Drug General Information (ID: DDI68XV0B4)
Drug Name			Tobramycin		Drug Info		Plazomicin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antibiotics				Aminoglycosides//Antibiotics
Structure

Mechanism of Tobramycin-Plazomicin Interaction (Severity Level: Moderate)
Increased risk of nephrotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Tobramycin				Plazomicin
Mechanism 1		Nephrotoxicity				Nephrotoxicity
Key Mechanism Factor 1
		Factor Name		Nephrotoxicity
		Factor Description		The combination of drugs that can induce nephrotoxicity may increase the risk of kidney injury. When kidney injury occurs, the inability to remove excess urine and waste from the body can lead to high levels of urea nitrogen, creatinine, and electrolytes (such as potassium and magnesium) in the blood.
Mechanism Description		Increased risk of nephrotoxicity by the combination of Tobramycin and Plazomicin
Increased risk of ototoxicity Click to Show/Hide Mechanism Graph
Drug Name		Tobramycin				Plazomicin
Mechanism 2		Ototoxicity				Ototoxicity
Key Mechanism Factor 2
		Factor Name		Ototoxicity
		Factor Description		Ototoxicity is the damage to the organs of hearing and/or balance following exposure to drugs or chemicals that affect the inner ear. Ototoxic drugs can impair hearing, balance, or both.
Mechanism Description		Increased risk of ototoxicity by the combination of Tobramycin and Plazomicin

Recommended Action
Management		The use of more than one aminoglycoside should be avoided. Patients receiving aminoglycosides should be closely monitored for development of toxicity, including renal function tests and serial, vestibular, and audiometric tests. Ototoxicity may be permanent and may not be apparent until long after therapy has been discontinued. The onset of auditory toxicity may be asymptomatic or may manifest with early symptoms such as feelings of fullness in the ear, high tone hearing loss, or tinnitus. Signs of vestibulotoxicity include ataxia, tinnitus, and vertigo.

References
1	Cerner Multum, Inc. "Australian Product Information.".
2	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
3	Dupuis JY, Martin R, Tetrault JP "Atracurium and vecuronium interaction with gentamicin and tobramycin." Can J Anaesth 36 (1989): 407-11. [PMID: 2569365]
4	Halstenson CE, Hirata CA, Heim-Duthoy KL, Abraham PA, Matzke GR "Effect of concomitant administration of piperacillin on the dispositions of netilmicin and tobramycin in patients with end-stage renal disease." Antimicrob Agents Chemother 34 (1990): 128-33. [PMID: 2327747]
5	Johnson AH, Hamilton CH "Kanamycin ototoxicity: possible potentiation by other drugs." South Med J 63 (1970): 511-3. [PMID: 5446818]
6	Kaka JS, Lyman C, Kilarski DJ "Tobramycin-furosemide interaction." Drug Intell Clin Pharm 18 (1984): 235-8. [PMID: 6697885]
7	Lawson DH, Tilstone WJ, Gray JM, Srivastava PK "Effect of furosemide on the pharmacokinetics of gentamicin in patients." J Clin Pharmacol 22 (1982): 254-8. [PMID: 7107971]
8	Mathog RH, Klein WJ "Ototoxicity of ethacrynic acid and aminoglycoside antibiotics in uremia." N Engl J Med 280 (1969): 1223-4. [PMID: 5767464]
9	Product Information. Arikayce (amikacin liposome). Insmed Incorporated, Bridgewater, NJ.
10	Product Information. Garamycin (gentamicin). Schering-Plough Corporation, Kenilworth, NJ.
11	Product Information. Mycifradin (neomycin). Emerson Laboratories, Texarkana, TX.
12	Product Information. Nebcin (tobramycin). Lilly, Eli and Company, Indianapolis, IN.
13	Weibert R, Keane W, Shapiro F "Carbenicillin inactivation of aminoglycosides in patients with severe renal failure." Trans Am Soc Artif Intern Organs 22 (1976): 439-43. [PMID: 951863]