Tobramycin - Inhalation

Tobramycin is an antibiotic. It is used to treat bacterial infections of the lungs in individuals with cystic fibrosis (an inherited disease that causes excessively thick and sticky mucus [phlegm] build up in the lungs, intestines, or other organs).

Use Tobramycin exactly as directed by your doctor or according to the instructions on the label. Do not use more or less than instructed by your doctor.

This medicine is available as a solution for inhalation (in ampoules) or a capsule for oral inhalation.

If you have been given the solution for inhalation, you will need a machine known as a nebuliser to administer your dose. Your doctor or pharmacist will show you how the nebuliser works.

If you have been given a capsule for oral inhalation, an inhaler will be used. To take a dose, follow these steps:

1. Wash your hands thoroughly with soap and water, then dry them.
2. Take the capsule out from the blister pack (remove the capsule only before use). Do not leave the capsule exposed to air for too long.
3. Unscrew the mouthpiece of the inhaler and place the capsule inside the chamber of the inhaler. Close the mouthpiece and screw it firmly until it stops. Do not over-tighten.
4. Hold the inhaler with the mouthpiece pointing down. Put your thumb on the blue button at the end of the inhaler and press it all the way down.
5. Fully exhale away from the inhaler then position the inhaler with the mouthpiece facing towards you.
6. Place the inhaler in your mouth and close your lips firmly around the mouthpiece.
7. Inhale the powder deeply with a single continuous inhalation.
8. Remove the inhaler from your mouth. Hold your breath for about 5 seconds, then exhale normally away from the inhaler.
9. After a few normal breaths, perform a second inhalation from the same capsule by repeating steps 5-8. This will ensure you receive the full dose.
10. Unscrew the mouthpiece and remove the capsule from the chamber of the inhaler. Inspect the used capsule, it should appear empty and punctured.
11. If the capsule is punctured but still has some powder, place it back into the chamber with the punctured side first. Replace the mouthpiece and take another two inhalations. Reinspect the capsule after.
12. If the capsule appears to be unpunctured, place it back into the chamber. Replace the mouthpiece and repeat steps 4-9. Reinspect the capsule after. If the capsule is still unpunctured, replace the inhaler with the reserve inhaler and repeat the whole process.
13. Discard the empty capsule after the full dose has been inhaled. Replace the mouthpiece and screw it firmly until it stops, then wipe it with a clean, dry cloth.
14. Use a new inhaler supplied in the pack when you start a new weekly pack.

Make sure you know how to use the device given to you. If you have problems or do not understand the instructions, ask your doctor or pharmacist.

The dose of this medicine will be decided by your doctor. Your doctor will advise you on the course of treatment depending on the type and severity of your infection and your response to the medication.

You must complete the entire course of this medicine. If you don't, the infection will not be properly controlled.

If you miss a dose and it is 6 hours or more before the next dose is due, administer the missed dose and return to your normal dosing schedule.

If it is less than 6 hours before the next dose is due, skip the missed dose and return to your normal dosing schedule.

DO NOT double a dose under any circumstances.

If you often forget to administer your medicine, let your doctor and pharmacist know.

Do not use Tobramycin if you ever had an allergic reaction (e.g. rashes, breathlessness, swollen eyes) to this medicine or similar antibiotics such as amikacin, neomycin, and streptomycin.

Inform your doctor if you have the following conditions:

• hearing or ear problems
• family history of hearing problems due to the use of certain antibiotics e.g. gentamicin, amikacin
• coughing up blood or mucus with blood
• myasthenia gravis (muscle weakness disorder)
• Parkison's disease (a disorder that affects the movement of a person, causing symptoms such as tremors, muscle stiffness, slowed movement and impaired balance or walking)
• kidney disease

Let your doctor know if you are pregnant or breastfeeding.

Be sure to check with your doctor or pharmacist before giving Tobramycin to a child. Children may be more sensitive to the side effects.

Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.

Routine ear examination may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have this test.

Tobramycin may cause any of the following side effects: cough, discolouration of mucus, throat irritation, runny or stuffy nose, fever, hoarseness, alteration or loss of voice, nausea, vomiting, altered taste, muscle pain, and feeling unwell.

Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:

• wheezing, shortness of breath, chest tightness
• pain or difficulty in passing urine, change in how much urine is passed, blood in the urine
• ringing in the ears, changes in hearing or hearing loss

Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.

Inform your doctor and pharmacist if you are taking any of these medicines:

• certain antibiotics e.g. cefalotin, amikacin, vancomycin, polymyxin B
• certain water pills or medicines for water retention e.g. etacrynic acid, furosemide
• amphotericin B (medicine used to treat fungal infection)
• cisplatin (medicine for cancer)
• ciclosporin (medicine used in organ transplants or certain immune disorders)

This list does not include all medicines that may interact with Tobramycin.

Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.

Store Tobramycin inhalation solution ampoules in the refrigerator, between 2-8°C. Do not freeze, otherwise it will no longer be effective and should not be used.

You may also store the inhalation solution ampoules in foil pouches (opened or unopened) at room temperature for up to 28 days.

Tobramycin inhalation solution is normally slightly yellow colour. It may get darker with age or if unrefrigerated. The colour change does not affect how the medicine works as long as it is stored within the recommended storage conditions.

Do not use this medicine if the solution is cloudy, has particles in it, or has been stored at room temperature for more than 28 days.

Keep the ampoules in its original package to protect it from light.

Once opened, use the medicine immediately. Throw away any unused solution.

Capsules for oral inhalation must always be stored in the blister to protect it from moisture. Remove only before use.

Medicines must not be used past the expiry date.