What Is Tobi?
Tobi (tobramycin) is a prescription inhaled medication used for cystic fibrosis (CF) management in people whose lungs have been infected with the Pseudomonas aeruginosa bacteria. Tobi is approved for adults and children 6 and older.
Tobi contains the active ingredient tobramycin, which belongs to the class of aminoglycoside antibiotics.
Aminoglycosides are natural or semisynthetic antibiotics derived from actinomycetes (a type of bacteria). These potent, broad-spectrum antibiotics act through the inhibition (stopping) of the protein synthesis mechanism in bacteria that allows it to spread.
Tobi solution stops the growth of the bacteria that commonly infects people with CF lungs. This effect decreases lung infections and damage and helps to improve breathing.
Tobramycin is available as a generic product that is inhaled orally.
Other brand-name medications that contain tobramycin and are administered with an inhaler include Bethkis and Kitabis Pak.
Tobi is administered via a nebulizer (a machine that turns liquid medicine into a mist so that it can be inhaled) and is available through a prescription from a healthcare provider.
Drug Facts
Generic Name: Tobramycin
Brand Name(s): Tobi, Tobi Podhaler, Bethkis, Kitabis Pak
Drug Availability: Prescription
Therapeutic Classification: Antibiotic
Available Generically: Yes
Controlled Substance: No
Administration Route: inhalation
Active Ingredient: Tobramycin
Dosage Form(s): Inhalation solution
What Is Tobi Used For?
The Food and Drug Administration (FDA) has approved Tobi to manage CF in adults and children 6 and older whose lungs have become infected with the Pseudomonas aeruginosa bacteria.
CF is an inherited life-threatening disease caused by a gene mutation causing dysfunction of the cystic fibrosis transmembrane conductance regulator (CFTR) protein. It affects various organ systems, including the lungs, pancreas, upper airways, liver, intestine, and reproductive organs.
A thick, sticky mucus is produced in people with CF in the lungs, which can plug up the tubes, ducts, and passageways in the lungs. If the infection is not adequately managed, it will continue to damage the lungs, causing further problems with breathing.
Pseudomonas aeruginosa is both a common and destructive form of bacteria that infects the organs of people with CF. In fact, it is known as the leading cause of morbidity and mortality in people with CF.
How to Use Tobi
Adhere to the following instructions to safely and effectively use Tobi. Ask your healthcare provider if you have any questions:
- Take Tobi precisely as your healthcare provider tells you.
- Take each dose of Tobi 12 hours apart.
- Do not take your Tobi dose less than six hours apart.
- Inhale Tobi while sitting or standing upright. Breathe normally through the mouthpiece of the nebulizer while taking the dose.
- Nose clips may help to breathe through the mouth.
- Take Tobi in an alternate 28-day cycle.
After using Tobi for 28 days:
- Stop using it for the next 28 days.
- After discontinuing Tobi for 28 days, use it again for 28 days.
- Complete the entire 28-day course even if you are feeling better.
In general, make sure the solution is clear before taking medicine. Do not take if the solution is turbid, has particulate matter, or is unclear. Finally, do not stop taking your medicine without asking your healthcare provider.
Storage
Keep your medications tightly closed and out of the reach of children and pets, ideally locked in a cabinet or closet.
You can store Tobi in the opened foil pouch for up to 28 days at room temperature (68 F to 77 F). Don't use the product stored at room temperature after 28 days. However, this depends on the manufacturer. Some versions of Tobi must be stored under refrigeration at all times.
Keep the unused product in the foil. Discard any leftover portion of this medicine, and do not use it again.
Avoid pouring unused and expired drugs down the drain or in the toilet. Ask your healthcare provider about the best ways to dispose of this medicine.
Visit the FDA's website to know where and how to discard all unused and expired drugs. You can also find disposal boxes in your area. Ask your healthcare provider if you have any questions about the best ways to dispose of your medications.
If you travel with Tobi, get familiar with your final destination's regulations. In general, be sure to make a copy of your Tobi prescription. Keep your medication in its original container from your pharmacy with your name on the label.
Ask your healthcare provider if you have any questions about traveling with your medicine.
Off-Label Uses
Healthcare providers may prescribe medicines for conditions not approved by the FDA. This is called "off-label" use.
Healthcare providers may prescribe Tobi off-label to treat COPD.
How Long Does Tobi Take to Work?
The average serum concentration of Tobi, one hour after inhalation of a single 300-milligram dose in people with cystic fibrosis, was 0.95 micrograms/milliliters.
What Are the Side Effects of Tobi?
This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.
Common Side Effects
Common side effects of Tobi may include but may not be limited to:
Severe Side Effects
Contact your healthcare provider immediately if you develop signs of a severe reaction. Call 911 if your symptoms feel life-threatening.
Severe side effects of Tobi may include but may not be limited to:
Report Side Effects
Tobi may cause other side effects. Call your healthcare provider if you have unusual problems while taking this medication.
If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
Dosage: How Much Tobi Should I Take?
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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
-
For Pseudomonas lung infections:
-
For inhalation dosage form (solution):
- Adults and children 6 years of age and older—One ampule or container with 300 milligrams (mg) of tobramycin 2 times a day for 28 days in the nebulizer. Then, stop using this medicine and wait 28 days, and repeat the cycle (28-day on, 28-day off cycle). You should space the doses at least 6 hours apart.
- Children younger than 6 years of age—Use and dose must be determined by your doctor.
-
For inhalation dosage form (capsule):
- Adults and children 6 years of age and older—Four capsules with 28 milligrams (mg) of tobramycin 2 times a day for 28 days in the Podhaler™ device. Then, stop using this medicine and wait 28 days, and repeat the cycle (28-day on, 28-day off cycle). You should space the doses at least 6 hours apart.
- Children younger than 6 years of age—Use and dose must be determined by your doctor.
-
For inhalation dosage form (solution):
Modifications
The following modifications (changes) should be kept in mind when using Tobi:
Severe allergic reaction: Avoid using Tobi if you have a known allergy to it or its ingredients. Ask your healthcare provider for a complete list of the ingredients if you're unsure.
Pregnancy: Tobi belongs to the class of drugs that can cause fetal harm. There is not enough data available about the safety and effectiveness of Tobi in pregnant people and their unborn fetuses following inhalation.
Discuss with your healthcare provider if you plan to become pregnant or are pregnant, and weigh the benefits and risks of taking Tobi during your pregnancy.
Breastfeeding: There is no data on the presence of Tobi in human milk and its effects on breastfed infants or milk production. Tobramycin may cause a change in the intestinal flora (natural gut bacteria) of the breastfeeding infant.
Talk with your healthcare provider to weigh the benefits and risks of taking Tobi while nursing and the different ways to feed your baby if you plan to breastfeed.
Adults over 65: Clinical studies haven't included enough people in this age group to see whether they respond differently from younger adults. However, older adults with impaired renal conditions are at greater risk of adverse effects. Therefore, it is advisable to monitor renal function.
Children: The safety and effectiveness of Tobi have not been established in children under the age of 6.
Missed Dose
If you accidentally forgot your Tobi dose, take it as soon as possible, up to six hours before the next scheduled dose. If it's less than six hours to the next dose, leave the missed dose and wait until it's time for your next scheduled dose. Don't try to double up to make up for the missed dose.
Try to find ways that work for you to help yourself remember to keep your appointments and take your medication routinely. If you miss too many doses, Tobi might be less effective at treating or preventing your condition.
Overdose: What Happens If I Take Too Much Tobi?
What Happens If I Overdose on Tobi?
If you think you or someone else may have overdosed on Tobi, call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn't breathing after taking Tobi, call 911 immediately.
Precautions
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It is very important that your doctor check your or your child's progress at regular visits to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
This medicine may cause hearing loss. Call your doctor right away if you notice any changes in your hearing or if you have ringing in your ears, headaches, nausea, vomiting, or dizziness.
Your doctor may want to test your hearing while you are being treated with tobramycin. Tell your doctor if you already have hearing problems before you are given this medicine.
Using this medicine may cause harm to your kidneys. Check with your doctor right away if you or your child have any of the following symptoms: blood in the urine, change in the frequency of urination, difficulty in breathing, increased thirst, swelling of the feet or lower legs, or weakness.
When you breathe in this medicine, you may have cough or trouble breathing. Call your doctor right away if you have a cough, trouble breathing, or tightness in the chest after using this medicine.
If any of your medicines do not seem to be working as well as usual, call your doctor right away. Do not change your doses or stop using your medicines without asking your doctor.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
What Are the Reasons I Shouldn’t Take Tobi?
Avoid using it if allergic to Tobi or other aminoglycosides and their ingredients. Ask your healthcare provider for a full list of the ingredients if you're unsure.
It is not known if Tobi is safe and effective in the following demographics:
- People with a forced expiratory volume (FEV1; the amount of air you can force from the lungs in one second) less than 25% or greater than 75% predicted.
- People colonized (germs found on the body but without symptoms) with Burkholderia cepacia (an antibiotic-resistant group of bacteria found in water and soil).
- In children under 6 years old.
What Other Medications Interact With Tobi?
The simultaneous use of Tobi should be avoided with other drugs that are neurotoxic (toxins that are destructive to nerve tissue), nephrotoxic (toxins that are destructive to the kidneys), or ototoxic (damage to the ear as a result of a drug or chemical poisoning) potential.
Some diuretics can enhance aminoglycoside toxicity by changing aminoglycoside concentrations in serum and tissue. Do not use Tobi simultaneously with:
Be sure to talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC), nonprescription products, vitamins, herbs, or plant-based medicines.
What Medications Are Similar?
Tobramycin is available in various other dosage forms under different brand names. Some of the common brands available in the market are:
- AK-Tob (tobramycin) ophthalmic
- Tobrex (tobramycin) ophthalmic
- TobraDex (containing dexamethasone, and tobramycin) ophthalmic suspension
- Zylet (containing loteprednol, tobramycin) ophthalmic suspension
Always use the brand prescribed by your healthcare provider, and never switch between the brands.
How Can I Stay Healthy While Taking Tobi?
CF is a life-threatening disorder, but early diagnosis and regular treatment can lead to improved quality of life and better health.
In order to manage or treat the condition while using Tobi consider the following:
- Take Tobi as recommended by your healthcare provider.
- Make sure to take two doses 12 hours apart.
- Tell your healthcare provider before using Tobi if you have breathing problems, kidney disorders, myasthenia gravis (a condition causing serious muscle weakness and atrophy), Parkinson’s disease, and hearing problems.
- Tell your healthcare provider if you are pregnant or breastfeeding.
Finally, speak to your healthcare provider if you experience any adverse reactions after taking Tobi.
Medical Disclaimer
Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.
