Drug interactions
Methoxyflurane + Tobramycin
Severity: Major
Methoxyflurane and Tobramycin: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Methoxyflurane releases fluoride during metabolism and is itself nephrotoxic at higher exposures. Combined with tobramycin, the risk of kidney injury, and potentially ototoxicity, is increased. Severe renal toxicity has been the main reason for withdrawal of high-dose anesthetic use.
What this interaction means in plain words
Methoxyflurane and Tobramycin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive nephrotoxicity from fluoride-mediated tubular injury with methoxyflurane and proximal tubular accumulation of tobramycin.
What to do
Avoid combining the two where possible, and prefer a non-nephrotoxic anesthetic or analgesic. If unavoidable, monitor serum creatinine, urine output and tobramycin levels.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Tobramycin
- Cidofovir + Tobramycin Contraindicated
- Adefovir + Tobramycin Major
- Amikacin + Tobramycin Major
- Amphotericin b deoxycholate + Tobramycin Major
- Amphotericin b + Tobramycin Major
- Atracurium + Tobramycin Major
Frequently asked questions
Can I take Methoxyflurane with Tobramycin?
MediHelp rates the interaction as major. Methoxyflurane and Tobramycin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Methoxyflurane releases fluoride during metabolism and is itself nephrotoxic at higher exposures. Combined with tobramycin, the risk of kidney injury, and potentially ototoxicity, is increased. Severe renal toxicity has been the main reason for withdrawal of high-dose anesthetic use.
How serious is the interaction between Methoxyflurane and Tobramycin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid combining the two where possible, and prefer a non-nephrotoxic anesthetic or analgesic. If unavoidable, monitor serum creatinine, urine output and tobramycin levels.
What other medicines interact with Tobramycin?
MediHelp also lists interactions of Tobramycin with, for example, Cidofovir, Adefovir, Amikacin. The full list is on the Tobramycin page.
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