Tobramycin Solution for Inhalation (TOBI)
TOBI® is an antibiotic solution that is breathed (inhaled) into the lungs. TOBI® is helpful in fighting lung infections, reducing the number of days in the hospital, and improving lung function. TOBI® is a clear to light yellow solution. It comes in a sterile, single-dose plastic vial holding 300mg in 5ml of fluid. TOBI® should be refrigerated and protected from the light. However, if you don’t refrigerate it, the color may darken, but it is still safe to use. If the medicine looks cloudy, has particles floating in it, or has been sitting out for more than 28 days, throw it away.
Each box of TOBI® contains a 28-day supply or 56 vials. These vials are packaged in 14 foil pouches. Each pouch contains 4 vials, which is enough for 2 days of therapy.
Are there side effects?
Side effects which have sometimes been noted:
• Decrease in kidney function
• Ringing in the ears or hearing loss
• Chest tightness
• Muscle weakness
• Hoarseness
• Wheezing
If any of these side effects occur while breathing in your TOBI®, stop the treatment at once and call your doctor. If you develop any of these side effects at any time you should call your doctor. If you are pregnant, consult your doctor before using TOBI®.
How long do I have to use TOBI®?
Before starting the treatment, your doctor will want to know about your cough and obtain breathing tests (PFTs) to compare the results before and after you have started using TOBI®. This will help your doctor decide if TOBI® is helping you. You may be using TOBI® twice a day for 28 days and then stop the TOBI® for 28 days or as your doctor recommends. Each day you will do 2 treatments about 12 hours apart; one vial in the morning and one vial in the evening. If you are on other drug treatments, you should complete them in this order:
- Bronchodilator therapy
- Nebulized hypertonic saline
- Nebulized DNase (Pulmozyme®)
- Airway clearance technique
- TOBI®
If you are taking inhaled corticosteroids or cromolyn/nedocromil sodium you should take those medicines after you have taken your TOBI®. TOBI® should not be mixed with any other medicine. This repeated pattern of 28 days on and 28 days off will continue until your doctor tells you differently.
Will I need special equipment?
TOBI® comes as a liquid and needs to be made into a mist so that it can go deep into the lungs. Certain nebulizers must be used in order for TOBI®to be delivered properly. The Pari LC Plus®, or the side stream nebulizer, is used with TOBI®. The Duraneb®, which runs on batteries, or any other portable battery-operated nebulizer, is not powerful enough to create the proper mist.
How do I use TOBI®?
• Place one vial of TOBI® in the nebulizer cup and throw the empty
vial away.
• Use a mouthpiece. If you have trouble breathing through your mouth,
use nose clips during the treatments. If you still cannot use a
mouthpiece, a mask can be used.
• Take a slow deep breath. Every few breaths, hold your breath for 5seconds.
• If you have to cough, rest or are interrupted during the treatment, turn
the air compressor off to save your medicine.
• The treatment will take between 10 - 15 minutes.
• After the treatment is over, pour 2 teaspoons of clean water into yournebulizer. Turn the air compressor on and let the water mist through
the nebulizer for 15 seconds just as if you were doing a treatment.
This will clean out any remaining TOBI® from the tiny tubes which
form the mist.
How Do I Clean and Disinfect My Nebulizer?
Daily cleaning and disinfecting of your TOBI® nebulizer is extremely important in preventing infection and keeping the nebulizer working well.
Dishwasher Cleaning
The reservoir tubing (pleated tube) cannot be placed in the dishwasher. This piece needs to be cleaned according to the “hand cleaning” directions.
1. Take the nebulizer apart.
2. Place the pieces in a dishwasher basket on the top rack of the dishwasher.
3. After the dishwasher cycle is done, remove the pieces and shake out the
extra water.
4. Air-dry the nebulizer pieces on a dry paper towel.
Hand Cleaning
If you would prefer not to clean and disinfect your nebulizer using the dishwasher, select one of the choices below.
Rubbing Alcohol
1. Take the nebulizer apart and wash the pieces in warm soapy water.
2. Rinse with hot tap water.
3. Place the nebulizer pieces in a bowl and add enough rubbing alcohol
(isopropyl alcohol) to completely cover the equipment.
4. Soak the nebulizer for 5 minutes.
5. Rinse all of the parts of the nebulizer with sterile water. Do not use water
from the faucet, bottled, or distilled water. You can make water sterile
by boiling it for 5 minutes. Use this water once, and then throw it out.
6. Place the pieces on a paper towel to dry.
Microwaving
1. Take the nebulizer apart and wash the pieces in warm soapy water.
2. Rinse with hot water.
3. Place nebulizer pieces in a bowl, add water to cover.
4. Microwave for 5 minutes.
5. Air dry on a clean paper towel.
Equipment
If you have questions or need more supplies, contact UW Home Health at (608) 203-2273.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 07/31/2012
Copyright © 04/19/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5305
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