Tobramycin and dexamethasone ophthalmic suspension pink eye

Contents

Dexamethasone and tobramycin (ophthalmic)

Generic Name: dexamethasone and tobramycin (ophthalmic) (DEX a METH a sone and TOE bra MYE sin off THAL mik)
Brand Name: Tobradex, TobraDex ST

Medically reviewed by Drugs.com on Nov 28, 2018 – Written by Cerner Multum

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Interactions
  • More

What is dexamethasone and tobramycin ophthalmic?

Dexamethasone and tobramycin ophthalmic (for the eyes) is a combination antibiotic and steroid medicine that is used to treat eye inflammation caused by uveitis, eye injury, radiation, chemical burns, or certain other conditions.

dexamethasone and tobramycin is used when there is a risk of bacterial infection in or around the eye.

Dexamethasone and tobramycin ophthalmic may also be used for purposes not listed in this medication guide.

Important Information

You should not use this medicine if you have a fungal or viral infection in your eyes (including herpes simplex).

Before taking this medicine

You should not use dexamethasone and tobramycin if you are allergic to dexamethasone or tobramycin, or if you have a fungal or viral infection in your eyes (including herpes simplex).

Tell your doctor if you have ever had:

  • glaucoma; or

  • cataracts, or if you need cataract surgery.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.

It may not be safe to breast-feed while using this medicine. Ask your doctor about any risk.

How should I use dexamethasone and tobramycin ophthalmic?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Do not use while wearing soft contact lenses. A preservative in this medicine could permanently stain the lenses. Use the medicine at least 15 minutes before inserting your contact lenses.

Wash your hands before using eye medication.

Shake the eye drops well just before each use.

To use the eye drops: Tilt your head back slightly and pull down your lower eyelid to create a small pocket. Hold the dropper above the eye and squeeze a drop into this pocket. Close your eyes for 1 or 2 minutes.

Use only the number of drops your doctor has prescribed.

To apply the ointment: Tilt your head back slightly and pull down your lower eyelid to create a small pocket. Squeeze a ribbon of ointment from the tube into this pocket. Blink your eye gently and then keep it closed for 1 or 2 minutes. Wipe excess ointment from your eyelashes using a clean tissue.

Do not touch the tip of the eye dropper or ointment tube or place it directly on your eye. A contaminated tip can infect your eye, which could lead to serious vision problems.

If you use this medicine for longer than 10 days, you may need frequent vision tests to check the pressure inside your eyes.

Call your doctor if your symptoms do not improve after 2 days of treatment.

You should not stop using this medicine suddenly. Follow your doctor’s instructions about tapering your dose.

Store this medicine at room temperature. Do not freeze. Keep the tube tightly closed when not in use. Store the eye drops in an upright position.

What happens if I miss a dose?

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if anyone has accidentally swallowed the medication.

Overdose symptoms may include eye redness or itching, watery eyes, and increased sensitivity to light.

What should I avoid while using dexamethasone and tobramycin ophthalmic?

Do not share dexamethasone and tobramycin with another person, even if they have the same symptoms you have.

Dexamethasone and tobramycin ophthalmic side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • severe eye redness, itching, or swelling;

  • blurred vision, tunnel vision, seeing halos around lights;

  • pain behind your eyes, sudden vision changes;

  • slow healing after eye surgery; or

  • signs of eye infection–redness, severe discomfort, crusting or drainage.

Common side effects may include:

  • minor burning or stinging.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect dexamethasone and tobramycin ophthalmic?

Medicine used in the eyes is not likely to be affected by other drugs you use. But many drugs can interact with each other. Tell each of your healthcare providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 7.01.

Medical Disclaimer

More about dexamethasone / tobramycin ophthalmic

  • Side Effects
  • During Pregnancy
  • Dosage Information
  • Drug Interactions
  • Pricing & Coupons
  • En Español
  • 11 Reviews
  • Drug class: ophthalmic steroids with anti-infectives

Consumer resources

  • Tobramycin and Dexamethasone Eye Drops
  • Tobramycin and Dexamethasone Eye Ointment
  • Tobramycin and dexamethasone Ophthalmic (Advanced Reading)

Other brands: TobraDex, Tobradex ST

Professional resources

  • Tobramycin and Dexamethasone (Wolters Kluwer)
  • … +1 more

Related treatment guides

  • Conjunctivitis, Bacterial
  • Keratitis
  • Postoperative Ocular Inflammation
  • Uveitis

Dexamethasone Plus Tobramycin

4.3 Nanomedicine in Ocular Diseases

Ocular drug delivery is hampered by physiological dynamic and static barriers presented by eyes, such as blinking, washout by tears, nasolacrimal drainage, impermeability of the cornea and sclera, absorption by blood and lymph conjunctival vessels, etc. Topical, systemic, and intraocular injections are the main routes for administering drugs. However, all of them have significant limitations; for instance, only 1%–5% of active principle applied on the surface of the eye penetrates the cornea and sclera and reaches the inner part of the eye; the rest is mainly absorbed by the systemic circulation through conjunctival vessels and nasolacrimal drainage. Therefore, in this context, one of the most important objectives is to prolong the ocular residence time of drugs and also encourage their penetration to reach therapeutic targets. To prolong the retention time, the interaction between the drug carrier (excipients) and the cornea and/or subconjunctiva should be enhanced. Polycarbophil, which is PAA crosslinked with divinyl glycol, forms hydrogen bonds with the mucus of the conjunctival epithelium and cornea, extending the effects of drugs. Also, we can mention formulations based on DuraSite, which has been used as a release-controlling excipient to deliver azithromycin (AzaSite) for bacterial conjunctivitis . Another release-controlling excipient is methylcellulose, which has a low critical solution temperature useful for rapid instillation on the ocular surface of eye drops. An example of this methylcellulose-based polymer is Rysmon, which is combined with sodium citrate and PEG to deliver timolol maleate for glaucoma therapy . For the same glaucoma therapy also is used Betoptic S, which contains betaxolol as the active ingredient mixed with a strong cationic ion-exchange resin called Amberlite, which is made of PS sulfonic acid crosslinked with divinyl benzene . Another positively charged emulsion loaded with active ingredients is Novasorb, which not only improves the solubility and absorption of lipophilic drugs, but also reduces the number of instillation times and side effects . For antiinflammatory and antiinfective formulations for blepharitis it is worth mentioning Tobradex, which combines tobramycin and dexamethasone with xanthan gum, which is an anionic polysaccharide that improves the ocular bioavailability of these two drugs . Another anionic polysaccharide formulated to treat intraocular pressure using timolol maleate as the active ingredient (Timoptic) is gellan gum, which in the presence of mono- and divalent cations such as Ca2+, Mg2+, K+, and Na+ undergoes gelation .

Among the most treated ocular diseases, the most epidemiological relevant are conjunctivitis, glaucoma, diabetic macular edema (DME), and age-related macular degeneration (AMD) . However, challenges are still present in the therapy: low compliance of patients, low sustained therapeutic levels of drugs for the long term, and the delivery of therapeutic proteins to the posterior segment of the eye is via painful intravitreal injections. Some strategies are available to improve these drawbacks: the aforementioned modifications of the formulation (suspensions and emulsions using release-controlling excipients), encapsulation of the active principle into NP drug-delivery systems (liposomes, PLGA-based microspheres, inserts), and enhancement of tissue permeability by iontophoresis or using permeability enhancers . Eye drop–based forms are been replaced by advanced drug-delivery contact lenses, cul-de-sac inserts, and subconjunctival implants. The improvements of modified soft contact lenses for drug delivery are based on absorption of active ingredients on the lens surface, drug immobilization, molecular imprinting of drugs, and ion ligand-containing polymeric hydrogels . Related to cul-de-sac inserts, we can mention Ocusert, which provides sustained release for the ocular hypotensive drug pilocarpine. It is made of two outer layers of ethylene–vinyl acetate copolymer (EVA) and an inner layer of pilocarpine in an alginate gel within di(ethylhexyl) phthalate . Also, Lacrisert, which is a rod-shaped cul-de-sac insert made of hydroxypropyl cellulose, is indicated for severe dry eye syndrome, because it lubricates the eye, thickening and prolonging the precorneal tear film . Another long-standing approach is the use of subconjunctival implants such as the silicone matrix LX201 to deliver cyclosporin A for keratoconjunctivitis . A subconjunctival insert containing latanoprost composed of a PLGA-based tube for glaucoma treatment has also been described . The same type of strategy but using liposomes was patented in 2011 .

Drug-delivery systems to the posterior segment of the eye include nonerodible intravitreal implants such as Iluvien, which is made of polyimide and PVA and loaded with the corticosteroid fluocinolone acetonide for the treatment of DME ; Durasert, which is made of EVA and PVA and loaded with the same active molecule but in this case is for the treatment of posterior uveitis ; Vitrasert, which is made of EVA and PVA and loaded with ganciclovir for the treatment of cytomegalovirus retinitis ; and Ozurdex, which is composed of PLGA and loaded with dexamethasone and indicated for DME, vein occlusion, or noninfectious uveitis . On the other hand, there are some intravitreal injectable particulate systems such as the RETAAC system based on PLGA microspheres with triamcinolone ; Cortiject, which is an oily emulsion with phospholipid loaded with the corticosteroid prodrug DEX palmitate, which is deesterified by a retina-specific esterase ; and Visudyne, which is used in photodynamic therapy to treat subfoveal choroidal neovascularization and is a liposomal formulation containing the photosensitizer verteporfin that is administered intravenously .

Protein-delivery systems specifically developed for applications to the back of the eye have emerged. These drug-delivery systems are classified as injectable colloidal particles, injectable hydrogels, implants, and cell-based systems . As of this writing, there is no FDA-approved controlled-release system for protein therapeutics, but some of them are in clinical phases. The intravitreal liquid injectable formulation IB-20089 Verisome combines triamcinolone acetonide and ranibizumab for treating subfoveal neovascular AMD . Also, the company ForSight Vision4 has designed a semipermeable nonbiodegradable membrane with a refillable port to release ranibizumab into the vitreous humor , and similar to this idea, a posterior micropump system has been described to release again ranibizumab . Finally, the company Neurotech has in clinical phase II/III two types of cell-based systems (Renexus NT-501 and NT-503) for AMD, in which live cells that secrete either ciliary neurotrophic factor or VEGFR-Fc proteins are entrapped in a semipermeable hollow polysulfone capsule .

Dexamethasone / Tobramycin Ophthalmic Dosage

Medically reviewed by Drugs.com. Last updated on Nov 28, 2018.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Interactions
  • More

Applies to the following strengths: 0.1%-0.3%; 0.05%-0.3%

Usual Adult Dose for:

  • Uveitis
  • Bacterial Conjunctivitis
  • Keratitis

Usual Pediatric Dose for:

  • Uveitis
  • Bacterial Conjunctivitis
  • Keratitis

Additional dosage information:

  • Renal Dose Adjustments
  • Liver Dose Adjustments
  • Precautions
  • Dialysis
  • Other Comments

Usual Adult Dose for Uveitis

Suspension: 1 or 2 drops into the conjunctival sac(s) every 4 to 6 hours
Ointment: Apply a small amount (approximately 1/2 inch ribbon) into the conjunctival sac(s) up to 3 or 4 times per day

SUSPENSION:
-During the initial 24 to 48 hours, the dosage may be increased to 1 or 2 drops every 2 hours.
-Frequency should be decreased gradually as indicated by improvement in clinical signs.
-No more than 20 mL should be prescribed initially and the prescription should not be refilled without additional evaluation.
OINTMENT:
-No more than 8 g should be prescribed initially and the prescription should not be refilled without further evaluation.
Use: Steroid-responsive inflammatory ocular conditions for which a corticosteroid is indicated and where superficial bacterial ocular infection or a risk of bacterial ocular infection exists

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Safety and efficacy have not been established in patients younger than 2 years.
Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-This drug is for topical use only and not for injection or oral use.
-Ointment: The manufacturer product information should be consulted.
Patient advice:
-Do not touch dropper tip to any surface, as this may contaminate the contents.
-Contact lenses should not be worn during the use of this product.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Tobramycin Ophthalmic

Ophthalmic tobramycin comes as as a solution (liquid) to instill in the eyes and as an eye ointment to apply to the eyes. The eye drops are usually applied every 4 to 8 hours and the ointment is usually applied two to four times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use tobramycin eye drops or ointment exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

To instill the eye drops, follow these steps:

  1. Wash your hands thoroughly with soap and water.
  2. Check the dropper tip to make sure that it is not chipped or cracked.
  3. Avoid touching the dropper tip against your eye or anything else; eye drops and droppers must be kept clean.
  4. While tilting your head back, pull down the lower lid of your eye with your index finger to form a pocket.
  5. Hold the dropper (tip down) with the other hand, as close to the eye as possible without touching it.
  6. Brace the remaining fingers of that hand against your face.
  7. While looking up, gently squeeze the dropper so that a single drop falls into the pocket made by the lower eyelid. Remove your index finger from the lower eyelid.
  8. Close your eye for 2 to 3 minutes and tip your head down as though looking at the floor. Try not to blink or squeeze your eyelids.
  9. Place a finger on the tear duct and apply gentle pressure.
  10. Wipe any excess liquid from your face with a tissue.
  11. If you are to use more than one drop in the same eye, wait at least 5 minutes before instilling the next drop.
  12. Replace and tighten the cap on the dropper bottle. Do not wipe or rinse the dropper tip.
  13. Wash your hands to remove any medication.

To use the eye ointment, follow these instructions:

  1. Wash your hands thoroughly with soap and water.
  2. Use a mirror or have someone else apply the ointment.
  3. Avoid touching the tip of the tube against your eye or anything else. The ointment must be kept clean.
  4. Tilt your head forward slightly.
  5. Holding the tube between your thumb and index finger, place the tube as near as possible to your eyelid without touching it.
  6. Brace the remaining fingers of that hand against your cheek or nose.
  7. With the index finger of your other hand, pull the lower lid of your eye down to form a pocket.
  8. Place a small amount of ointment into the pocket made by the lower lid and the eye. A 1/2-inch (1.25-centimeter) strip of ointment usually is enough unless otherwise directed by your doctor.
  9. Look downward, then gently close your eyes and keep them closed for 1 to 2 minutes to allow the medication to be absorbed.
  10. Replace and tighten the cap right away.
  11. Wipe off any excess ointment from your eyelids and lashes with a clean tissue. Wash your hands again.

Clinical author’s note Michael Stewart 30/02/2018: Tobravisc® eye drops were discontinued in the UK in April 2017. At the time of review there are no branded or generic eye drop products solely containing tobramycin available in the UK. Tobramycin is still available in combination with dexamethasone for the prevention of eye infections following cataract surgery (Tobradex®). Tobramycin eye drops may still be available in other countries. This Medicine Leaflet only covers the use of tobramycin in the treatment of eye infections and is based on medical information available in the UK at the time of writing. It is left here for reference purposes only. Please also refer to the manufacturer’s information supplied with your medicine.

About tobramycin for eye infections

Type of medicine Antibacterial eye preparation
Used for Eye infections in adults and children
Also called Tobrex® (in USA)
Tobradex® (contains tobramycin with dexamethasone)
Available as Eye drops

Tobramycin eye drops are prescribed to treat bacterial eye infections. They work by helping to kill the germs (bacteria) which are causing the infection.

Eye infections are a common cause of conjunctivitis. In conjunctivitis, your eye becomes inflamed, feels gritty, and may water more than usual. The white of your eye may look red, and your eyelids may become swollen and stuck together with a discharge when you wake up in the morning. Only one eye may be infected to begin with, but it often spreads to both eyes. Although infective conjunctivitis may clear without treatment, for more severe infections or for infections which do not clear on their own, antibiotic eye drops like tobramycin are helpful.

Tobramycin is also available combined with a medicine called dexamethasone in eye drops called Tobradex®. This combination brand helps to prevent infection and reduces inflammation after eye cataract surgery.

Before using tobramycin eye drops

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start using tobramycin eye drops it is important that your doctor knows:

  • If you are pregnant or breastfeeding.
  • If you have ever had an allergic reaction to an antibiotic, or to any eye drops.
  • If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.

How to use tobramycin eye drops

  1. Wash your hands before you use the drops.
  2. Remove the cap from the bottle.
  3. Tilt your head back a little and pull the lower lid of your eye downwards to form a pocket.
  4. Hold the bottle upside down near to your eye. Try not to touch your eye as you do this.
  5. Gently press on the base of the bottle to release one drop into your eye. Only use a second drop if the first drop missed going into your eye.
  6. Close your eye for a minute or two, and press gently on the side of your nose where the corner of your eye meets your nose. This helps to stop the drop from draining away and keeps it in your eye.
  7. Repeat the process in your other eye if you have been told to use the drops in both eyes.
  8. Replace the cap.

Getting the most from your treatment

  • Before you start the treatment, read the manufacturer’s printed information leaflet from the pack. It will give you more information about the drops and will provide you with a full list of any side-effects which you may experience from using them.
  • If your eyes have an obvious discharge or ‘crust’, it can help if you bathe them with cool clean water before using tobramycin drops.
  • Use the drops twice a day – in the morning and in the evening. (If your infection is particularly severe, your doctor may ask you to use the drops four times on the first day.) Try not to miss any doses, but if you do forget to put the drops in on time, do it as soon as you remember.
  • You should continue to use the drops for seven days unless your doctor has told you otherwise. If your infection is no better after this time, make another appointment to see your doctor for advice.
  • When you first put the drops into your eye, they may cause blurred vision. This should quickly clear, but make sure you can see clearly before you drive and before you use machines or tools.
  • Take care to avoid spreading the infection from one eye to the other, and to other members of your family. Washing your hands regularly (particularly after touching your eyes) and not sharing towels or pillows will help to prevent the infection from spreading.
  • If the tip of the bottle touches your eye(s) when putting the drops in, it is a good idea to squeeze out two or three drops straightaway on to some tissue and rinse the tip with salt water.
  • Eye infections can cause your eyes to become more sensitive to sunlight than usual. Wearing sunglasses may help to prevent this.
  • If you are using any other eye drops, leave 5-10 minutes between applying each preparation. This is to prevent more liquid going into your eye than it can handle. Otherwise the drops will overflow from your eye and not have the intended effect.
  • If your symptoms become worse despite using tobramycin, you should arrange to see your doctor for advice straightaway. In particular, see your doctor again if your eye becomes painful, if light starts to hurt your eyes, or if your sight is affected.
  • Do not wear contact lenses until your symptoms have completely gone. Wait for 24 hours after the last dose of eye drops before using your lenses again.

Can tobramycin eye drops cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with tobramycin eye drops. You will find a full list in the manufacturer’s information leaflet supplied with the drops. Speak with your doctor if any of the following continue or become troublesome.

Common tobramycin eye drop side-effects (these affect less than 1 in 10 people) What can I do if I experience this?
Eye itching, discomfort, or redness If troublesome, speak with your doctor. They may be symptoms of the infection; or, they may indicate that you have an allergy to the drops

If you experience any other symptoms which you think may be due to the eye drops, speak with your doctor or pharmacist for further advice.

How to store tobramycin eye drops

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.
  • Throw away the bottle of eye drops after you have finished the course of treatment, even if there is some liquid left. Never keep opened bottles of eye drops to use later.

Important information about all medicines

Make sure that the person supplying this medicine knows about any other medicines that you are taking or using. This includes any medicines you have bought, and herbal and homeopathic medicines.

If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are using.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

If you suspect that someone might have swallowed some of this medicine, contact your local accident and emergency department for advice.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Tobradex ST

WARNINGS

Included as part of the PRECAUTIONS section.

PRECAUTIONS

IOP increase

Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. If this product is used for 10 days or longer, IOP should be monitored.

Aminoglycoside sensitivity

Sensitivity to topically applied

aminoglycosides may occur.

Cataracts

Use of corticosteroids may result in posterior subcapsular cataract formation.

Delayed Healing

The use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation. In those diseases causing thinning of the cornea or sclera, perforations have been known to occur with the use of topical steroids. The initial prescription and renewal of the medication order should be made by a physician only after examination of the patient with the aid of magnification such as slit lamp biomicroscopy and, where appropriate, fluorescein staining.

Bacterial infections

Prolonged use of corticosteroids may suppress the host response and thus increase the hazard of secondary ocular infections. In acute purulent conditions, steroids may mask infection or enhance existing infection. If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated.

Viral infections

Employment of a corticosteroid medication in the treatment of patients with a history of herpes simplex requires great caution. Use of ocular steroids may prolong the course and may exacerbate the severity of many viral infections of the eye (including herpes simplex).

Fungal infections

Fungal infections of the cornea are particularly prone to develop coincidentally with long-term local steroid application. Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use.

Use with systemic aminoglycosides

If product is used in combination with systemic aminoglycoside antibiotics the patient should be monitored for total serum concentration.

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment of Fertility

No studies have been conducted to evaluate the carcinogenic or mutagenic potential. No impairment of fertility was noted in studies of subcutaneous tobramycin in rats at doses of 50 and 100 mg/kg/day (equivalent to human doses of 8 and 16 mg/kg/day, at least 2 orders of magnitude greater than the topical ocular dose).

Use In Specific Populations

Pregnancy

Pregnanacy Category C. Corticosteroids have been shown to be teratogenic in animal studies. Ocular administration of 0.1% dexamethasone resulted in 15.6% and 32.3% incidence of fetal anomalies in two groups of pregnant rabbits. Fetal growth retardation and increased mortality rates have been observed in rats with chronic dexamethasone therapy. Reproduction studies have been performed in rats and rabbits with tobramycin at doses up to 100 mg/kg/day (equivalent to human doses of 16 and 32 mg/kg/day, respectively) and have revealed no evidence of impaired fertility or harm to the fetus. There are no adequate and well controlled studies in pregnant women. TOBRADEX® ST (tobramycin / dexamethasone ophthalmic suspension 0.3%/0.05%) ophthalmic suspension should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers

Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in human milk. Because many drugs are excreted in human milk, caution should be exercised when TOBRADEX® ST (tobramycin / dexamethasone ophthalmic suspension 0.3%/0.05%) is administered to a nursing woman.

Pediatric Use

Safety and effectiveness in pediatric patients below the age of 2 years have not been established.

Geriatric Use

No overall differences in safety or effectiveness have been observed between elderly and younger patients.

What is Tobramycin / Dexamethasone?

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.

  • Artemether
  • Ataluren
  • Desmopressin
  • Praziquantel
  • Rilpivirine
  • Rotavirus Vaccine, Live

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.

  • Aceclofenac
  • Acemetacin
  • Alcuronium
  • Aldesleukin
  • Alfentanil
  • Amtolmetin Guacil
  • Atracurium
  • Balofloxacin
  • Bemiparin
  • Benzhydrocodone
  • Besifloxacin
  • Boceprevir
  • Bromfenac
  • Bufexamac
  • Buprenorphine
  • Bupropion
  • Celecoxib
  • Ceritinib
  • Cholera Vaccine, Live
  • Choline Salicylate
  • Cidofovir
  • Ciprofloxacin
  • Cisatracurium
  • Clarithromycin
  • Clonixin
  • Cobicistat
  • Codeine
  • Colistimethate Sodium
  • Conivaptan
  • Daclatasvir
  • Darunavir
  • Decamethonium
  • Desogestrel
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Dienogest
  • Diflunisal
  • Dihydrocodeine
  • Dipyrone
  • Doxacurium
  • Doxorubicin
  • Doxorubicin Hydrochloride Liposome
  • Dronedarone
  • Drospirenone
  • Droxicam
  • Efavirenz
  • Elvitegravir
  • Enoxacin
  • Enzalutamide
  • Estradiol
  • Ethacrynic Acid
  • Ethinyl Estradiol
  • Ethynodiol
  • Etodolac
  • Etofenamate
  • Etonogestrel
  • Etoricoxib
  • Etravirine
  • Fazadinium
  • Felbinac
  • Fenoprofen
  • Fentanyl
  • Fepradinol
  • Feprazone
  • Fleroxacin
  • Floctafenine
  • Flufenamic Acid
  • Flumequine
  • Flurbiprofen
  • Fosamprenavir
  • Foscarnet
  • Furosemide
  • Gallamine
  • Gatifloxacin
  • Gemifloxacin
  • Gestodene
  • Hemin
  • Hexafluorenium
  • Hydrocodone
  • Ibuprofen
  • Indomethacin
  • Ixabepilone
  • Ketoprofen
  • Ketorolac
  • Lapatinib
  • Levofloxacin
  • Levonorgestrel
  • Lomefloxacin
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Lysine
  • Macimorelin
  • Mannitol
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Meperidine
  • Mestranol
  • Methadone
  • Metocurine
  • Mivacurium
  • Morniflumate
  • Moxifloxacin
  • Nabumetone
  • Nadifloxacin
  • Nadroparin
  • Naproxen
  • Nepafenac
  • Nevirapine
  • Nifedipine
  • Niflumic Acid
  • Nilotinib
  • Nimesulide
  • Nimesulide Beta Cyclodextrin
  • Nimodipine
  • Norethindrone
  • Norfloxacin
  • Norgestimate
  • Norgestrel
  • Ofloxacin
  • Oxaprozin
  • Oxycodone
  • Oxyphenbutazone
  • Pancuronium
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Tobradex

Generic Name: tobramycin and dexamethasone ophthalmic (TOE bra MYE sin and DEX a METH a sone off THAL mik)
Brand Names: Tobradex, Tobradex ST

Medically reviewed by Kaci Durbin, MD Last updated on Apr 30, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Interactions
  • More

What is Tobradex?

Tobradex contains a combination of tobramycin and dexamethasone. Tobramycin is an antibiotic. It is used to treat bacterial infections.

Dexamethasone is a steroid. Dexamethasone ophthalmic is used to treat the swelling associated with bacterial infections of the eye.

Tobradex is used to treat bacterial infections or inflammation of the eyes. It is available as an ointment and a liquid suspension.

Tobradex may also be used for purposes other than those listed in this medication guide.

Important information

Contact your doctor if the symptoms begin to get worse or if you do not see any improvement in the condition after a few days.

Do not touch the dropper or tube opening to any surface, including your eyes or hands. The dropper or tube opening is sterile. If it becomes contaminated, it could cause an infection in the eye.

Apply light pressure to the inside corner of your eye (near your nose) after each drop to prevent the fluid from draining down your tear duct.

What should I discuss with my doctor before using?

Do not use Tobradex if you have a viral or fungal infection in the eye, such as herpes, vaccinia, or varicella. It is used to treat infections caused by bacteria only. Do not use Tobradex for mycobacterial infections of the eye.

Tell your doctor if you are allergic to any aminoglycoside antibiotics (including gentamicin, streptomycin, tobramycin, others). This may cause an allergic reaction to Tobradex.

It is not known whether Tobradex will be harmful to an unborn baby. Do not use Tobradex without first talking to your doctor if you are pregnant. It is not known whether tobramycin or dexamethasone passes into breast milk. Do not use this medication without first talking to your doctor if you are breast-feeding a baby.

How should I use Tobradex?

Use Tobradex eye drops or ointment exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Do not use the eye drops or ointment longer than your doctor recommends. Long-term treatment with steroids (such as in Tobradex) may cause glaucoma, nerve damage in the eye, or cataract formation.

Wash your hands before and after using the eye drops or ointment.

To apply the eye drops:

  • Shake the drops gently to be sure the medicine is well mixed. Tilt your head back slightly and pull down on your lower eyelid. Position the dropper above your eye. Look up and away from the dropper. Squeeze out a drop and close your eye. Apply gentle pressure to the inside corner of your eye (near your nose) for about 1 minute to prevent the liquid from draining down your tear duct. If you are using more than one drop in the same eye, repeat the process with about 5 minutes between drops. If you are using drops in both eyes, repeat the process in the other eye.

To apply the ointment:

  • Hold the tube in your hand for a few minutes to warm it up so that the ointment comes out easily. Tilt your head back slightly and pull down gently on your lower eyelid. Apply a thin film of the ointment into your lower eyelid. Close your eye and roll your eyeball around in all directions for 1 to 2 minutes. If you are applying another eye medication, allow at least 10 minutes before application of the other medication.

Do not touch the dropper or tube opening to any surface, including your eyes or hands. The dropper or tube opening is sterile. If it becomes contaminated, it could cause an infection in the eye. Do not use any eyedrop that is discolored or has particles in it. Store Tobradex at room temperature away from moisture and heat. Keep the bottle or tube properly capped.

Apply the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and apply the next one as directed. Do not use a double dose of this medication.

An overdose of Tobradex is unlikely to occur. If you do suspect an overdose or if the medication has been ingested, contact an emergency room or Poison Control Center for advice.

What should I avoid?

Do not touch the dropper or tube opening to any surface, including your eyes or hands. The dropper or tube opening is sterile. If it becomes contaminated, it could cause an infection in the eye. Use caution when driving, operating machinery, or performing other hazardous activities. Tobradex may cause blurred vision. If you experience blurred vision, avoid these activities.

If you wear contact lenses, ask your doctor if you should wear them during treatment with Tobradex. After applying the medication, wait at least 15 minutes before inserting contact lenses, unless otherwise directed by your doctor.

Do not use other eye drops or medications during treatment with Tobradex unless otherwise directed by your doctor.

Tobradex side effects

Serious side effects are not expected to occur with the use of Tobradex.

Some burning, stinging, irritation, itching, redness, blurred vision, eyelid itching, eyelid swelling, or sensitivity to light may occur.

Long-term use of Tobradex could lead to glaucoma, nerve damage in the eye, or cataract formation.

This is not a complete list of Tobradex side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Tobradex?

Do not use other eye drops or medications during treatment with Tobradex unless otherwise directed by your doctor.

Before using Tobradex, tell your doctor if you are taking an oral steroid medication such as prednisone (Deltasone, Orasone, others).

Drugs other than those listed here may also interact with Tobradex. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.

More about TobraDex (dexamethasone / tobramycin ophthalmic)

  • Side Effects
  • During Pregnancy
  • Dosage Information
  • Drug Interactions
  • Compare Alternatives
  • Support Group
  • Pricing & Coupons
  • En Español
  • 9 Reviews
  • Generic Availability
  • Drug class: ophthalmic steroids with anti-infectives
  • TobraDex (Tobramycin and Dexamethasone Eye Drops)
  • TobraDex (Tobramycin and Dexamethasone Eye Ointment)
  • Tobradex (Advanced Reading)
  • Tobradex Ointment (Advanced Reading)
  • Tobradex Suspension (Advanced Reading)
  • TobraDex (FDA)
  • … +1 more

Other Formulations

  • TobraDex ST ophthalmic
  • Keratitis
  • Conjunctivitis, Bacterial
  • Uveitis

Tobramycin/Dexamethasone Eye Drops
Rx

Tobramycin and Dexamethasone Eye Drops

Veterinarians prescribe Tobramycin and Dexamethasone eye drops for dogs and cats with bacterial eye infections. These antibiotic drops combine two active ingredients to treat the infection while reducing swelling.

  • Effective against bacterial eye infections
  • For dogs and cats
  • Reduces swelling associated with infection

Eye infections including conjunctivitis can cause pain, swelling, itching, and light sensitivity in dogs and cats. If your pet appears to have an eye infection or eye discomfort, talk to your veterinarian about prescription Tobramycin and Dexamethasone eye drops. These sterile drops fight infection in two ways. Tobramycin is an antibiotic that stops the growth of bacteria and the spread of the infection. Dexamethasone is a corticosteroid that reduces the swelling associated with many infections. The bottle has a dropper top for convenient application.

What you should know about Tobramycin and Dexamethasone eye drops:

  • Talk to your veterinarian before using this product.
  • Follow dosing directions exactly – don’t give your pet more medication than directed and don’t skip doses.
  • Read the label carefully for information about storage, possible side effects, and drug interactions.

For additional information about Tobramycin and Dexamethasone eye drops click the “More Information” and “Package Insert” tabs above.

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