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Active substance(s): TOBRAMYCIN

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Package leaflet: Information for the user

TOBI® 300 mg/5 ml
Nebuliser Solution
Read all of this leaflet carefully before you start taking this
medicine because it contains important information for you.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor
or pharmacist.
• This medicine has been prescribed for you only. Do not pass
it on to others. It may harm them, even if their signs of
illness are the same as yours.
• If you get any side effects talk to your doctor or pharmacist.
This includes any possible side effects not listed in this leaflet.
What is in this leaflet:
1. What Tobi is and what it is used for
2. What you need to know before you use Tobi
3. How to use Tobi
4. Possible side effects
5. How to store Tobi
6. Contents of the pack and other information
1. What Tobi is and what it is used for
What is Tobi for?
Tobi contains a medicine called tobramycin. This is an
aminoglycoside antibiotic.
Tobi is used in patients aged six years and older who have
cystic fibrosis to treat chest infections caused by a bacteria
called Pseudomonas aeruginosa
Tobi fights the infection caused by Pseudomonas bacteria in
your lungs, and helps to improve your breathing.
When you inhale Tobi, the antibiotic can get directly into your
lungs to fight against the bacteria causing the infection. For the
best results of this medicine, take it as this leaflet instructs you.
What is Pseudomonas aeruginosa?
This is a very common bacteria that infects nearly everyone
with cystic fibrosis at some time during their lives. Some
people do not get this infection until later on in their lives,
while others get it very young.

This is one of the most damaging bacteria for people with
cystic fibrosis. If the infection is not properly controlled, it will
continue to damage your lungs causing further problems to
your breathing.

Children and adolescents
Tobi can be taken by children and adolescents aged 6 years
and older. Tobi should not be given to children less than
6 years old.

Tobi kills the bacteria that cause infections in the lungs. The
infection can be controlled successfully if the problem is
tackled early.

Older people
If you are aged 65 years and older, your doctor may perform
additional tests to decide if Tobi is right for you.

2. What you need to know before you use Tobi
Do not use Tobi:
• if you are allergic to tobramycin, any
type of aminoglycoside antibiotic, or any of the other
ingredients of this medicine (listed in Section 6).

Other medicines and Tobi
Please tell your doctor or pharmacist if you are taking or have
recently taken or might take any other medicines, including
medicines obtained without a prescription.

If any of the above apply to you, do not take this medicine
and talk to your doctor.
If you think you may be allergic, ask your doctor for advice.
Warnings and precautions
Talk to your doctor before using Tobi if you have or if you
have ever had any of the following conditions:
• Hearing problems (including ringing in your ears
and dizziness)
• Kidney problems
• Unusual difficulty in breathing with wheezing or coughing,
chest tightness
• Blood in your sputum (the substance you cough up)
• Muscle weakness that lasts or becomes worse in time,
symptom mostly related to condition such as myasthenia or
Parkinson’s disease

You should not take the following medicines while you are
taking Tobi:
• Furosemide or ethacryric acid, diuretics (“water tablets”)
• Urea or mannitol
• Other medicines which may harm your nervous system,
kidneys or hearing.
The following medicines can increase the chances of harmful
effects occurring if they are given to you while you are
receiving injections of tobramycin:
• Amphotericin B, cefalotin, ciclosporin, tacrolimus,
polymyxins: these medicines may harm your kidneys.
• Platinum compounds (such as carboplatin and cisplatin):
these medicines may harm your kidneys or hearing.
• Anticholinesterases, (such as neostigmine and
pyridostigmine), or botulinum toxin: these medicines may
cause muscle weakness to appear or become worse.

If any of these apply to you, tell your doctor before you
take Tobi.

If you are taking one or more of the above medicines, discuss
with your doctor before you take Tobi.

Inhaling medicines can cause chest tightness and wheezing and
this can happen with Tobi. Your doctor will supervise your first
dose of Tobi and check your lung function before and after
dosing. If you are not already doing so, your doctor may ask you
to use a bronchodilator, (e.g. salbutamol), before taking Tobi.

You should not mix or dilute Tobi with any other medicine in
your nebuliser.
If you are taking several different treatments for cystic fibrosis,
you should take them in the following order:
1. bronchodilator therapy, such as salbutamol
2. chest physiotherapy
3. other inhaled medicines
4. then Tobi.

If you are taking Tobi, strains of Pseudomonas can become
resistant to the treatment over time. This can mean the
medicine may not work as well as it should over time. Talk to
your doctor if you are concerned about this.
If you have it by an injection, tobramycin can sometimes cause
hearing loss, dizziness and kidney damage, and can harm an
unborn child.

Please check this order with your doctor as well.
Pregnancy and breast-feeding
If you want to become pregnant or are pregnant, you should
talk to your doctor about the possibility of this medicine
causing any harm to you or the unborn child.

It is not known whether inhaling this medicine when you are
pregnant causes side effects.
When they are given by an injection, tobramycin and other
aminoglycoside antibiotics can cause harm to an unborn child,
such as deafness.
If you are breast feeding your child, you should talk to your
doctor before using your medicine.
Driving and using machines
Tobi should not affect your ability to drive and use machines.
3. How to use Tobi
Always use this medicine exactly as your doctor has told you.
Check with your doctor if you are not sure.
How much of this medicine you should take and how often
you should take it
• The recommended dose is the same for all persons aged
6 years and older.
• Use two ampoules each day, for 28 days. Inhale the full
contents of one ampoule in the morning, and one in the
evening. Ideally, there should be a 12 hour gap between
the doses.
• You must leave at least 6 hours between two Tobi inhalations.
• After taking your medicine for 28 days, you then have a
28 day break, where you don’t inhale any Tobi, before
starting another course
• It is important that you keep using the product twice each
day during your 28 days on treatment and that you keep to
the 28-day on, 28-day off cycle.

Take Tobi twice a day,
every day for 28 days

Do not take any Tobi for
the next 28 days

Repeat cycle
If you take more Tobi than you should
If you inhale too much Tobi you may get a very hoarse voice.
Make sure you tell your doctor as soon as possible. If Tobi is
swallowed, tell your doctor as soon as possible.
If you forget to take Tobi
If you forget to take Tobi and there are at least 6 hours to
your next dose, take your dose as soon as you can.
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Otherwise, wait for your next dose. Do not double the dose to
make up for the missed dose.
Instructions for use of Tobi
This part of the leaflet explains how to use, care and handle
Tobi. Please read carefully and follow these instructions.
If you have any further questions on the use of this medicine,
ask your doctor or pharmacist.
The equipment you need for inhaling Tobi
Tobi should be used with a clean and dry reusable nebuliser.
The LC PLUS nebuliser (manufactured by PARI GmbH) is
suitable for use with Tobi.
Your doctor or physiotherapist can advise you on the proper use
of Tobi and the equipment you need. You may need different
nebulisers for your other inhaled medicines for cystic fibrosis.
Preparing to inhale Tobi
• Wash your hands thoroughly with soap and water.
• Each Tobi foil pouch contains a tray with 14 ampoules. Cut
or tear open the pouch. Remove one Tobi ampoule from
the tray by gently pulling apart from any attached
ampoules at the bottom tabs. Put the tray back in the foil
pouch and keep it in the refrigerator.
• Lay out all the pieces of your nebuliser on a clean, dry
paper or cloth towel.
• Make sure you have the suitable compressor, and tubing to
connect the nebuliser and compressor.
• Be careful to follow the appropriate instructions for use for
your type of nebuliser, you must read the leaflet provided
with the nebuliser by the manufacturer. Check that your
nebuliser and compressor are working properly according
to the manufacturer‘s instructions before you start to take
your medicine.
Use of Tobi with LC PLUS (PARI GmbH)
For more detailed instructions on the use and care of the
nebuliser, please read the leaflet provided with the PARI LC
1. Remove the nebuliser top from the nebuliser bottom by
twisting the top anticlockwise and then lifting it. Place the
top on the towel and stand the nebuliser bottom upright
on the towel.
2. Connect one end of the tubing to the compressor air
outlet. Make sure that the tubing fits snugly. Plug the
compressor into the electrical outlet.
3. Open the Tobi ampoule by holding the bottom tab with one
hand and twisting off the top with your other hand. Squeeze
all the contents of the ampoule into the nebuliser bottom.

4. Replace the nebuliser top, put the mouthpiece
and the inspiratory valve cap in place on the
nebuliser, then connect the compressor as
indicated in your PARI LC PLUS nebuliser leaflet.
5. Turn on the compressor. Check that there is a
steady mist coming from the mouthpiece. If
there is no mist, check
all tubing connections and that the compressor is
working properly.
6. Sit or stand in an upright position so that you can
breathe normally.
7. Place the mouthpiece between your
teeth and on top of your tongue.
Breathe normally, but only through
your mouth (you may use a nose clip if
your doctor agrees). Try not to block
the airflow with your tongue.
8. Continue until all of the Tobi is gone
and there is no longer any mist being
produced. It should take about 15 minutes to take all the
treatment. You may hear a spluttering sound when the
nebuliser cup is empty.
9. Please remember to clean and disinfect your nebuliser after
treatment according to the manufacturer’s instructions.
You should never use a dirty or clogged nebuliser. You
should not share your nebuliser with other people.

Loss of hearing (ringing in the ears is a potential warning
sign of hearing loss), noises (such as hissing) in the ears
Your underlying lung disease may worsen while you are taking
Tobi. This may be due to a lack of efficacy. Tell your doctor
straight away if this happens.
Some side effects are very common
These side effects may affect more than 1 in 10 people.
• Runny or stuffy nose, sneezing
• Voice alteration (hoarseness)
• Discoloration of the substance you cough up (sputum)
• Worsening of lung function test results
If any of these affects you severely, tell your doctor.
Some side effects are common
These side effects may affect up to 1 in 10 people.
• Generally feeling unwell
• Muscle pain
• Voice alteration with sore throat and difficulty swallowing
If any of these affects you severely, tell your doctor.
Other side effects:
• Itching
• Itchy rash
• Rash
• Loss of the voice
• Disturbed sense of taste
• Sore throat
If any of these affects you severely, tell your doctor.

If you are interrupted, or need to cough or rest during your
treatment, turn off the compressor to save your medicine.
Turn the compressor on again when you are ready to restart
your treatment. Leave out this dose if your next dose is due in
less than 6 hours.

If you have had Tobi at the same time as or following repeated
courses of tobramycin or another aminoglycoside antibiotic by
injection, hearing loss has been reported as a side effect.
Injections of tobramycin or other aminoglycosides can cause
allergic reactions, hearing problems and kidney problems.

4. Possible side effects
Like all medicines, this medicine can cause side effects,
although not everybody gets them.

People with cystic fibrosis have many symptoms of the disease.
These may still happen while taking Tobi, but should not be any
more frequent or seem worse than before.

Some side effects can be serious
If you experience any of the following, stop taking Tobi and
tell your doctor straight away:
• Unusual difficulty in breathing with wheezing or coughing
and chest tightness
• Allergic reactions including hives and itching

If you get any side effects talk to your doctor or pharmacist.
This includes any possible side effects not listed in this leaflet.

If you experience any of the following, tell your doctor
straight away:

5. How to store Tobi
• Keep this medicine out of the sight and reach of children.
• Do not use this medicine after the expiry date which is
stated on the box or pouch, or stamped on the ampoule.
• Do not use this medicine if you notice that it has gone
cloudy, or if there are bits in the solution.

Store at 2–8°C (in a refrigerator). If you don‘t have a
refrigerator available (such as when you are transporting
your medicine) you can store the foil pouches (opened or
unopened) at room temperature (not above 25°C) for up to
28 days.
Do not use Tobi ampoules which have been stored at room
temperature for more than 28 days.
Store your ampoules in the original packaging as this
medicine is sensitive to very strong light. This medicine is
normally a slightly yellow colour but this can vary and
sometimes it can be a darker yellow. This does not change
the way this medicine works provided that the storage
instructions have been followed.

Never store an opened ampoule. Once opened an ampoule
should be used immediately, and any remaining product
should be discarded.
6. Contents of the pack and other information
What Tobi contains
• The active ingredient is tobramycin. One ampoule contains
300 mg of tobramycin as a single dose.
• The other ingredients are sodium chloride, water for
injections, sodium hydroxide and sulphuric acid (for
adjusting the level of acidity).
What Tobi looks like and contents of the pack
Tobi is a clear, slightly yellow solution that comes in a
ready-to-use ampoule.
Ampoules are packed in foil pouches, one foil pouch contains
14 ampoules which corresponds to 7 days of treatment.
Tobi is available in packs of 56, 112 or 168 ampoules, which is
enough to last one, two or three cycles of treatment, respectively.
Not all pack sizes may be available.
Marketing Authorisation Holder and Manufacturer
The Marketing Authorisation Holder is:
Novartis Pharmaceuticals UK Limited
Frimley Business Park
Frimley, Camberley, Surrey, GU16 7SR, UK
The manufacturer is:
Novartis Pharmaceuticals UK Limited
Wimblehurst Road, Horsham, West Sussex, RH12 5AB, UK
For further information please call
01 260 1255 (Ireland only)
01276 698370 (UK only)
This leaflet was last revised in March 2012

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.