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chloramphenicol (Rx)Brand and Other Names:Chloramphenicol IV, Chloromycetin

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 1000mg/vial
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Serious Infections Caused by Susceptible Strains

50 mg/kg/day IV divided q6hr; in exceptional cases, patients with moderately resistant organisms or severe infections may require increased dosage up to 100 mg/kg/day; decrease these high doses as soon as possible 

Other Indications & Uses

Use only as alternative for treatment of meningitis, typhoid, or rickettsial infection

Dosage Forms & Strengths

injectable solution

  • 1000mg/vial
more...

Systemic Infections

Infants and children: As in adults; when adequate cerebrospinal fluid concentrations desired, may require up to 100 mg/kg/day; however, should reduce dose to 50 mg/kg/day as soon as possible  

Infants and children with suspected immature metabolic functions: 25 mg/kg/day divided q6hr will usually produce therapeutic concentrations of the drug in the blood

Neonates (<28 Days Old)

Loading dose (LdD): 20 mg/kg IV once; give maintenance dose 12 hours after loading dose 

Maintenance Dose

  • <7 days old: 25 mg/kg/day IV q24hr
  • >7 days old, <2000 g: 25 mg/kg/day IV q24hr
  • >7 days old, >2000 g: 50 mg/kg/day IV divided q12hr

Other Information

Peaks 10-20 mg/L, troughs 5-10 mg/L

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Interactions

Interaction Checker

chloramphenicol and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            <1%

            Nightmares

            Headache

            Rash

            Diarrhea

            Stomatitis

            Enterocolitis

            Nausea

            Vomiting

            Bone marrow suppression

            Aplastic anemia

            Peripheral neuropathy

            Optic neuritis

            Gray syndrome

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            Warnings

            Black Box Warnings

            Serious and fatal blood dyscrasias, including aplastic anemia, hypoplastic anemia, thrombocytopenia, and granulocytopenia, have occurred after short-term and prolonged therapy

            Monitor CBC frequently in all patients. Use only in serious infections

            Contraindications

            Hypersensitivity

            Do not use oral or topical; not for use in trivial infections or for prophylaxis

            Avoid during breastfeeding

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: enters breast milk; discontinue drug or do not nurse

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Distribution: to most tissues & body fluids; readily crosses placenta; enters breast milk CSF: blood level ratio: normal meninges: 66%; inflamed meninges: >66%

            Protein Bound: 60%

            Half-life Elimination

            Normal renal function: 1.6-3.3 hr

            End-stage renal disease: 3-7 hr

            Cirrhosis: 10-12 hr

            Excretion

            Urine: 5-15%

            Feces: 4%

            Other Information

            Metabolism: extensively hepatic (90%) to inactive metabolites, principally by glucuronidation; chloramphenicol palmitate is hydrolyzed by lipases in GI tract to the active base; chloramphenicol sodium succinate is hydrolyzed by esterases to active base

            Mechanism of Action

            Inhibits bacterial protein synthesis by binding to 50S ribosomal subunit; mainly bacteriostatic

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            Administration

            IV Incompatibilities

            Additive: chlorpromazine, hydroxyzine, phenytion, polymyxin B sulfate, prochlorperazine, promethazine, vancomycin

            Syringe: glycopyrrolate, metoclopramide

            Y-site: fluconazole

            IV Compatibilities

            Solution: compatible with most common solvents

            Additive (partial list): amikacin, aminophylline, ascorbic acid, CaCl2, Ca-gluconate, dimenhydrinate, dopamine, heparin, KCl, MgSO4, metronidazole, NaHCO3

            Syringe: ampicillin, heparin, penicillin G sodium

            Y-site: acyclovir, cyclophosphamide, enalaprilat, esmolol, foscarnet, hydromorphone, labetalol, MgSO4, meperidine, morphine, nicardipine, perphenazine, tacrolimus

            IV Preparation

            pH: 6.4-7.0

            IV Administration:

            Infuse via direct IV over 3-5 min; intermittent infusion over 30-60 min

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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