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Tobramycin Disease Interactions

There are 4 disease interactions with tobramycin.

Major

Aminoglycosides (applies to tobramycin) dehydration

Major Potential Hazard, High plausibility. Applicable conditions: Diarrhea, Vomiting

Adequate hydration is crucial to minimize the risk of oto- and nephrotoxicity associated with the use of aminoglycosides. Dehydration should preferably be corrected prior to initiation of therapy. In patients who may be at risk for dehydration, such as those with severe and/or prolonged diarrhea or vomiting, fluid status should be monitored closely. If signs of renal irritation develop during therapy, hydration should be increased as indicated, accompanied by a reduction in dosage if necessary. Therapy should be withdrawn if urinary output decreases progressively or azotemia increases.

References

  1. "Product Information. Amikin (amikacin)." Bristol-Myers Squibb (2002):
  2. "Product Information. Garamycin (gentamicin)." Schering-Plough Corporation (2007):
  3. "Product Information. Netromycin (netilmicin)." Schering Corporation (2002):
  4. "Product Information. Streptomycin Sulfate (streptomycin)." Pfizer U.S. Pharmaceuticals
  5. "Product Information. Nebcin (tobramycin)." Lilly, Eli and Company (2001):
  6. "Product Information. Mycifradin (neomycin)." Emerson Laboratories (2001):
View all 6 references
Major

Aminoglycosides (applies to tobramycin) neuromuscular blockade

Major Potential Hazard, Moderate plausibility. Applicable conditions: Botulism, Hypocalcemia, Myoneural Disorder, Parkinsonism

Aminoglycosides can cause dose-related neuromuscular blockade and muscle weakness, particularly in patients with neuromuscular disease or hypocalcemia and in patients receiving general anesthetics, neuromuscular blocking agents, or massive transfusions of citrate-anticoagulated blood. Although aminoglycoside- induced neuromuscular blockade is generally self-limiting, it may rarely result in respiratory paralysis. Neomycin is thought to be the most potent neuromuscular blocking agent in the class. However, the risk is greatest with intraperitoneal or intrapleural instillation of large doses or rapid intravenous administration of parenteral aminoglycosides. Therapy with aminoglycosides should be administered cautiously in patients with neuromuscular disorders (e.g., myasthenia gravis, parkinsonian syndrome, botulism) or hypocalcemia. If signs of respiratory paralysis occur during aminoglycoside therapy, the drug should be discontinued and mechanical respiratory assistance provided if necessary.

References

  1. Kaeser HE "Drug-induced myasthenic syndromes." Acta Neurol Scand 70 (1984): 39-47
  2. Ristuccia AM, Cunha BA "The aminoglycosides." Med Clin North Am 66 (1982): 303-12
  3. "Product Information. Amikin (amikacin)." Bristol-Myers Squibb (2002):
  4. "Product Information. Garamycin (gentamicin)." Schering-Plough Corporation (2007):
  5. "Product Information. Netromycin (netilmicin)." Schering Corporation (2002):
  6. "Product Information. Streptomycin Sulfate (streptomycin)." Pfizer U.S. Pharmaceuticals
  7. "Product Information. Nebcin (tobramycin)." Lilly, Eli and Company (2001):
  8. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  9. "Product Information. Mycifradin (neomycin)." Emerson Laboratories (2001):
  10. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
  11. "Product Information. Arikayce (amikacin liposome)." Insmed Incorporated (2018):
View all 11 references
Major

Aminoglycosides (applies to tobramycin) ototoxicity

Major Potential Hazard, High plausibility. Applicable conditions: Hearing Loss, Tinnitus

Aminoglycosides can cause eighth cranial nerve damage, resulting in vestibular and/or auditory toxicities. Symptoms include dizziness, nystagmus, vertigo, ataxia, tinnitus, and varying degrees of hearing impairment. Permanent hearing loss may occur, including, rarely, total or partial irreversible bilateral deafness after the drug has been discontinued. Therapy with aminoglycosides, particularly if prolonged (> 10 days), should be administered cautiously in patients with preexisting vestibular and/or auditory impairment, since it may delay the recognition or confound the diagnosis of a drug-induced ototoxic effect. To minimize the risk of toxicity, patients should be adequately hydrated, the usual aminoglycoside dosage should not be exceeded, use with other ototoxic agents should be avoided, and peak and trough serum aminoglycoside concentrations should be periodically determined and dosage adjusted to maintain desired levels. Serial audiograms should be obtained in patients old enough to be tested, since loss of high- frequency perception usually precedes clinical hearing loss. The dosage should be reduced or therapy withdrawn promptly if signs and symptoms of toxicity develop.

References

  1. Barza M, Lauermann MW, Tally FP, Gorbach SL "Prospective, randomized trial of netilmicin and amikacin, with emphasis on eighth-nerve toxicity." Antimicrob Agents Chemother 17 (1980): 707-14
  2. Barza M, Lauermann MW, Tally FP, Gorbach SL "Prospective, randomized trial of netilmicin and amikacin, with emphasis on eighth-nerve toxicity." Antimicrob Agents Chemother 17 (1980): 707-14
  3. Bock BV, Edelstein PH, Meyer RD "Prospective comparative study of efficacy and toxicity of netilmicin and amikacin." Antimicrob Agents Chemother 17 (1980): 217-25
  4. Danhauer FJ, Fortner CL, Schimpff SC, DeJongh CA, Wesley MN, Wiernik PH "Ototoxicity and pharmacokinetically determined dosages of amikacin in granulocytopenic cancer patients." Clin Pharm 1 (1982): 539-43
  5. Uziel A "Non-genetic factors affecting hearing development." Acta Otolaryngol (Stockh) 421 (1985): 57-61
  6. Lerner SA, Schmitt BA, Seligsohn R, Matz G "Comparative study of ototoxicity and nephrotoxicity in patients randomly assigned to treatment with amikacin or gentamicin." Am J Med 80 Suppl 6 (1986): 98-104
  7. Bock BV, Edelstein PH, Meyer RD "Prospective comparative study of efficacy and toxicity of netilmicin and amikacin." Antimicrob Agents Chemother 17 (1980): 217-25
  8. Bernstein JM, Gorse GJ, Linzmayer MI, et al. "Relative efficacy and toxicity of netilmicin and tobramycin in oncology patients." Arch Intern Med 146 (1986): 2329-34
  9. Smith CR, Lipsky JJ, Laskin OL, et al. "Double-blind comparison of the nephrotoxicity and auditory toxicity of gentamicin and tobramycin." N Engl J Med 302 (1980): 1106-9
  10. Tablan OC, Reyes MP, Rintelmann WF, Lerner AM "Renal and auditory toxicity of high-dose, prolonged therapy with gentamicin and tobramycin in pseudomonas endocarditis." J Infect Dis 149 (1984): 257-63
  11. Gatell JM, SanMiguel JG, Araujo V, et al. "Prospective randomized double-blind comparison of nephrotoxicity and auditory toxicity of tobramycin and netilmicin." Antimicrob Agents Chemother 26 (1984): 766-9
  12. Bernstein JM, Gorse GJ, Linzmayer I, et al. "Relative efficacy and toxicity of netilmicin and tobramycin in oncology patients." Arch Intern Med 146 (1986): 2329-34
  13. Mathog RH, Klein WJ "Ototoxicity of ethacrynic acid and aminoglycoside antibiotics in uremia." N Engl J Med 280 (1969): 1223-4
  14. Ristuccia AM, Cunha BA "The aminoglycosides." Med Clin North Am 66 (1982): 303-12
  15. Gailiunas P, Dominguez-Moreno M, Lazarus JM, et al. "Vestibular toxicity of gentamicin: incidence in patients receiving long-term hemodialysis therapy." Arch Intern Med 138 (1978): 1621-4
  16. Deka RC, Ghosh P, Kacker SK "Streptomycin ototoxicity: an audiologic and vestibular study." Ear Nose Throat J 56 (1977): 218-24
  17. Esterhai JL, Bednar J, Kimmelman CP "Gentamicin-induced ototoxicity complicating treatment of chronic osteomyelitis." Clin Orthop Aug (1986): 185-6
  18. "Product Information. Amikin (amikacin)." Bristol-Myers Squibb (2002):
  19. "Product Information. Garamycin (gentamicin)." Schering-Plough Corporation (2007):
  20. "Product Information. Netromycin (netilmicin)." Schering Corporation (2002):
  21. "Product Information. Streptomycin Sulfate (streptomycin)." Pfizer U.S. Pharmaceuticals
  22. "Product Information. Nebcin (tobramycin)." Lilly, Eli and Company (2001):
  23. Gendeh BS, Said H, Gibb AG, Aziz NS, Kong N, Zahir ZM "Gentamicin ototoxicity in continuous ambulatory peritoneal dialysis." J Laryngol Otol 107 (1993): 681-5
  24. Hybels RL "Drug toxicity of the inner ear." Med Clin North Am 63 (1979): 309-19
  25. Marlowe FI "Ototoxic agents." Otolaryngol Clin North Am 11 (1978): 791-800
  26. Sheffield PA, Turner JS Jr "Ototoxic drugs: a review of clinical aspects, histopathologic changes and mechanisms of action." South Med J 64 (1971): 359-63
  27. Ballantyne J "Ototoxicity: a clinical review." Audiology 12 (1973): 325-36
  28. Ajodhia JM, Dix MR "Drug-induced deafness and its treatment." Practitioner 216 (1976): 561-70
  29. Boston Collaborative Drug Surveillance Program "Drug-induced deafness." JAMA 224 (1973): 515-6
  30. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  31. Minor LB "Gentamicin-induced bilateral vestibular hypofunction." JAMA 279 (1998): 541-4
  32. ElBakri F, Pallett A, Smith AG, Duncombe AS "Ototoxicity induced by once-daily gentamicin." Lancet 351 (1998): 1407-8
  33. "Product Information. Mycifradin (neomycin)." Emerson Laboratories (2001):
  34. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
  35. "Product Information. Arikayce (amikacin liposome)." Insmed Incorporated (2018):
View all 35 references
Major

Aminoglycosides (applies to tobramycin) renal dysfunction

Major Potential Hazard, High plausibility.

Aminoglycosides are potentially oto- and nephrotoxic. Eighth cranial nerve damage may manifest as vestibular and/or auditory toxicities, including dizziness, nystagmus, vertigo, ataxia, tinnitus, and varying degrees of hearing impairment. Nephrotoxicity is usually evidenced by tubular necrosis; increases in BUN, nonprotein nitrogen, and serum creatinine concentration; decreases in urine specific gravity and creatinine clearance; proteinuria; and cells or casts in the urine. Rarely, renal electrolyte wasting may occur, resulting in hypocalcemia, hypomagnesemia, and hypokalemia that may be associated with paresthesia, tetany, confusion, and positive Chvostek and Trousseau signs. Although aminoglycoside- induced nephrotoxicity is generally reversible following discontinuation of the drug, death from uremia has occurred rarely. Therapy with aminoglycosides should be administered cautiously at reduced dosages in patients with renal impairment, since they may be at increased risk for oto- and nephrotoxicity due to drug accumulation. To minimize the risk of toxicity, patients should be adequately hydrated, the usual aminoglycoside dosage should not be exceeded, use with other neuro- and nephrotoxic agents should be avoided, and peak and trough serum aminoglycoside concentrations should be periodically determined and dosage adjusted to maintain desired levels. Renal and eighth cranial nerve function should be closely monitored, and the dosage reduced or therapy withdrawn if toxicity develops.

References

  1. Beauchamp D, Gourde P, Theriault G, Bergeron MG "Age-dependent gentamicin experimental nephrotoxicity." J Pharmacol Exp Ther 260 (1992): 444-9
  2. Dahlgren JG, Anderson ET, Hewitt WL "Gentamicin blood levels: a guide to nephrotoxicity." Antimicrob Agents Chemother 8 (1975): 58-62
  3. Fanning WL, Gump D, Jick H "Gentamicin and cephalothin-associated rises in blood urea nitrogen." Antimicrob Agents Chemother 10 (1976): 80-2
  4. Madhavan T, Yaremchuk K, Levin N, et al. "Effect of renal failure and dialysis on the serum concentration of the aminoglycoside amikacin." Antimicrob Agents Chemother 10 (1976): 464-5
  5. Plantier J, Forrey AW, O'Neill MA, Blair AD, Christopher TG, Cutler RE "Pharmacokinetics of amikacin in patients with normal or impaired renal function: radioenzymatic acetylation assay." J Infect Dis 134 Suppl (1976): s323-30
  6. McHenry MC, Wagner JG, Hall PM, Vidt DG, Gavan TL "Pharmacokinetics of amikacin in patients with impaired renal function." J Infect Dis 134 Suppl (1976): s343-54
  7. Sarubbi FA, Hull JH "Amikacin serum concentrations: prediction of levels and dosage guidelines." Ann Intern Med 89 (1978): 612-8
  8. Bock BV, Edelstein PH, Meyer RD "Prospective comparative study of efficacy and toxicity of netilmicin and amikacin." Antimicrob Agents Chemother 17 (1980): 217-25
  9. Lerner SA, Schmitt BA, Seligsohn R, Matz G "Comparative study of ototoxicity and nephrotoxicity in patients randomly assigned to treatment with amikacin or gentamicin." Am J Med 80 Suppl 6 (1986): 98-104
  10. Williams PJ, Hull JH, Sarubbi FA, Rogers JF, Wargin WA "Factors associated with nephrotoxicity and clinical outcome in patients receiving amikacin." J Clin Pharmacol 26 (1986): 79-86
  11. Emanuelli G, Anfossi G, Calcamuggi G, Marcarino C, Lanzio M "Urinary enzyme release following aminoglycoside administration in single low dose." Enzyme 39 (1988): 119-22
  12. Contreras AM, Gamba G, Cortes J, et al. "Serial trough and peak amikacin levels in plasma as predictors of nephrotoxicity." Antimicrob Agents Chemother 33 (1989): 973-6
  13. French MA, Cerra FB, Plaut ME, Schentag JJ "Amikacin and gentamicin accumulation pharmacokinetics and nephrotoxicity in critically ill patients." Antimicrob Agents Chemother 19 (1981): 147-52
  14. Pijck J, Hallynck T, Soep H, Baert L, Daniels R, Boelaert J "Pharmacokinetics of amikacin in patients with renal insufficiency: relation of half-life and creatinine clearance." J Infect Dis 134 (1976): s331-41
  15. Solberg CO, Madsen ST, Digranes A, et al. "High dose netilmicin therapy: efficacy, tolerance and tissue penetration." J Antimicrob Chemother 6 (1980): 133-41
  16. Bhattacharya BK, Gorringe H, Farr MJ "Netilmicin and nephrotoxicity." Lancet 2 (1983): 216-7
  17. Bergeron MG, Lessard C, Ronald A, Stiver G, Van Roogen CE, Chadwick P "Three to eight weeks of therapy with netilmicin: toxicity in normal and diabetic patients." J Antimicrob Chemother 12 (1983): 245-8
  18. Bernstein JM, Gorse GJ, Linzmayer MI, et al. "Relative efficacy and toxicity of netilmicin and tobramycin in oncology patients." Arch Intern Med 146 (1986): 2329-34
  19. Matzke GR, Millikin, Kovarik JM "Variability in pharmacokinetic values for gentamicin, tobramycin, and netilmicin in patients with renal insufficiency." Clin Pharm 8 (1989): 800-6
  20. Herrero A, Alarco FR, Diez JM, Mahiques E, Domingo JV "Pharmacokinetics of netilmicin in renal insufficiency and hemodialysis." Int J Clin Pharmacol Ther Toxicol 26 (1988): 84-7
  21. Craig WA, Gudmundsson S, Reich RM "Netilmicin sulfate: a comparative evaluation of antimicrobial activity, pharmacokinetics, adverse reactions and clinical efficacy." Pharmacotherapy 3 (1983): 305-15
  22. Luft FC, Brannon DR, Stropes LL, Costello RJ, Sloan RS, Maxwell DR "Pharmacokinetics of netilmicin in patients with renal impairment and in patients on dialysis." Antimicrob Agents Chemother 14 (1978): 403-7
  23. Humbert G, Leroy A, Fillastre JP, Oksenhendler G "Pharmacokinetics of netilmicin in the presence of normal or impaired renal function." Antimicrob Agents Chemother 14 (1978): 40-4
  24. Russo ME, Atkin-Thor E "Gentamicin and ticarcillin in subjects with end-stage renal disease." Clin Nephrol 15 (1981): 175-80
  25. Federspil P, Schatzle W, Tiesler E "Pharmacokinetics and ototoxicity of gentamicin, tobramycin and amikacin." J Infect Dis 134 (1976): s200-5
  26. Smith CR, Lipsky JJ, Laskin OL, et al. "Double-blind comparison of the nephrotoxicity and auditory toxicity of gentamicin and tobramycin." N Engl J Med 302 (1980): 1106-9
  27. Kumin GD "Clinical nephrotoxicity of tobramycin and gentamicin." JAMA 244 (1980): 1808-10
  28. Keys TF, Kurtz SB, Jones JD, Muller SM "Renal toxicity during therapy with gentamicin or tobramycin." Mayo Clin Proc 56 (1981): 556-9
  29. Schentag JJ, Cerra FB, Plaut ME "Clinical and pharmacokinetic characteristics of aminoglycoside nephrotoxicity in 201 critically ill patients." Antimicrob Agents Chemother 21 (1982): 721-6
  30. Pines A, Goldhammer E, Kaplinsky N, Frankl O "Hypopotassemia associated with tobramycin treatment." Infection 10 (1982): 101-
  31. Tablan OC, Reyes MP, Rintelmann WF, Lerner AM "Renal and auditory toxicity of high-dose, prolonged therapy with gentamicin and tobramycin in pseudomonas endocarditis." J Infect Dis 149 (1984): 257-63
  32. Watson AJ, Watson MM, Keogh JA "Metabolic abnormalities associated with tobramycin therapy." Isr J Med Sci 153 (1984): 96-9
  33. Gatell JM, SanMiguel JG, Araujo V, et al. "Prospective randomized double-blind comparison of nephrotoxicity and auditory toxicity of tobramycin and netilmicin." Antimicrob Agents Chemother 26 (1984): 766-9
  34. Cimino MA, Rotstein C, Slaughter RL, Emrich LJ "Relationship of serum antibiotic concentrations to nephrotoxicity in cancer patients receiving concurrent aminoglycoside and vancomycin therapy." Am J Med 83 (1987): 1091-7
  35. Contrepois A, Brion N, Garaud JJ, et al. "Renal disposition of gentamicin, dibekacin, tobramycin, netilmicin, and amikacin in humans." Antimicrob Agents Chemother 27 (1985): 520-4
  36. Wilkinson R, Lucas GL, Heath DA, et al. "Hypomagnesaemic tetany associated with prolonged treatment with aminoglycosides." Br Med J 292 (1986): 818-9
  37. Pedersen SS, Jensen J, Osterhammel D, Osterhammel P "Cumulative and acute toxicity of repeated high-dose tobramycin treatment in cystic fibrosis." Antimicrob Agents Chemother 31 (1987): 594-9
  38. Kunin CM, Finland M "Persistence of antibiotics in blood of patients with acute renal failure. III. Penicillin, streptomycin, erythromycin and kanamycin." J Clin Invest 38 (1959): 1509-19
  39. Yoshikawa TT, Nagami PH "Adverse drug reactions in TB therapy: risks and recommendations." Geriatrics 37 (1982): 61-3, 67-8
  40. Siegenthaler WE, Bonetti A, Luthy R "Aminoglycoside antibiotics in infectious diseases: an overview." Am J Med 80 (1986): 2-14
  41. Ristuccia AM, Cunha BA "The aminoglycosides." Med Clin North Am 66 (1982): 303-12
  42. Trollfors B, Alestig K, Krantz I, Norrby R "Quantitative nephrotoxicity of gentamicin in nontoxic doses." J Infect Dis 141 (1980): 306-9
  43. Letona JM, Barbolla L, Frieyro E, et al. "Immune haemolytic anaemia and renal failure induced by streptomycin." Br J Haematol 35 (1977): 561-71
  44. McQueen EG "Antibiotic allergy and acute renal failure." N Z Med J 64 (1965): 561-3
  45. Gyselnyck AM, Forrey A, Cutler R "Pharmacokinetics of gentamicin: distribution and plasma and renal clearance." J Infect Dis 124 (1971): s70
  46. Jaffe, Meyers BR, Hirschman SZ "Pharmacokinetics of tobramycin in patients with stable renal impairment, patients undergoing peritoneal dialysis, and patients on chronic hemodialysis." Antimicrob Agents Chemother 5 (1974): 611-6
  47. Schentag JJ, Lasezkay G, Cumbo TJ, et al. "Accumulation pharmacokinetics of tobramycin." Antimicrob Agents Chemother 13 (1978): 649-56
  48. Pechere JC, Dugal R, Pechere MM "Pharmacokinetics of netilmicin in renal insufficiency and haemodialysis." Clin Pharmacokinet 3 (1978): 395-406
  49. "Product Information. Amikin (amikacin)." Bristol-Myers Squibb (2002):
  50. "Product Information. Garamycin (gentamicin)." Schering-Plough Corporation (2007):
  51. "Product Information. Netromycin (netilmicin)." Schering Corporation (2002):
  52. "Product Information. Streptomycin Sulfate (streptomycin)." Pfizer U.S. Pharmaceuticals
  53. "Product Information. Nebcin (tobramycin)." Lilly, Eli and Company (2001):
  54. Gilbert DN, Bennett WM "Use of antimicrobial agents in renal failure." Infect Dis Clin North Am 3 (1989): 517-31
  55. Matz GJ, Naunton RF "Ototoxic drugs and poor renal function." JAMA 206 (1968): 2119
  56. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  57. "Product Information. Mycifradin (neomycin)." Emerson Laboratories (2001):
  58. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
  59. "Product Information. Arikayce (amikacin liposome)." Insmed Incorporated (2018):
View all 59 references

Tobramycin drug interactions

There are 178 drug interactions with tobramycin.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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