Side Effects of Tobradex (tobramycin/dexamethasone)

Tobradex (tobramycin/dexamethasone) ophthalmic suspension is a combination antibiotic and steroid used for steroid-responsive inflammatory eye (ocular) conditions for which a corticosteroid is indicated and where superficial bacterial eye infection or a risk of bacterial eye infection exists. 

The use of a combination drug with an anti-infective component is indicated where the risk of superficial ocular infection is high or where there is an expectation that potentially dangerous numbers of bacteria will be present in the eye.

Common side effects of Tobradex include:

• eye itching,
• swelling of the eyelids, and
• eye redness.

Other side effects of Tobradex include:

• increased intraocular pressure,
• delayed wound healing,
• optic nerve damage, and
• cataract formation.

Drug interactions of Tobradex include oral steroids. 

Although no human studies have assessed the effects of Tobradex on the fetus, animal studies have shown adverse fetal effects. Physicians should prescribe it to women who are pregnant only if its benefits are deemed to outweigh potential risks. 

It is unknown if Tobradex is excreted into breast milk. Consult your doctor before breastfeeding. 

The most frequently reported side effects of Tobradex are: 

• itching,
• swelling of the eye lids, and
• redness of the conjunctivae.

Other side effects include:

• Increased intraocular pressure,
• delayed wound healing,
• optic nerve damage, and
• formation of cataract.

Adverse reactions have occurred with steroid/anti-infective combination drugs which can be attributed to the steroid component, the anti-infective component, or the combination. Exact incidence figures are not available. The most frequent adverse reactions to topical ocular tobramycin [Tobrex (tobramycin ophthalmic solution)] are hypersensitivity and localized ocular toxicity, including lid itching and swelling, and conjunctival erythema.

These reactions occur in less than 4% of patients. Similar reactions may occur with the topical use of other aminoglycoside antibiotics. Other adverse reactions have not been reported; however, if topical ocular tobramycin is administered concomitantly with systemic aminoglycoside antibiotics, care should be taken to monitor the total serum concentration.

The reactions due to the steroid component are:

• elevation of intraocular pressure (IOP) with possible development of glaucoma, and infrequent optic nerve damage;
• posterior subcapsular cataract formation; and
• delayed wound healing.

Secondary Infection

The development of secondary infection has occurred after use of combinations containing steroids and antimicrobials. Fungal infections of the cornea are particularly prone to develop coincidentally with long-term applications of steroids.

The possibility of fungal invasion must be considered in any persistent corneal ulceration where steroid treatment has been used. Secondary bacterial ocular infection following suppression of host responses also occurs.

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