ABBOTT HEALTHCARE PVT LTD 271 BUSINESS PARK 6TH FLOOR MODEL INDUSTRIAL COLONY GOREGAON EAST MUMBAI 400063
Chloramphenicol 250mg/500mg capsules, Chloramphenicol 250mg DRAGEES, Chloramphenicol 125mg per 5ml susp. PALMITATE SUSPENSION,
|125mg/5ml susp||105.60||60ml PALMITATE SUSP|
List of Related Indications:
List Of Drugs:
- Chloramphenicol (***) -@- (Antibiotic)
Indication Type Description:
Dosages/ Overdosage Etc
Interaction with Food
Pregnancy and lactation
Interacting drugs - summary
Barbiturate + Chloramphenicol
decreased chloramphenicol serum levels occur
Chloramphenicol + Barbiturate
resulting in clearance decreased, resulting in increased levels of toxicity
Rifampicin + Chloramphenicol
concomitant administration reduce serum chloramphenicol levels,
Chloramphenicol + anticoagulants
anticoagulant action enhanced
Chloramphenicol + cyclophosphamide
decreased or delayed activation of cyclophosphamide occur,
Hydantoin + Chloramphenicol
serum hydantoin levels increased , possibly resulting in toxicity.
In addition chloramphenicol levels increased or decreased
Chloramphenicol + Iron salts
serum iron levels increased
Chloramphenicol + Penicillins
synergistic efectsdevelop in the treatment of certain microorganisms,
but antagonism may also occur
Chloramphenicol + sulfonylureas
clinical manifestastions of hypoglycemia occur with concurrent use
hematologic effects of Vitamin B12 decreased in patients with
pernicious anemia by concurrent chloramphenicol
these drugs are associated with peripheral neuropathy
Avoid concomittant use when possible
systemic chloramphenicol impair amnestic response to tetanus
toxoid. Avoid concurrent use.
Serious infections for which less potentially dangerous drugs are ineffective.
Most serious adverse effect is bone marrow suppression and aplastic anaemia, irreversible in some cases. Neutropenia and Thrombocytopenia.
Paroxymal nocturnal hemoglobinuria has been reported
Nausea, vomting, glossitis, stomatitis, diarrhea, enterocolitis (low incidence)
Headache and mild depression, mental confusion, delirium. Optic and peripheral neurotis have been reported, usually following long-term therapy. If this occurs promptly withdraw the drug.
Hypersensitivity- Fever, macular and vesicular rashes, angioedema, urticaria, anaphylaxis. Herxheimer reactions have occured during therapy for typhoid fever. Grey baby syndrome Toxic reactions including fatalities (aapproximately (40%) have occurred in the premature infant and newborn.
The signs and symptoms associated with these reactions have been referred to as the -grey syndrome and these are- * In most cases therapy was insituted within the first 48 hours.
* Symptoms first appeared after 3 to 4 days of treatment with high doses.
* Symptoms appeared in the following order- abdominaldistentiuonwith or without emesis, progressive palid cyanosis, vasmotor collapse, frequently accompanied by irregular respiration, death within few hours of onset.
* Progress of symptoms was accelrated with higher doses.
* serum levels studies revealed unusually high drug concentrations.
* terminaton of theapy upon early evidence of associated symptoms frequently reversed the process with complete recovery.
* prexisting liver dysfunction may be significant risk factor. Interferes with determination of serum proteins.
BUN, urine, sugar.
Topical application to eye:
Hypersensitivity reaction including rashes, fever and angioedema. Very rarely aplastic anaemia.
Eye drops: Ototoxicity.
History of sensitivity & or toxic reaction. Lactation, pregnancy.
Evaluate baseline and periodic blood studies every 2 days during therapy.
Discontinue the drug upon appearanace of reticulocytopenia,leukopenia, thrombocytopenia, anemia or any other findings attributable to chloramphenicol. Such studies do not exclude the possible appearanace of the irrvesible chloramphenicol type bone marrow depression.
Avoid concurrent therapy with other drugs tht amay cause bone marrow depression. Avoid repeated course if at all possoble.
Do not continue treatment longer than required to produce a cure.
Acute intermittant porphria- or glucose phosphate dehydrodenase deficiency (G6PD - Use with caution in patients with these conditions.
Superinfection: Use of antibiotics especially over a prolonged or repeated therapy may result in bacterial or fungal overgrowth of susecptible organisms. such overgrowth may lead to secondary infection. Take appropiate measures if this occurs.
Blood dyscrasis- Serious and fatal blood dyscrasias (plastic anemia, hypoplastic anemia, thrombocytopenia and granulocytopenia) occur.
An irreversble type of bone marrow depression leading to aplastic anemia with a high rate of mortality is characterrized by appearance of bone marrow aplasia or hypoplasia weeks or months after therapy.
Peripherally pancytopenia is most often observed but only one or two of the three major cell types (erythrocytes, leukocytes and platelets ) may be depressed.
Several cases of aplastic anemia have been associated with chloramphenicol opthalmic ointment.
Renal/hepatic function impairment- excessive blood levels may result from use of the recommended dose in patients with impaired liver or kidney function including that due to immature metabolic processes in the infant,
Adjust the dosage accordingly or determine the blood concentration at appropiate intervals.
Pregnancy- Since it readily crosses the placental barrier, cautious use is particularly important during pregnancy at term or during labor because of potential toxic effects on the fetus.(gray syndrome)
Lactation- Use with caution, if at all during lactaion, because of the possbile toxic effect on the nursing infant.
Children- Use with caution with reduced dosage in premature and full term infants to avoid gray syndrome toxicity. Monitor drug serum levels carefullly during therapy of the new born.
Dosages/ Overdosage Etc:
Serious infections for which less potentially dangerous drugs are ineffective.
Acute infections caused by Stap Typhi- Chloramphenicol is the drug of choice. In treatment of typhoid fever, some authorities recommended that chloramphenicol be used at therapeutic levels for 8 to 10 day afer the patient becomes afebrile, to lessen the possibility of relapse
Adults- 50mg/kg/day in divided doses every 6 hours for typhoid fever and rickettisial infections. Exceptional infections due to moderately resistent organisms, may require dosage upto 100mg/kg/day.
Children- 50 to 75mg/kg/day in divided doses every 6 hours recommended for most infections.
For meningitis- 50 to 100mg/kg/day in divided doses every 6 hours,has been recommended. .
New borns- 25mg/kg/day in 4doses every 6 hours usually produces and maintains adequate concentration in blood and tissues after first 2 weeks of life.
Full term infants ordinarily may receive upto 50mg/kg/day in 4doses every 6 hours..
1. If you miss a dose of this medicine, take it as soon as possible.
2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.
3. Do not double doses.
Pancytopenia ( aplastic anemia )
Severe anemia accompanied by fever, neutropenia, and bleeding. Post mosterm examination revealed a yellow, hypocellular bone marrow. The term aplastic anemia was applied to all patients with refractory and progressive pancytopenia until the advent of bone marrow examination in diagnostic purposes.
Drugs causing adverse reactions-
7. Gold salts
10. Potassium perchlorate
Chloramphenicol binds 50S ribosomal subunits of bacteria and interferes with or inhibits protein synthesis. In vitro, chloramphenicol exerts mainly a bacteriostatic effect on a wide range of gram -ve and gram +ve bacteria
Chloramphenicol base is absorbed rapidly from the intestinal tract and is 75% to 90% bioavailable. Chloramphenicol diffuse rapidly and highest concentrations are found in liver and kidney, and lowest concentrations are found in brain and CNS fluid.
Interaction with Food:
Take on an empty stomach 1 hr before or 2 hr after meals
Pregnancy and lactation:
There are no studies to establish the safety of this drug in pregnancy. Since it readily crosses the placentel barrier, cautious use is particularly important during pregnancy.
Chloramphenicol appears in breast milk with a milk:plasna ratio of 0.5. Use with caution, if at all during lactation.
Use with caution and in reduced dosage forms in pre-mature and full term infants to avoid gray syndrome toxicity.