Alternatives to Dexamethasone/Tobramycin If You Can't Fill Your Prescription

Your doctor prescribed Dexamethasone/Tobramycin for your eye condition, but your pharmacy doesn't have it — or the cost is more than you expected. Whatever the reason, it's natural to wonder: are there alternatives that could work just as well?

The answer is yes — there are several comparable ophthalmic medications your doctor might consider. But it's important to understand that you should never switch medications on your own. Always talk to your prescriber before making any changes to your eye treatment.

What Is Dexamethasone/Tobramycin and How Does It Work?

Dexamethasone/Tobramycin — sold under the brand names TobraDex and TobraDex ST — is a prescription eye medication that combines two ingredients in one bottle:

• Tobramycin (0.3%) — An aminoglycoside antibiotic that kills bacteria by stopping their ability to make proteins. It targets a wide range of bacteria that commonly cause eye infections.
• Dexamethasone (0.1%) — A potent corticosteroid that reduces inflammation, swelling, redness, and discomfort in the eye by suppressing the immune response.

This combination is prescribed when you have eye inflammation that needs a steroid and there's also a risk of bacterial infection — or when you already have a bacterial eye infection with significant inflammation. Common situations include post-surgical care, uveitis, eye injuries, and chemical burns.

Alternatives Your Doctor May Consider

Each of these alternatives combines an antibiotic with a steroid in eye drop or ointment form. Your doctor will choose the best option based on your specific condition, allergy history, and what's available.

1. Zylet (Tobramycin/Loteprednol)

Zylet pairs the same antibiotic (Tobramycin) with a different steroid — Loteprednol instead of Dexamethasone. Loteprednol is considered a "softer" steroid, meaning it's less likely to raise the pressure inside your eye (intraocular pressure) compared to Dexamethasone. This makes Zylet a particularly good option for patients who are at risk for glaucoma or who need a longer course of treatment.

• Best for: Patients concerned about intraocular pressure, those with glaucoma risk, or those needing longer treatment courses
• Key difference: Milder steroid with lower risk of pressure-related side effects

2. Maxitrol (Neomycin/Polymyxin B/Dexamethasone)

Maxitrol contains the same steroid (Dexamethasone) but uses two different antibiotics — Neomycin and Polymyxin B — instead of Tobramycin. This gives it broader antibiotic coverage against a wider range of bacteria. However, Neomycin has a higher rate of causing allergic contact reactions, so it's not the best choice for everyone.

• Best for: Cases where broader antibiotic coverage is desired
• Key difference: Two antibiotics instead of one; higher risk of allergic reaction to Neomycin

3. Pred-G (Prednisolone/Gentamicin)

Pred-G combines a different steroid (Prednisolone) with a different aminoglycoside antibiotic (Gentamicin). Both ingredients have a long track record in treating eye infections and inflammation. Prednisolone is slightly less potent than Dexamethasone but is still very effective for most conditions.

• Best for: Patients who may be sensitive to Tobramycin or need an alternative aminoglycoside
• Key difference: Different steroid and antibiotic combination entirely

4. Separate Eye Drops (Tobramycin + Dexamethasone Individually)

If the combination product is unavailable, your doctor can prescribe Tobramycin eye drops and Dexamethasone eye drops as two separate medications. You'll use them both, just at different times (typically spaced 5-10 minutes apart). This approach uses the exact same active ingredients — you just apply them separately. Both individual medications are widely available and often less expensive than the combination.

• Best for: When the combination product is unavailable; identical ingredients
• Key difference: Two bottles instead of one; slightly less convenient but same active ingredients

How to Compare These Options

When talking to your doctor about switching, here are some important questions to ask:

1. Is the alternative equally effective for my specific eye condition?
2. Will the alternative have a different side effect profile I should know about?
3. Am I at risk for elevated eye pressure, and does that change which option is best?
4. Is the alternative covered by my insurance, and what will it cost?
5. Do I have any allergies (especially to Neomycin) that would rule out certain options?

What About the Generic Version?

Before switching to a completely different medication, make sure you've explored the generic option. Generic Tobramycin/Dexamethasone ophthalmic suspension contains the same active ingredients as brand-name TobraDex and typically costs $28 to $55 with a discount card — compared to $200 to $350 for the brand. Your pharmacy may not have the brand in stock but could have or easily order the generic. Use Medfinder to check which pharmacies near you have the generic in stock.

Final Thoughts

If you can't fill your Dexamethasone/Tobramycin prescription, you have options. Start by asking your pharmacy about the generic version. If it's truly unavailable, your doctor can evaluate alternatives like Zylet, Maxitrol, Pred-G, or separate drops — each with its own strengths depending on your situation. The most important thing is not to go without treatment. Eye infections and inflammation can get worse quickly, so work with your doctor to find a solution that works. For more tips on locating your medication, read our guide on how to find Dexamethasone/Tobramycin in stock near you.