Toby is assigned in the form of inhalations. When inhaled tobramycin formulation preferably remains in the airway epithelium does not penetrate. Bioavailability depends on the technique of tobramycin inhalation and respiratory state.

Ten minutes after inhalation liothyronine average concentration of tobramycin in the sputum . Tobramycin does not accumulate in the sputum. The concentration varies widely. After 2 hours after inhalation tobramycin concentration is 14% of the concentration after 10 minutes.

Average serum concentration of tobramycin one hour after inhalationcystic fibrosis patients.

After 20 weeks of treatment  average tobramycin concentration one hour after inhalation equal.

Report mostly in the sputum, a small part – by glomerular filtration. The half-life of tobramycin from serum -primerno 2:00.

Long-term treatment of chronic pulmonary infections caused by Pseudomonas aeruginosa (Pseudomonas aeruginosa) in patients with cystic fibrosis aged 6 years and older.

Hypersensitivity to any aminoglycoside.
Pregnancy and lactation.
Children under 6 years of age.

Toby with caution in patients with impaired renal function, vestibular system, disorders of neuromuscular conduction and hearing pathology.

Toby appoint patients with severe hemoptysis in active form follows only if the benefit of treatment outweighs the risk of liothyronine stimulation of hemoptysis.

Pregnancy and lactation
Aminoglycoside pass the blood-placental barrier and can cause fetal damage  in the appointment of pregnant women.

Patients taking  pregnant or planning a pregnancy during treatment Toby should be warned about the potential risk of adverse effects on the fetus.

Application  during pregnancy and lactation is possible only in cases where the potential benefit to the mother outweighs the risk of harmful effects to the fetus.

It is not known whether tobramycin passes into breast milk  inhalation. However, if necessary, use during lactation should stop breastfeeding.

Dosage and administration
Only for inhalation!

The recommended dosage for adults and children 6 years – one ampoule (300 mg tobramycin) twice a day for 28 days. The interval between doses should be about 12 hours, but not less than 6 hours. After 28 days of therapy, patients should stop taking the drug for 28 days. It is necessary to comply with such 28-day active treatment cycle alternating with 28-day cycles of rest, including standard therapy.

The contents of one ampoule should be moved into the nebulizer and inhaled about 15 minutes, using a hand sprayer reusable liothyronine with an appropriate compressor. A suitable compressor is considered that when connected . Follow the manufacturer’s instructions for care and use of the nebulizer and compressor.

Inhalation Toby patient must sit or stand up straight and breathe normally through the mouthpiece of the nebulizer. Nose clip to help the patient breathe through the mouth. The patient should continue to comply with the standard regimen of chest physiotherapy procedures. In clinical need should continue to receive appropriate bronchodilator drugs. If the patient is receiving a number of different procedures, they are recommended as follows: receiving bronchodilator drugs, chest physiotherapy, inhalation of other medicinal products, and finally, Tobi inhalation.

Side effect
From the digestive system: loss of appetite, nausea, vomiting, diarrhea, sores and candidiasis in the oral cavity.
From the side of hematopoiesis: rarely lymphadenopathy.
Nervous system: dizziness, drowsiness.
From the senses: ototoxicity (ringing, roar in the ears, ear pain, partial or complete loss of hearing), vestibular and labyrinth disorders (impaired coordination, dizziness, nausea, vomiting, unsteadiness), distortion of taste.
From the urinary system: not marked renal dysfunction (inhalation use of tobramycin) , but the group of aminoglycosides has liothyronine a nephrotoxic effect. If a patient receiving Toby develops renal failure, treatment should be discontinued until such time as the serum concentration of tobramycin is reduced to 2 mg / mL.
The respiratory system: voice changes, shortness of breath, laryngitis, voice changes, increased cough, pharyngitis, bronchospasm, lung disorder, increased sputum, hemoptysis, epistaxis, sinusitis, asthma, hypoxia, hyperventilation.
Allergic reactions: itching, skin redness, hives, angioedema.

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