Tobramycin

Nephrotoxic agents Concomitant administration of cidofovir injection and agents with nephrotoxic potential [e.g., intravenous aminoglycosides (e.g., tobramycin, gentamicin, and amikacin), amphotericin B, foscarnet, intravenous pentamidine, vancomycin, and nonsteroidal anti-inflammatory agents] is contraindicated.

Nephrotoxic Agents Concomitant administration of cidofovir injection and agents with nephrotoxic potential [e.g., intravenous aminoglycosides (e.g., tobramycin, gentamicin, and amikacin), amphotericin B, foscarnet, intravenous pentamidine, vancomycin, and nonsteroidal anti-inflammatory agents] is contraindicated.

Concomitant administration not recommended due to possible enhancement of aminoglycoside toxicity by altering serum and tissue concentrations.

Concomitant administration not recommended due to possible enhancement of aminoglycoside toxicity by altering serum and tissue concentrations.

Intravenous mannitol not recommended due to possible enhancement of aminoglycoside toxicity by altering serum and tissue concentrations.

Concomitant administration not recommended due to possible enhancement of aminoglycoside toxicity by altering serum and tissue concentrations.

Concurrent and/or sequential use should be avoided due to potential neurotoxicity and nephrotoxicity.

Piperacillin may inactivate tobramycin by converting it to microbiologically inert amides. In hemodialysis patients, tobramycin concentrations may be significantly reduced and require monitoring.

7 DRUG INTERACTIONS 7.1 Drugs with Nephrotoxic or Ototoxic Potential Avoid concurrent and/or sequential use of Tobramycin for Injection with other drugs with nephrotoxic and/or ototoxic potential. 7.3 Drugs with Neuromuscular Blockade or Neurotoxic Potential Prolonged respiratory paralysis may occur in patients concomitantly receiving neuromuscular blocking agents with Tobramycin for Injection [see Boxed Warning , Warnings and Precautions ( 5.5 )] . In addition, avoid concurrent and/or sequential use of Tobramycin for Injection with other neurotoxic drugs.

May potentiate renal dysfunction when used concomitantly with cyclosporine. Close monitoring of renal function required.

The interaction between inhaled mannitol and TOBI Podhaler has not been evaluated.

7.15 Concomitant Drugs That Do Not Need Dosage Adjustment No dosage adjustment of ORKAMBI or concomitant drug is recommended when ORKAMBI is given with the following: azithromycin, aztreonam, budesonide, ceftazidime, cetirizine, ciprofloxacin, colistimethate, colistin, dornase alfa, fluticasone, ipratropium, levofloxacin, pancreatin, pancrelipase, salbutamol, salmeterol, sulfamethoxazole, trimethoprim, tiotropium, and tobramycin.

The combination of penicillin G and tobramycin results in a synergistic bactericidal effect in vitro against certain strains of Enterococcus faecali s.

Combined with tobramycin results in synergistic bactericidal effect in vitro against certain strains of Enterococcus faecalis, but not synergistic against Enterococcus faecium.

7 DRUG INTERACTIONS Concurrent and/or sequential use of Tobramycin Inhalation Solution with other drugs with neurotoxic, nephrotoxic or ototoxic potential should be avoided. ( 7.1 ) Tobramycin Inhalation Solution should not be administered concomitantly with ethacrynic acid, furosemide, urea, or intravenous mannitol. ( 7.2 ) 7.1 Drugs with Neurotoxic, Nephrotoxic, or Ototoxic Potential Concurrent and/or sequential use of Tobramycin Inhalation Solution with other drugs with neurotoxic, nephrotoxic, or ototoxic potential should be avoided.

7 DRUG INTERACTIONS Concurrent and/or sequential use of tobramycin inhalation solution with other drugs with neurotoxic, nephrotoxic, or ototoxic potential should be avoided.( 7.1 ) Concomitant administration with ethacrynic acid, furosemide, urea, or intravenous mannitol is not recommended due to possible enhancement of aminoglycoside toxicity. 7.1 Drugs with Neurotoxic, Nephrotoxic or Ototoxic Potential Concurrent and/or sequential use of tobramycin inhalation solution with other drugs with neurotoxic, nephrotoxic, or ototoxic potential should be avoided. Tobramycin inhalation solution should not be administered concomitantly with ethacrynic acid, furosemide, urea, or intravenous mannitol.