—2.5 mg/kg/dose q 18 hr; Postnatal age <7 days—2.5 mg/kg/dose q 12 hr; Postnatal age >7 days,1200–2000 g—2.5 mg/kg/dose q 8–12 hr; Postnatal age >7 days, >2000 g—2.5 mg/kg/dose q 8 hr.
Inhaln (Adults and Children ≥6 yr): Nebulizer solution—300 mg twice daily for 28 days, then off for 28 days, then repeat cycle; Powder for inhalation—Inhale contents of four 28–mg capsules twice daily for 28 days, then off for 28 days, then repeat cycle.

Renal Impairment

IM IV (Adults ): 1 mg/kg initially, further dosing determined by blood level monitoring and assessment of renal function.

(Generic available)

Injection: 10 mg/mL; 40 mg/mL
Nebulizer solution (TOBI, Kitabis Pak): 300 mg/5 mL
Nebulizer solution (Bethkis): 300 mg/4 mL
Powder for inhalation (TOBI Podhaler): 28 mg/capsule
Powder for injection (requires reconstitution): 1200 mg/vial
Premixed injection: 80 mg/100 mL

Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, WBC) at beginning of and throughout therapy.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Evaluate eighth cranial nerve function by audiometry before and throughout therapy. Hearing loss is usually in the high-frequency range. Prompt recognition and intervention are essential in preventing permanent damage. Monitor for vestibular dysfunction (vertigo, ataxia, nausea, vomiting). Eighth cranial nerve dysfunction is associated with persistently elevated peak aminoglycoside levels. Aminoglycosides should be discontinued if tinnitus or subjective hearing loss occurs.
Monitor intake and output and daily weight to assess hydration status and renal function.
Assess patient for signs of superinfection (fever, upper respiratory infection, vaginal itching or discharge, increasing malaise, diarrhea).
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridium difficile-associated diarrhea (CDAD). May begin up to several wk following cessation of therapy.

Lab Test Considerations:

Monitor renal function by urinalysis, specific gravity, BUN, creatinine, and CCr before and during therapy.
- May cause ↑ BUN, AST, ALT, serum alkaline phosphatase, bilirubin, creatinine, and LDH concentrations.
- May cause ↓ serum calcium, magnesium, potassium, and sodium concentrations.

Toxicity and Overdose:

Blood levels should be monitored periodically during oral, IM, and IV therapy; not needed for inhalation therapy. Timing of blood levels is important in interpreting results. Draw blood for peak levels 1 hr after IM injection and 30 min after a 30-min IV infusion is completed. Trough levels should be drawn just before next dose. Peak level should not exceed 10 mcg/mL; trough level should not exceed 2 mcg/mL.

Keep patient well hydrated (1500–2000 mL/day) during therapy.
IM: Administration should be deep into a well-developed muscle. Alternate injection sites.
Inhaln: Do not mix TOBI with dornase alpha in nebulizer.
- TOBI Podhaler capsules are not for oral use. Store capsules in blister until immediately before use. Use new Podhaler device provided with each weekly packet. Check to see capsule is empty after inhaling. If powder remains in capsule, repeat inhalation until capsule is empty.

IV Administration:

Intermittent Infusion: Diluent: Dilute each dose of tobramycin in 50–100 mL of D5W, D10W, D5/0.9% NaCl, 0.9% NaCl, Ringer’s or lactated Ringer’s solution. Concentration: not >10 mg/mL. Pediatric doses may be diluted in proportionately smaller amounts. Stable for 24 hr at room temperature, 96 hr if refrigerated. Also available in commercially mixed piggyback injections.
Rate: Infuse slowly over 30–60 min in both adult and pediatric patients.
Y-Site Compatibility:
- acyclovir
- aldesleukin
- alemtuzumab
- alfentanil
- amifostine
- aminophylline
- amiodarone
- amsacrine
- anidulafungin
- argatroban
- ascorbic acid
- atropine
- aztreonam
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- cangrelor
- carboplatin
- carmustine
- caspofungin
- chloramphenicol
- chlorpromazine
- cisatracurium
- cisplatin
- clindamycin
- cyanocobalamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- daptomycin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin
- doxycycline
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- epoetin alfa
- eptifibatide
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- furosemide
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- hydrocortisone
- hydromorphone
- idarubicin
- ifosfamide
- imipenem/cilastatin
- irinotecan
- isoproterenol
- ketamine
- ketorolac
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- mesna
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- mitoxantrone
- morphine
- multivitamins
- mycophenolate
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- pancuronium
- papaverine
- pemetrexed
- phenobarbital
- phentolamine
- phenylephrine
- phytonadione
- posaconazole
- potassium acetate
- potassium chloride
- procainamide
- prochlorperazine
- promethazine
- propranolol
- protamine
- pyridoxine
- quinupristin/dalfopristin
- ranitidine
- remifentanil
- rituximab
- rocuronium
- sargramostim
- sodium acetate
- sodium bicarbonate
- streptokinase
- succinylcholine
- sufentanil
- tacrolimus
- teniposide
- theophylline
- thiamine
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- warfarin
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- allopurinol
- amphotericin B deoxycholate
- amphotericin B lipid complex
- amphotericin B liposome
- azathioprine
- dacarbazine
- dantrolene
- diazepam
- diazoxide
- folic acid
- ganciclovir
- ibuprofen lysine
- indomethacin
- mitomycin
- pentamidine
- pentobarbital
- phenytoin
- propofol
- trastuzumab
- trimethoprim/sulfamethoxazole

Instruct patient to report signs of hypersensitivity, tinnitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating.
- Advise patient of the importance of drinking plenty of liquids.
- Instruct patient to notify health care professional immediately if rash, diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professionals.
Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Inhaln: Instruct patient to take inhalation twice daily as close to 12 hrs apart as possible; not <6 hrs apart. Solution is colorless to pale yellow and may darken with age without effecting quality. Administer over 15 min period using a hand-held PARI LC PLUS reusable nebulizer with a PARI VIOS (for Bethkis) or DeVibiss Pulmo Aide (for TOBI) compressor. Instruct patient on multiple therapies to take others first and use tobramycin last. Tobramycin-induced bronchospasm may be reduced if tobramycin is administered following bronchodilators. Instruct patient to sit or stand upright during inhalation and breathe normally through mouthpiece of nebulizer. Nose clips may help patient breathe through mouth. Store at room temperature for up to 28 days. Advise patient to disinfect the nebulizer parts (except tubing) by boiling them in water for a full 10 minutes every other treatment day.
- Instruct patient in correct technique for use of TOBI Podhaler. Wipe mouthpiece with clean, dry cloth after use; do not wash with water.
Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Resolution of the signs and symptoms of infection. If no response is seen within 3–5 days, new cultures should be taken.

Bethkis, Kitabis Pak, TOBI, TOBI Podhaler

Risk for infection(Indications)
Disturbed sensory perception(auditory)(Side Effects)
Deficient knowledge, Relate med(Patient/Family Teaching)

NDC Code

0078- Novartis Pharmaceuticals Corporation
- 0078-0813- TOBREX
  - 0078-0813-01- 3.5 g in 1 TUBE (0078-0813-01)

0093- Teva Pharmaceuticals USA, Inc.
- 0093-3750- Tobramycin
  - 0093-3750-28- 7 POUCH in 1 CARTON (0093-3750-28) / 4 AMPULE in 1 POUCH / 4 mL in 1 AMPULE

0093- Teva Pharmaceuticals USA, Inc.
- 0093-3750- Tobramycin
  - 0093-3750-63- 14 POUCH in 1 CARTON (0093-3750-63) / 4 AMPULE in 1 POUCH / 4 mL in 1 AMPULE

0093- Teva Pharmaceuticals USA, Inc.
- 0093-4085- Tobramycin
  - 0093-4085-63- 56 AMPULE in 1 CARTON (0093-4085-63) / 5 mL in 1 AMPULE

0409- Hospira, Inc.
- 0409-3578- TOBRAMYCIN
  - 0409-3578-01- 25 VIAL, MULTI-DOSE in 1 TRAY (0409-3578-01) / 2 mL in 1 VIAL, MULTI-DOSE (0409-3578-11)

10122- Chiesi USA, Inc.
- 10122-820- BETHKIS
  - 10122-820-04- 4 AMPULE in 1 POUCH (10122-820-04) / 4 mL in 1 AMPULE

10122- Chiesi USA, Inc.
- 10122-820- BETHKIS
  - 10122-820-28- 7 POUCH in 1 CARTON (10122-820-28) / 4 AMPULE in 1 POUCH / 4 mL in 1 AMPULE

10122- Chiesi USA, Inc.
- 10122-820- BETHKIS
  - 10122-820-56- 14 POUCH in 1 CARTON (10122-820-56) / 4 AMPULE in 1 POUCH / 4 mL in 1 AMPULE

10695- Willow Birch Pharma, Inc.
- 10695-008-
  - 10695-008-55- 7 kg in 1 BOTTLE (10695-008-55)

11722- Pliva Hrvatska d.o.o.
- 11722-073-
  - 11722-073-00- 1 kg in 1 CARTON (11722-073-00)

24208- Bausch & Lomb Incorporated
- 24208-290- Tobramycin
  - 24208-290-05- 1 BOTTLE, DROPPER in 1 CARTON (24208-290-05) / 5 mL in 1 BOTTLE, DROPPER

24492- Pari Respiratory Equipment, Inc.
- 24492-850- Kitabis Pak
  - 24492-850-56- 14 POUCH in 1 CARTON (24492-850-56) / 4 AMPULE in 1 POUCH / 5 mL in 1 AMPULE

36000- Baxter Healthcare Corporation
- 36000-242- Tobramycin
  - 36000-242-01- 1 VIAL, MULTI-DOSE in 1 CARTON (36000-242-01) / 30 mL in 1 VIAL, MULTI-DOSE

36000- Baxter Healthcare Corporation
- 36000-244- Tobramycin
  - 36000-244-25- 25 VIAL, MULTI-DOSE in 1 BLISTER PACK (36000-244-25) / 2 mL in 1 VIAL, MULTI-DOSE

38779- Medisca Inc.
- 38779-0319-
  - 38779-0319-1- 10 g in 1 BOTTLE, GLASS (38779-0319-1)

38779- Medisca Inc.
- 38779-0319-
  38779-0319-3- 5 g in 1 BOTTLE, GLASS (38779-0319-3)

38779- Medisca Inc.
- 38779-0319-
  38779-0319-4- 25 g in 1 JAR (38779-0319-4)

38779- Medisca Inc.
- 38779-0319-
  38779-0319-5- 100 g in 1 JAR (38779-0319-5)

38779- Medisca Inc.
- 38779-0319-
  38779-0319-6- 1 g in 1 BOTTLE, GLASS (38779-0319-6)

38779- Medisca Inc.
- 38779-0319-
  38779-0319-8- 500 g in 1 JAR (38779-0319-8)

38779- Medisca Inc.
- 38779-0319-
  38779-0319-9- 1000 g in 1 JAR (38779-0319-9)

39822- XGen Pharmaceuticals DJB, Inc.
- 39822-0412- Tobramycin
  39822-0412-1- 1 VIAL in 1 CARTON (39822-0412-1) / 30 mL in 1 VIAL

39822- XGen Pharmaceuticals DJB, Inc.
- 39822-0412- Tobramycin
  - 39822-0412-6- 6 VIAL in 1 CARTON (39822-0412-6) / 30 mL in 1 VIAL

42513- Livzon Group Fuzhou Fuxing Pharmaceutical Co., Ltd.
- 42513-0009-
  - 42513-0009-1- 1 BOTTLE in 1 CARTON (42513-0009-1) / 1 kg in 1 BOTTLE

42513- Livzon Group Fuzhou Fuxing Pharmaceutical Co., Ltd.
- 42513-0009-
  42513-0009-2- 1 BOTTLE in 1 CARTON (42513-0009-2) / 7 kg in 1 BOTTLE

42513- Livzon Group Fuzhou Fuxing Pharmaceutical Co., Ltd.
- 42513-0009-
  42513-0009-4- 2 BOTTLE in 1 CARTON (42513-0009-4) / 7 kg in 1 BOTTLE

42513- Livzon Group Fuzhou Fuxing Pharmaceutical Co., Ltd.
- 42513-0009-
  42513-0009-5- 1 BOTTLE in 1 CARTON (42513-0009-5) / 7 kg in 1 BOTTLE

42513- Livzon Group Fuzhou Fuxing Pharmaceutical Co., Ltd.
- 42513-0009-
  42513-0009-6- 1 BOTTLE in 1 CARTON (42513-0009-6) / 1.5 kg in 1 BOTTLE

42513- Livzon Group Fuzhou Fuxing Pharmaceutical Co., Ltd.
- 42513-0009-
  42513-0009-7- 2 BOTTLE in 1 CARTON (42513-0009-7) / 7 kg in 1 BOTTLE

42513- Livzon Group Fuzhou Fuxing Pharmaceutical Co., Ltd.
- 42513-0011-
  42513-0011-1- 1 BOTTLE in 1 CARTON (42513-0011-1) / 3 kg in 1 BOTTLE

42513- Livzon Group Fuzhou Fuxing Pharmaceutical Co., Ltd.
- 42513-0011-
  42513-0011-2- 2 BOTTLE in 1 CARTON (42513-0011-2) / 3 kg in 1 BOTTLE

42513- Livzon Group Fuzhou Fuxing Pharmaceutical Co., Ltd.
- 42513-0011-
  42513-0011-3- 1 BOTTLE in 1 CARTON (42513-0011-3) / 1 BAG in 1 BOTTLE / 3 kg in 1 BAG

42513- Livzon Group Fuzhou Fuxing Pharmaceutical Co., Ltd.
- 42513-0011-
  42513-0011-4- 2 BOTTLE in 1 CARTON (42513-0011-4) / 1 BAG in 1 BOTTLE / 3 kg in 1 BAG

42513- Livzon Group Fuzhou Fuxing Pharmaceutical Co., Ltd.
- 42513-0011-
  42513-0011-5- 1 BAG in 1 DRUM (42513-0011-5) / 15 kg in 1 BAG

45932- Xellia Pharmaceuticals ApS
- 45932-0012-
  45932-0012-0- 4 kg in 1 CONTAINER (45932-0012-0)

45932- Xellia Pharmaceuticals ApS
- 45932-0012-
  45932-0012-1- .01 kg in 1 CONTAINER (45932-0012-1)

45932- Xellia Pharmaceuticals ApS
- 45932-0012-
  45932-0012-2- 2.15 kg in 1 CONTAINER (45932-0012-2)

45932- Xellia Pharmaceuticals ApS
- 45932-0014-
  45932-0014-0- 4 kg in 1 CONTAINER (45932-0014-0)

45932- Xellia Pharmaceuticals ApS
- 45932-0014-
  45932-0014-1- 2.15 kg in 1 CONTAINER (45932-0014-1)

47335- Sun Pharmaceutical Industries, Inc.
- 47335-171- Tobramycin
  47335-171-49- 14 POUCH in 1 CARTON (47335-171-49) / 4 AMPULE in 1 POUCH (47335-171-48) / 5 mL in 1 AMPULE

49452- Spectrum Laboratory Products, Inc.
- 49452-7821-
  - 49452-7821-1- 500 g in 1 BOTTLE (49452-7821-1)

49452- Spectrum Laboratory Products, Inc.
- 49452-7821-
  49452-7821-3- 5 g in 1 BOTTLE (49452-7821-3)

49452- Spectrum Laboratory Products, Inc.
- 49452-7821-
  49452-7821-4- 25 g in 1 BOTTLE (49452-7821-4)

49452- Spectrum Laboratory Products, Inc.
- 49452-7821-
  49452-7821-5- 50 g in 1 BOTTLE (49452-7821-5)

49502- Viatris Specialty LLC
- 49502-345- TOBI
  49502-345-73- 56 POUCH in 1 CARTON (49502-345-73) / 4 AMPULE in 1 POUCH (49502-345-99) / 5 mL in 1 AMPULE

49502- Viatris Specialty LLC
- 49502-401- TOBI Podhaler
  - 49502-401-09- 8 CAPSULE in 1 BOX, UNIT-DOSE (49502-401-09)

49502- Viatris Specialty LLC
- 49502-401- TOBI Podhaler
  - 49502-401-24- 224 PACKAGE in 1 BOX, UNIT-DOSE (49502-401-24) / 56 BLISTER PACK in 1 PACKAGE / 4 CAPSULE in 1 BLISTER PACK

49502- Viatris Specialty LLC
- 49502-401- TOBI Podhaler
  - 49502-401-57- 7 BLISTER PACK in 1 BOX, UNIT-DOSE (49502-401-57) / 8 CAPSULE in 1 BLISTER PACK

50090- A-S Medication Solutions
- 50090-2127- Tobramycin
  - 50090-2127-0- 1 BOTTLE, DROPPER in 1 CARTON (50090-2127-0) / 5 mL in 1 BOTTLE, DROPPER

50090- A-S Medication Solutions
- 50090-4190- Tobramycin
  - 50090-4190-0- 1 BOTTLE in 1 CARTON (50090-4190-0) / 5 mL in 1 BOTTLE

51846- Teva Pharmaceutical Works Private Limited Company
- 51846-1012-
  - 51846-1012-0- 1 kg in 1 CARTON (51846-1012-0)

51927- Professional Compounding Centers of America
- 51927-0226-
  51927-0226-0- 1 kg in 1 BOTTLE (51927-0226-0)

55150- Eugia US LLC
- 55150-470- TOBRAMYCIN
  55150-470-06- 6 VIAL, PHARMACY BULK PACKAGE in 1 CARTON (55150-470-06) / 30 mL in 1 VIAL, PHARMACY BULK PACKAGE (55150-470-01)

57885- Chongqing Daxin Pharmaceutical Co. Ltd.
- 57885-0002-
  - 57885-0002-1- 90 kg in 1 BAG (57885-0002-1)

59651- Aurobindo Pharma Limited
- 59651-129- TOBRAMYCIN
  59651-129-56- 14 POUCH in 1 CARTON (59651-129-56) / 4 AMPULE in 1 POUCH (59651-129-04) / 5 mL in 1 AMPULE

60687- American Health Packaging
- 60687-731- Tobramycin
  - 60687-731-83- 30 POUCH in 1 CARTON (60687-731-83) / 1 AMPULE in 1 POUCH (60687-731-79) / 5 mL in 1 AMPULE

60760- St. Mary's Medical Park Pharmacy
- 60760-583- Tobramycin
  - 60760-583-05- 1 BOTTLE in 1 CARTON (60760-583-05) / 5 mL in 1 BOTTLE

61314- Sandoz Inc
- 61314-643- Tobramycin
  - 61314-643-05- 5 mL in 1 BOTTLE, PLASTIC (61314-643-05)

61919- DirectRX
- 61919-642- TOBRAMYCIN
  - 61919-642-05- 5 mL in 1 BOTTLE (61919-642-05)

62250- Belcher Pharmaceuticals, LLC
- 62250-110- Tobramycin
  - 62250-110-01- 1 BOTTLE, PLASTIC in 1 CARTON (62250-110-01) / 5 mL in 1 BOTTLE, PLASTIC

62991- LETCO MEDICAL, LLC
- 62991-1351-
  - 62991-1351-2- 5 g in 1 JAR (62991-1351-2)

62991- LETCO MEDICAL, LLC
- 62991-1351-
  62991-1351-3- 10 g in 1 JAR (62991-1351-3)

62991- LETCO MEDICAL, LLC
- 62991-1351-
  62991-1351-5- 25 g in 1 JAR (62991-1351-5)

62991- LETCO MEDICAL, LLC
- 62991-1351-
  62991-1351-6- 100 g in 1 JAR (62991-1351-6)

62991- LETCO MEDICAL, LLC
- 62991-1351-
  62991-1351-8- 500 g in 1 JAR (62991-1351-8)

63187- Proficient Rx LP
- 63187-024- Tobramycin
  63187-024-05- 1 BOTTLE, DROPPER in 1 CARTON (63187-024-05) / 5 mL in 1 BOTTLE, DROPPER

63187- Proficient Rx LP
- 63187-902- Tobramycin
  - 63187-902-02- 1 BOTTLE, DROPPER in 1 CARTON (63187-902-02) / 2 mL in 1 BOTTLE, DROPPER

63187- Proficient Rx LP
- 63187-902- Tobramycin
  - 63187-902-05- 1 BOTTLE, DROPPER in 1 CARTON (63187-902-05) / 5 mL in 1 BOTTLE, DROPPER

63187- Proficient Rx LP
- 63187-973- Tobramycin
  - 63187-973-05- 5 mL in 1 BOTTLE, PLASTIC (63187-973-05)

63323- Fresenius Kabi USA, LLC
- 63323-303- Tobramycin
  - 63323-303-51- 6 VIAL, PHARMACY BULK PACKAGE in 1 TRAY (63323-303-51) / 30 mL in 1 VIAL, PHARMACY BULK PACKAGE (63323-303-01)

63323- Fresenius Kabi USA, LLC
- 63323-303- Tobramycin
  - 63323-303-55- 6 VIAL, PHARMACY BULK PACKAGE in 1 TRAY (63323-303-55) / 30 mL in 1 VIAL, PHARMACY BULK PACKAGE (63323-303-21)

63323- Fresenius Kabi USA, LLC
- 63323-305- Tobramycin
  - 63323-305-02- 25 VIAL, MULTI-DOSE in 1 TRAY (63323-305-02) / 2 mL in 1 VIAL, MULTI-DOSE (63323-305-01)

63323- Fresenius Kabi USA, LLC
- 63323-306- Tobramycin
  - 63323-306-02- 25 VIAL, MULTI-DOSE in 1 TRAY (63323-306-02) / 2 mL in 1 VIAL, MULTI-DOSE (63323-306-01)

63323- Fresenius Kabi USA, LLC
- 63323-306- Tobramycin
  - 63323-306-30- 10 VIAL, MULTI-DOSE in 1 TRAY (63323-306-30) / 30 mL in 1 VIAL, MULTI-DOSE (63323-306-05)

63323- Fresenius Kabi USA, LLC
- 63323-307- Tobramycin
  - 63323-307-51- 1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON (63323-307-51) / 50 mL in 1 VIAL, PHARMACY BULK PACKAGE

63552- Patheon Manufacturing Services LLC
- 63552-025-
  - 63552-025-01- 72 VIAL, GLASS in 1 CASE (63552-025-01) / 50 mL in 1 VIAL, GLASS

63552- Patheon Manufacturing Services LLC
- 63552-025-
  63552-025-02- 96 VIAL, GLASS in 1 CASE (63552-025-02) / 50 mL in 1 VIAL, GLASS

65162- Amneal Pharmaceuticals LLC
- 65162-914- Tobramycin
  65162-914-46- 56 AMPULE in 1 CARTON (65162-914-46) / 5 mL in 1 AMPULE

66267- NuCare Pharmaceuticals,Inc.
- 66267-936- Tobramycin
  - 66267-936-05- 5 mL in 1 BOX (66267-936-05)

67296- Redpharm Drug
- 67296-0391- Tobramycin
  - 67296-0391-1- 5 mL in 1 BOTTLE, PLASTIC (67296-0391-1)

67296- Redpharm Drug
- 67296-1639- Tobramycin
  - 67296-1639-5- 1 BOTTLE in 1 CARTON (67296-1639-5) / 5 mL in 1 BOTTLE

67457- Mylan Institutional LLC
- 67457-428- Tobramycin
  - 67457-428-30- 10 VIAL in 1 CARTON (67457-428-30) / 30 mL in 1 VIAL (67457-428-00)

67457- Mylan Institutional LLC
- 67457-473- Tobramycin
  - 67457-473-22- 25 VIAL in 1 CARTON (67457-473-22) / 2 mL in 1 VIAL (67457-473-00)

67877- Ascend Laboratories, LLC
- 67877-678- Tobramycin
  - 67877-678-70- 56 POUCH in 1 CARTON (67877-678-70) / 7 AMPULE in 1 POUCH (67877-678-69) / 5 mL in 1 AMPULE

68071- NuCare Pharmaceuticals,Inc.
- 68071-2272- Tobramycin
  - 68071-2272-5- 1 BOTTLE in 1 CARTON (68071-2272-5) / 5 mL in 1 BOTTLE

68083- Gland Pharma Limited
- 68083-241- Tobramycin
  - 68083-241-01- 1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON (68083-241-01) / 50 mL in 1 VIAL, PHARMACY BULK PACKAGE

68083- Gland Pharma Limited
- 68083-253- Tobramycin
  - 68083-253-25- 25 VIAL, MULTI-DOSE in 1 CARTON (68083-253-25) / 2 mL in 1 VIAL, MULTI-DOSE (68083-253-01)

68083- Gland Pharma Limited
- 68083-254- Tobramycin
  - 68083-254-25- 25 VIAL, MULTI-DOSE in 1 CARTON (68083-254-25) / 2 mL in 1 VIAL, MULTI-DOSE (68083-254-01)

68083- Gland Pharma Limited
- 68083-312- Tobramycin
  - 68083-312-06- 6 VIAL, PHARMACY BULK PACKAGE in 1 CARTON (68083-312-06) / 30 mL in 1 VIAL, PHARMACY BULK PACKAGE (68083-312-01)

68083- Gland Pharma Limited
- 68083-374- Tobramycin
  - 68083-374-01- 1 BOTTLE, PLASTIC in 1 CARTON (68083-374-01) / 5 mL in 1 BOTTLE, PLASTIC

68180- Lupin Pharmaceuticals, Inc.
- 68180-962- Tobramycin
  - 68180-962-56- 56 POUCH in 1 CARTON (68180-962-56) / 4 AMPULE in 1 POUCH / 5 mL in 1 AMPULE

68788- Preferred Pharmaceuticals Inc.
- 68788-7252- Tobramycin
  - 68788-7252-5- 1 BOTTLE in 1 CARTON (68788-7252-5) / 5 mL in 1 BOTTLE

70069- Somerset Therapeutics, LLC
- 70069-131- Tobramycin
  - 70069-131-01- 1 BOTTLE in 1 CARTON (70069-131-01) / 5 mL in 1 BOTTLE

70436- Slate Run Pharmaceuticals, LLC
- 70436-110- tobramycin
  - 70436-110-36- 30 mL in 1 VIAL (70436-110-36)

70436- Slate Run Pharmaceuticals, LLC
- 70436-110- tobramycin
  - 70436-110-56- 180 mL in 1 CARTON (70436-110-56)

70436- Slate Run Pharmaceuticals, LLC
- 70436-110- tobramycin
  - 70436-110-80- 30 mL in 1 CARTON (70436-110-80)

70518- REMEDYREPACK INC.
- 70518-1370- Tobramycin
  - 70518-1370-0- 1 BOTTLE in 1 CARTON (70518-1370-0) / 5 mL in 1 BOTTLE

70644- Genericus, Inc.
- 70644-899- Tobramycin Inhalation Solution Pak
  - 70644-899-99- 14 POUCH in 1 CARTON (70644-899-99) / 4 AMPULE in 1 POUCH / 5 mL in 1 AMPULE

70700- Xiromed LLC
- 70700-173- Tobramycin
  - 70700-173-86- 6 CARTON in 1 CARTON (70700-173-86) / 1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON (70700-173-22) / 50 mL in 1 VIAL, PHARMACY BULK PACKAGE

70756- Lifestar Pharma LLC
- 70756-604- TOBRAMYCIN
  - 70756-604-56- 14 POUCH in 1 CARTON (70756-604-56) / 4 AMPULE in 1 POUCH (70756-604-44) / 5 mL in 1 AMPULE

70756- Lifestar Pharma LLC
- 70756-617- Tobramycin
  - 70756-617-56- 14 POUCH in 1 CARTON (70756-617-56) / 4 AMPULE in 1 POUCH (70756-617-44) / 4 mL in 1 AMPULE

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Pot. Nursing Diagnoses ⬆ ⬇

Code ⬆