A sterile, topical ophthalmic suspension/ointment combining a potent corticosteroid (Dexamethasone) with a broad-spectrum aminoglycoside antibiotic (Tobramycin). It is primarily indicated for the treatment of steroid-responsive inflammatory ocular conditions where the risk of superficial bacterial infection is high or where such an infection already exists. This combination provides anti-inflammatory, anti-allergic, and antibacterial actions.
Adult: Suspension: Instill 1 or 2 drops into the conjunctival sac(s) every 4 to 6 hours. In severe disease, may be used hourly initially, tapering as inflammation subsides. Ointment: Apply a small ribbon (approx. 1 cm) into the conjunctival sac up to 3-4 times daily.
Note: Shake suspension well before use. Wash hands. Tilt head back, pull lower eyelid down to form a pouch. Instill drops/apply ointment without touching the tip to the eye or any surface. Close eye gently for 1-2 minutes. Apply gentle pressure to the nasolacrimal duct (inner corner of eye) for 1 minute to reduce systemic absorption. Wait at least 5-10 minutes before instilling any other ophthalmic medication.
Dexamethasone exerts potent anti-inflammatory, anti-allergic, and anti-proliferative effects by inducing phospholipase A2 inhibitory proteins (lipocortins), which control the biosynthesis of potent mediators of inflammation like prostaglandins and leukotrienes. It suppresses migration of polymorphonuclear leukocytes and reverses increased capillary permeability. Tobramycin is a bactericidal aminoglycoside that binds irreversibly to the 30S ribosomal subunit of susceptible bacteria, inhibiting protein synthesis and causing misreading of the genetic code.
Pregnancy: Category C (US FDA). Dexamethasone and tobramycin cross the placenta. Topical use is generally considered low risk, but should be used only if the potential benefit justifies the potential risk to the fetus. Avoid prolonged or high-dose use. Consult physician.
Driving: May cause transient blurred vision after instillation. Patients should not drive or operate machinery until vision clears.
| Other Aminoglycosides (systemic or topical) | Increased risk of ototoxicity and nephrotoxicity (additive). | Moderate |
| Systemic Corticosteroids | Additive systemic steroid effects, increasing risk of hypercortisolism. | Moderate |
| Neuromuscular Blocking Agents (e.g., Succinylcholine) | Tobramycin may potentiate neuromuscular blockade, leading to respiratory depression. | Major |
| Loop Diuretics (e.g., Furosemide) | Increased risk of ototoxicity when combined with tobramycin. | Moderate |
| Cyclosporine | Concurrent use may increase risk of cataract formation. | Moderate |