Prescription Drug Information: Tobradex
Other Formulations Available: Tobradex Ointment & Tobradex ST
Tobradex contains a combination of two active ingredients, tobramycin and dexamethasone. Tobramycin is classified as an aminoglycoside antibiotic, while dexamethasone is classified as a corticosteroid. Tobradex is prescribed for the treatment and prevention of wide spectrum ocular bacterial infections. Dexamethasone works against inflammations caused by infections and tobramycin works against ocular bacterial infections.
Indication/Usage: Tobradex is approved for the treatment of steroid responsive ocular inflammatory conditions associated with superficial bacterial infection. It also prevents the risk of bacterial ocular infection. Other indications for Tobradex are as follows:
- Ocular inflammation post-cataract operation.
- Inflammatory palpebral and bulbar conjunctiva, cornea and anterior globe.
- Chronic anterior uveitis.
- Various corneal injuries like chemical, radiation or thermal burns, etc.
- Pink eye associated with bacterial infections.
Tobradex shows antibiotic effects against various bacterial ocular pathogens such as S. aureus, S. epidermidis, S. pneumoniae, Kiebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia cob, Enterobacter aerogenes, Proteus mirabilis, Proteus vulgaris, H. influenzae and H. aegyptius, Moraxella lacunata, Acinetobacter calcoaceticus, etc.
Tobradex should not be prescribed for other ocular infections as this may decrease its efficacy.
Dose, Administration and Dosage Forms: The starting dose for Tobradex eye drops is 1-2 drops in each eye every four to six hours or as prescribed by an ophthalmologist. During the first two days of therapy, this dose may be titrated to 1-2 drops every two hours. Tobradex should be gradually withdrawn after desired results are achieved. No more than 20 ml should be prescribed initially and refilling should be done only after proper monitoring.
To avoid contamination, patients must not touch the dropper or tube while administering Tobradex.
Mechanism of Action: Tobradex works by dual mechanism of action due to its two active ingredients. Dexamethasone is a corticosteroid which helps in controlling inflammations associated with various bacterial infections. Tobramycin is an antibiotic which blocks the growth of various microorganisms in the eyes. Studies have shown that Tobramycin is effective against microbes in Gentamicin failure cases.
Side-effects and Safety Profile: There are various ocular side-effects reported with Tobradex usage which include: burning sensation, redness, stinging, irritation, eye pain, light sensitivity, pupil dilatation, cornea inflammation (punctate keratitis), suppressed corneal healing, increased tearing, dryness, secondary infections, cataracts development, increased ocular pressure, vision changes, blurry vision, glaucoma, ocular nerve damages, drooping eyelid, eyelid itching and swelling, etc.
Tobradex may also cause headaches, nausea, stomach discomfort, altered taste sensations, and various hypersensitivity reactions like skin rash, face, hand, and feet swelling, wheezing, dyspnea, itchy swellings, hives, etc.
Patients experiencing any of the above side-effects should immediately report to the emergency room.
Warnings and Contraindications:
- If symptoms get worse, patients should contact their physician immediately.
- Tobradex is highly contraindicated in patients with herpetic and viral ocular infections, or fungal and mycobacterial infections.
- Tobradex is contraindicated in patients with corneal lesions and dendritic keratitis.
- Tobradex is contraindicated in patients who are allergic to tobramycin or dexamethasone.
- Prolonged usage of Tobradex may cause glaucoma, optic nerve damage, vision problems and increased risk of secondary ocular infections.
- Pregnant women: Tobradex is classified as a pregnancy category C drug which means it may result in fetal teratogenic effects, fetal abnormalities, fetal growth retardation, and increased risks to fetal outcomes. Therefore, Tobradex should only be used in pregnant women if the potential benefits justify risks to the fetus.
- Nursing women: Tobradex should not be prescribed to nursing women as systemically administered dexamethasone is reported to excrete in human milk and can suppress growth or cause other untoward effects. Topical formulations have not yet been studied in nursing women and should therefore not be prescribed to nursing women.
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Tobradex Eye Drops (Tobramycin/Dexamethasone)
