Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 1000mg/vial
Serious Infections Caused by Susceptible Strains
Dosing considerations
- 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
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (18)
- alfuzosin
chloramphenicol will increase the level or effect of alfuzosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- aprepitant
chloramphenicol will increase the level or effect of aprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- avanafil
chloramphenicol will increase the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- bromocriptine
chloramphenicol will increase the level or effect of bromocriptine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- conivaptan
chloramphenicol will increase the level or effect of conivaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- eletriptan
chloramphenicol will increase the level or effect of eletriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- eplerenone
chloramphenicol will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- finerenone
chloramphenicol will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- fosaprepitant
chloramphenicol will increase the level or effect of fosaprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- isavuconazonium sulfate
chloramphenicol will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- lonafarnib
chloramphenicol will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lonafarnib is a sensitive CYP3A4 substrate. Coadministration with strong or moderate CYP3A4 inhibitors is contraindicated.
- lurasidone
chloramphenicol increases levels of lurasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of lurasidone and strong CYP3A4 inhibitors is contraindicated.
- mavacamten
chloramphenicol will increase the level or effect of mavacamten by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Strong CYP3A4 inhibitors may increase mavacamten systemic exposure, resulting in heart failure due to systolic dysfunction.
chloramphenicol will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Contraindicated. Strong or moderate CYP2C19 inhibitors may increase mavacamten systemic exposure, resulting in heart failure due to systolic dysfunction. - naloxegol
chloramphenicol will increase the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- pacritinib
chloramphenicol will increase the level or effect of pacritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- triazolam
chloramphenicol will increase the level or effect of triazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- ubrogepant
chloramphenicol will increase the level or effect of ubrogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- voclosporin
chloramphenicol will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
Serious - Use Alternative (130)
- abemaciclib
chloramphenicol will increase the level or effect of abemaciclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with chloramphenicol necessary, reduce dose of abemaciclib to 100 mg PO BID in patients on either of recommended starting doses whether 200 mg or 150 mg BID; In patients who have had already had a dose reduction to 100 mg BID due to adverse reactions, further reduce dose of abemaciclib to 50 mg PO BID; discontinue abemaciclib if patient unable to tolerate 50 mg BID; if chloramphenicol discontinued, increase dose of abemaciclib to original dose after 3-5 half-lives of chloramphenicol
- acalabrutinib
chloramphenicol will increase the level or effect of acalabrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- adagrasib
chloramphenicol will increase the level or effect of adagrasib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a CYP3A4 substrate, with strong CYP3A4 inhibitors until adagrasib concentrations have reached steady-state (after ~8 days). If steady state is not reached, concomitant use of strong CYP3A4 inhibitors will increase adagrasib concentrations and risk of its toxicities
- ado-trastuzumab emtansine
chloramphenicol will increase the level or effect of ado-trastuzumab emtansine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- alprazolam
chloramphenicol will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- amlodipine
chloramphenicol will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- aripiprazole
chloramphenicol will increase the level or effect of aripiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- atazanavir
chloramphenicol will increase the level or effect of atazanavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- avapritinib
chloramphenicol will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of avapritinib with strong CYP3A4 inhibitors.
- BCG vaccine live
chloramphenicol decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- bedaquiline
chloramphenicol will increase the level or effect of bedaquiline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- benzhydrocodone/acetaminophen
chloramphenicol will increase the level or effect of benzhydrocodone/acetaminophen by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration with strong CYP3A4 inhibitors may increase hydrocodone (benzhydrocodone is prodrug of hydrocodone) plasma concentrations and can result in potentially fatal respiratory depression.
- brexpiprazole
chloramphenicol will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- brigatinib
chloramphenicol will increase the level or effect of brigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- buprenorphine
chloramphenicol will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- buprenorphine transdermal
chloramphenicol will increase the level or effect of buprenorphine transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- cabozantinib
chloramphenicol will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- cariprazine
chloramphenicol will increase the level or effect of cariprazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- cefoxitin
chloramphenicol decreases effects of cefoxitin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. bacteriostatic agents may inhibit the effects of bactericidal agents.
- ceritinib
chloramphenicol, ceritinib. Either increases toxicity of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration necessary, reduce dose of crizotinib to 250 mg once daily; resume original crizotinib dose after discontinuing .
- cholera vaccine
chloramphenicol, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
- cobicistat
chloramphenicol will increase the level or effect of cobicistat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- cobimetinib
chloramphenicol will increase the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- colchicine
chloramphenicol will increase the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- copanlisib
chloramphenicol will increase the level or effect of copanlisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- crizotinib
chloramphenicol will increase the level or effect of crizotinib by aldehyde dehydrogenase inhibition. Avoid or Use Alternate Drug.
- cyclosporine
chloramphenicol will increase the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- daclatasvir
chloramphenicol will increase the level or effect of daclatasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- daridorexant
chloramphenicol will increase the level or effect of daridorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- darifenacin
chloramphenicol will increase the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- darunavir
chloramphenicol will increase the level or effect of darunavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- dasatinib
chloramphenicol will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- deferiprone
deferiprone, chloramphenicol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- deflazacort
chloramphenicol will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Decrease dose by one third if combination cannot be avoided
- docetaxel
chloramphenicol will increase the level or effect of docetaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- doxorubicin
chloramphenicol will increase the level or effect of doxorubicin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- dronedarone
chloramphenicol will increase the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- elacestrant
chloramphenicol will increase the level or effect of elacestrant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- elbasvir/grazoprevir
chloramphenicol will increase the level or effect of elbasvir/grazoprevir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- eliglustat
chloramphenicol will increase the level or effect of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- encorafenib
chloramphenicol will increase the level or effect of encorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concomitant use of a strong CYP3A4 inhibitor is unavoidable, reduce encorafenib dose to one-third of the dose (eg, reduce from 450 mg/day to 150 mg/day). After discontinuing the inhibitor for 3-5 elimination half-lives, resume previous encorafenib dose.
- entrectinib
chloramphenicol will increase the level or effect of entrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of strong CYP3A4 inhibitors with entrectinib, a CYP3A4 substrate. If coadministration unavoidable, reduce entrectinib dose to 100 mg/day for patients aged 12 y or older with BSA >1.50m2. Resume previous entrectinib dose after discontinuing strong CYP3A inhibitor for 3-5 elimination half-lives.
- erdafitinib
chloramphenicol will increase the level or effect of erdafitinib by affecting hepatic enzyme CYP2E1 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with strong CYP3A4 inhibitors, monitor closely for adverse reactions and consider decreasing dose accordingly. If strong CYP3A4 inhibitor is discontinued, consider increasing erdafitinib dose in the absence of any drug-related toxicities.
- erlotinib
chloramphenicol will increase the level or effect of erlotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- eszopiclone
chloramphenicol will increase the level or effect of eszopiclone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- everolimus
chloramphenicol will increase the level or effect of everolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- fedratinib
chloramphenicol will increase the level or effect of fedratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid fedratinib coadministration with strong CYP3A4 inhibitors, decrease fedratinib dose to 200 mg/day. If CYP3A4 inhibitor discontinued, increase fedratinib dose to 300 mg/day for 2 weeks, and then 400 mg/day thereafter as tolerated.
chloramphenicol will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied. - fexinidazole
chloramphenicol will decrease the level or effect of fexinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration, monitor fexinidazole for decreased efficacy owing to decreased plasma concentrations of active M1 and M2 metabolites.
- fluticasone inhaled
chloramphenicol will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- gilteritinib
chloramphenicol will increase the level or effect of gilteritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Consider alternatives to any strong CYP3A4 inhibitor when coadministered with gilteritinib. If such a combination cannot be avoided, closely monitor for gilteritinib-related adverse effects. Interrupt and reduce gilteritinib dosage in patients with serious or life-threatening toxicity.
- glasdegib
chloramphenicol will increase the level or effect of glasdegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Consider alternate therapies that are not strong CYP3A inhibitors or monitor for increased risk of adverse effects, including QTc interval prolongation.
- guanfacine
chloramphenicol will increase the level or effect of guanfacine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- haloperidol
chloramphenicol will increase the level or effect of haloperidol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ibrutinib
chloramphenicol will increase the level or effect of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- infigratinib
chloramphenicol will increase the level or effect of infigratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- irinotecan
chloramphenicol will increase the level or effect of irinotecan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- irinotecan liposomal
chloramphenicol will increase the level or effect of irinotecan liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. UGT1A1 inhibitors decrease irinotecan metabolism
- ivosidenib
chloramphenicol will increase the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- ixabepilone
chloramphenicol will increase the level or effect of ixabepilone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- lapatinib
chloramphenicol will increase the level or effect of lapatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- larotrectinib
chloramphenicol will increase the level or effect of larotrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of larotrectinib with strong CYP3A4 inhibitors is unavoidable, reduce larotrectinib dose by 50%. Resume prior larotrectinib dose once CYP3A4 inhibitor discontinued for 3-5 half-lives.
- lefamulin
chloramphenicol will increase the level or effect of lefamulin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of lefamulin with strong CYP3A inhibitors.
- lemborexant
chloramphenicol will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of lemborexant with moderate or strong CYP3A inhibitors.
- leniolisib
chloramphenicol will increase the level or effect of leniolisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- levomilnacipran
chloramphenicol will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- lorlatinib
chloramphenicol will increase the level or effect of lorlatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministering lorlatinib with strong CYP3A inhibitors. If unavoidable, reduce lorlatinib dose by 25 mg/day. If strong CYP3A inhibitor discontinued, increase to previous lorlatinib (dose after 3 plasma half-lives of strong CYP3A inhibitor). See monograph for further details.
- lumacaftor/ivacaftor
chloramphenicol will increase the level or effect of lumacaftor/ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- lurbinectedin
chloramphenicol will increase the level or effect of lurbinectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce lurbinectedin dose by 50%. After strong CYP3A inhibitor discontinued for 5 half-lives, increase lurbinectedin to dose used before coadministration.
- mefloquine
chloramphenicol will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration during and for 15 weeks after discontinuing mefloquine.
- microbiota oral
chloramphenicol decreases effects of microbiota oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Microbiota oral contains bacterial spores. Antibacterial agents may decrease efficacy if coadministered. Complete antibiotic regimens 2-4 days before initiating microbiota oral. .
- midostaurin
chloramphenicol will increase the level or effect of midostaurin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- mifepristone
chloramphenicol will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- mobocertinib
chloramphenicol will increase the level or effect of mobocertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- nilotinib
chloramphenicol will increase the level or effect of nilotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- nisoldipine
chloramphenicol will increase the level or effect of nisoldipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- olaparib
chloramphenicol will increase the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- omaveloxolone
chloramphenicol will increase the level or effect of omaveloxolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unavoidable, reduce omaveloxolone dose to 50 mg/day. Closely monitor and discontinue if adverse effects emerge.
- ombitasvir/paritaprevir/ritonavir
chloramphenicol will increase the level or effect of ombitasvir/paritaprevir/ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)
chloramphenicol will increase the level or effect of ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- palbociclib
chloramphenicol will increase the level or effect of palbociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- palovarotene
chloramphenicol will increase the level or effect of palovarotene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- pazopanib
chloramphenicol will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- pemigatinib
chloramphenicol will increase the level or effect of pemigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pemigatinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pemigatinib dose.
- pexidartinib
chloramphenicol will increase the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pexidartinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pexidartinib dose.
- pimavanserin
chloramphenicol will increase the level or effect of pimavanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- pimozide
chloramphenicol will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- pirtobrutinib
chloramphenicol will increase the level or effect of pirtobrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration is unavoidable, reduce pirtobrutinib by 50 mg. If current pirtobrutinib dose is 50 mg qDay, discontinue pirtobrutinib for duration of strong CYP3A inhibitor use. Once strong CYP3A inhibitor discontinued for 5 half-lives, resume pirtobrutinib at the dose taken before initiating the strong CYP3A inhibitor.
- ponatinib
chloramphenicol will increase the level or effect of ponatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concurrent use cannot be avoided, reduce ponatinib dose to next lower dose level (45 mg to 30 mg; 30 mg to 15 mg; 15 mg to 10 mg); if patient is taking ponatinib 10 mg once daily prior to concurrent use, avoid use of chloramphenicol and consider alternative therapy; after chloramphenicol discontinued for 3 to 5 half-lives, resume dose of ponatinib tolerated prior to starting chloramphenicol
- pralsetinib
chloramphenicol will increase the level or effect of pralsetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- quetiapine
chloramphenicol will increase the level or effect of quetiapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ranolazine
chloramphenicol will increase the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- red yeast rice
chloramphenicol will increase the level or effect of red yeast rice by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. May increase creatine kinase levels and increase risk of myopathy or rhabdomyolysis; red yeast rice contains monocolin K (reportedly identical to lovastatin)
- regorafenib
chloramphenicol will increase the level or effect of regorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- ribociclib
chloramphenicol will increase the level or effect of ribociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If a strong CYP3A inhibitor must be coadministered with ribociclib, reduce the ribociclib starting dose to 400 mg/day.
- rimegepant
chloramphenicol will increase the level or effect of rimegepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ritonavir
chloramphenicol will increase the level or effect of ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ropeginterferon alfa 2b
ropeginterferon alfa 2b, chloramphenicol. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.
- ruxolitinib
chloramphenicol will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Reduce ruxolitinib dosage during coadministration with chloramphenicol in patients with myelofibrosis (MF) or polycythemia vera (PV); no dose adjustments necessary for patients with graft-versus-host disease
- ruxolitinib topical
chloramphenicol will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Reduce ruxolitinib dosage during coadministration with chloramphenicol in patients with myelofibrosis (MF) or polycythemia vera (PV); no dose adjustments necessary for patients with graft-versus-host disease
- saxagliptin
chloramphenicol will increase the level or effect of saxagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- selumetinib
chloramphenicol will increase the level or effect of selumetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors cannot be avoided, reduce selumetinib dosage (refer to selumetinib monograph for further information). After discontinuation of the strong or moderate CYP3A4 inhibitor for 3 elimination half-lives, resume selumetinib dose that was taken before initiating the inhibitor.
- sildenafil
chloramphenicol will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- siponimod
chloramphenicol will increase the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with a moderate or strong CYP3A4 inhibitor PLUS a moderate or strong CYP2C9 inhibitor is not recommended.
- sirolimus
chloramphenicol will increase the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- sonidegib
chloramphenicol will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- sparsentan
chloramphenicol will increase the level or effect of sparsentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unavoidable, interrupt treatment with sparsentan. When resuming sparsentan, consider dose titration.
- sufentanil
chloramphenicol will increase the level or effect of sufentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- sunitinib
chloramphenicol will increase the level or effect of sunitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- suvorexant
chloramphenicol will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- tacrolimus
chloramphenicol will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tamsulosin
chloramphenicol will increase the level or effect of tamsulosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- tazemetostat
chloramphenicol will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of tazemetostat with strong CYP3A4 inhibitors.
- temsirolimus
chloramphenicol will increase the level or effect of temsirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tezacaftor
chloramphenicol will increase the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tofacitinib
chloramphenicol will increase the level or effect of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tolterodine
chloramphenicol will increase the level or effect of tolterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tolvaptan
chloramphenicol will increase the level or effect of tolvaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- toremifene
chloramphenicol will increase the level or effect of toremifene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- trabectedin
chloramphenicol will increase the level or effect of trabectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- trazodone
chloramphenicol will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- typhoid vaccine live
chloramphenicol decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- umeclidinium bromide/vilanterol inhaled
chloramphenicol will increase the level or effect of umeclidinium bromide/vilanterol inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- vemurafenib
chloramphenicol will increase the level or effect of vemurafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- venetoclax
chloramphenicol will increase the level or effect of venetoclax by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration with a strong CYP3A inhibitor at initiation and during the ramp-up phase in patients with CLL/SLL is contraindicated. In CLL/SLL patients taking a steady daily dosage (after ramp-up phase), consider an alternant or adjust venetoclax dosage and closely monitor for adverse reactions. In AML patients, adjust venetoclax dosage and closely monitor for adverse reactions. Resume venetoclax dosage that was used before initiating the strong CYP3A inhibitor 2-3 days after discontinuing of the inhibitor.
- vilanterol/fluticasone furoate inhaled
chloramphenicol will increase the level or effect of vilanterol/fluticasone furoate inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- vilazodone
chloramphenicol increases levels of vilazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Strong CYP3A4 inhibitors may increase vilazodone plasma levels by 50% - Reduce daily dose to 20 mg.
- vinblastine
chloramphenicol will increase the level or effect of vinblastine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- vincristine
chloramphenicol will increase the level or effect of vincristine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- vincristine liposomal
chloramphenicol will increase the level or effect of vincristine liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- vorapaxar
chloramphenicol will increase the level or effect of vorapaxar by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
Monitor Closely (94)
- abrocitinib
chloramphenicol will increase the level or effect of abrocitinib by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Start abrocitinib 50 mg qDay when coadministered with CYP2C19 inhibitors. If adequate response not achieved after 12 weeks, may increase to 100 mg qDay. Discontinue if inadequate response after dosage increase.
- apalutamide
chloramphenicol will increase the level or effect of apalutamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No initial dose adjustment
- artemether/lumefantrine
chloramphenicol will decrease the level or effect of artemether/lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- atogepant
chloramphenicol will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Recommended atogepant dosage is 10 mg PO qDay when coadministered with strong CYP3A4 inhibitors.
- axitinib
chloramphenicol increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- bazedoxifene/conjugated estrogens
chloramphenicol will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- belzutifan
chloramphenicol will increase the level or effect of belzutifan by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Belzutifan is a CYP2C19 substrate. Coadministration with CYP2C19 inhibitors may increase incidence or severity of adverse effects. Monitor for anemia and hypoxia and reduce belzutifan dose as recommended.
- bortezomib
chloramphenicol will increase the level or effect of bortezomib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- bosentan
chloramphenicol will increase the level or effect of bosentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- cannabidiol
chloramphenicol will increase the level or effect of cannabidiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a strong CYP3A4 inhibitor.
chloramphenicol will increase the level or effect of cannabidiol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a strong CYP2C19 inhibitor. - capmatinib
chloramphenicol will increase the level or effect of capmatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- ceftriaxone
chloramphenicol decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- citalopram
chloramphenicol will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- cocaine topical
chloramphenicol will increase the level or effect of cocaine topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- conjugated estrogens, vaginal
chloramphenicol increases levels of conjugated estrogens, vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May increase side effects.
- diazepam intranasal
chloramphenicol will increase the level or effect of diazepam intranasal by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Strong or moderate CYP2C19 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.
chloramphenicol will increase the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong or moderate CYP3A4 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam. - doravirine
chloramphenicol will increase the level or effect of doravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of doravirine and CYP3A4 inhibitors may increase plasma concentrations and toxicities of doravirine.
- dronabinol
chloramphenicol will increase the level or effect of dronabinol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- duvelisib
chloramphenicol will increase the level or effect of duvelisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with a strong CYP3A4 inhibitor increases duvelisib AUC, which may increase the risk of duvelisib toxicities. Reduce duvelisib dose to 15 mg BID when coadministered with a strong CYP3A4 inhibitor.
- elagolix
chloramphenicol will increase the level or effect of elagolix by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration of elagolix 200 mg BID with strong CYP3A inhibitors for >1 month is not recommended. Limit elagolix dose to 150 mg qDay and CYP3A inhibitor duration of use to 6 months if coadministered.
- eluxadoline
chloramphenicol increases levels of eluxadoline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. As a precautionary measure due to incomplete information on the metabolism of eluxadoline, use caution when coadministered with strong CYP2C19 inhibitors.
- enfortumab vedotin
chloramphenicol increases toxicity of enfortumab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Enfortumab vedotin is an antibody-drug conjugate that releases monomethylauristatin E (MMAE) via proteolytic cleavage. MMAE is primarily metabolized by CYP3A4 in vitro. Coadministration with strong CYP3A4 inhibitors may increase free MMAE exposure, which may increase the incidence or severity of toxicities.
- escitalopram
chloramphenicol will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- estradiol
chloramphenicol increases levels of estradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May increase side effects.
- estrogens conjugated synthetic
chloramphenicol increases levels of estrogens conjugated synthetic by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May increase side effects.
- estrogens esterified
chloramphenicol increases levels of estrogens esterified by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May increase side effects.
- estropipate
chloramphenicol increases levels of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May increase side effects.
- ethinylestradiol
chloramphenicol will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- fentanyl intranasal
chloramphenicol will increase the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved
- fentanyl transdermal
chloramphenicol will increase the level or effect of fentanyl transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved
- fentanyl transmucosal
chloramphenicol will increase the level or effect of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved
- flibanserin
chloramphenicol will increase the level or effect of flibanserin by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Coadministration of flibanserin with strong CYP2C19 inhibitors may increase flibanserin exposure and increase the risk of hypotension, syncope, and CNS depression.
chloramphenicol will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors. - fluticasone furoate
chloramphenicol will increase the level or effect of fluticasone furoate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong CYP3A4 inhibitors may increase fluticasone systemic exposure
- fosphenytoin
chloramphenicol increases levels of fosphenytoin by decreasing metabolism. Use Caution/Monitor.
- fostamatinib
chloramphenicol will increase the level or effect of fostamatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- gefitinib
chloramphenicol will increase the level or effect of gefitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- hydrocodone
chloramphenicol will increase the level or effect of hydrocodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- idelalisib
chloramphenicol will increase the level or effect of idelalisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ifosfamide
ifosfamide, chloramphenicol. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Ifosfamide may enhance the toxicities of myelosuppressive agents. Monitor for increased risk of myelosuppression.
chloramphenicol will increase the level or effect of ifosfamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. - istradefylline
chloramphenicol will increase the level or effect of istradefylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Do not exceed istradefylline 20 mg/day if coadministered with strong CYP3A4 inhibitors.
- ivacaftor
chloramphenicol will increase the level or effect of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce ivacaftor dose if coadministered with strong CYP3A4 inhibitors. See specific ivacaftor-containing product for precise dosage modification.
- levamlodipine
chloramphenicol will increase the level or effect of levamlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate and strong CYP3A inhibitors results in increased systemic exposure to amlodipine and may require dose reduction. Monitor for symptoms of hypotension and edema when amlodipine is coadministered with CYP3A inhibitors to determine the need for dose adjustment.
- levonorgestrel oral/ethinylestradiol/ferrous bisglycinate
chloramphenicol will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.
- lomitapide
chloramphenicol increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.
- lumateperone
chloramphenicol will increase the level or effect of lumateperone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce lumateperone dose to 10.5 mg/day if coadministered with strong CYP3A4 inhibitors.
- lumefantrine
chloramphenicol will increase the level or effect of lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- maraviroc
chloramphenicol increases levels of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Adjust maraviroc dose to 150mg BID.
- midazolam
chloramphenicol will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of strong CYP3A4 inhibitors with midazolam intranasal causes higher midazolam systemic exposure, which may prolong sedation.
- midazolam intranasal
chloramphenicol will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of strong CYP3A4 inhibitors with midazolam intranasal causes higher midazolam systemic exposure, which may prolong sedation.
- mirvetuximab soravtansine
chloramphenicol will increase the level or effect of mirvetuximab soravtansine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with strong CYP3A4 inhibitors may increase unconjugated DM4 (a CYP3A4 substrate and the cytotoxic component of the antibody drug conjugate for mirvetuximab soravtansine) exposure, which may increase the risk of adverse reactions.
- montelukast
chloramphenicol will increase the level or effect of montelukast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nafcillin
chloramphenicol decreases effects of nafcillin by pharmacodynamic antagonism. Use Caution/Monitor. Bacteriostatic antibiotics may interfere with the bactericidal actions of penicillins.
- naldemedine
chloramphenicol will increase the level or effect of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- norgestrel
chloramphenicol will increase the level or effect of norgestrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong or moderate CYP3A4 inhibitors may increase systemic concentration of norgestrel, which may increase risk for adverse effects
- oliceridine
chloramphenicol will increase the level or effect of oliceridine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.
- osilodrostat
chloramphenicol will increase the level or effect of osilodrostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce dose of osilodrostat, a CYP3A4 substrate, by half when coadministered with a strong CYP3A4 inhibitor.
- oxacillin
chloramphenicol decreases effects of oxacillin by pharmacodynamic antagonism. Use Caution/Monitor. Bacteriostatic agents may inhibit the effects of bactericidal agents.
- oxycodone
chloramphenicol will increase the level or effect of oxycodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- paclitaxel protein bound
chloramphenicol will increase the level or effect of paclitaxel protein bound by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- paricalcitol
chloramphenicol will increase the level or effect of paricalcitol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- pentobarbital
chloramphenicol increases levels of pentobarbital by decreasing metabolism. Use Caution/Monitor.
- phenobarbital
chloramphenicol increases levels of phenobarbital by decreasing metabolism. Use Caution/Monitor.
- phenytoin
chloramphenicol increases levels of phenytoin by decreasing metabolism. Use Caution/Monitor.
- piperacillin
chloramphenicol decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- polatuzumab vedotin
chloramphenicol will increase the level or effect of polatuzumab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Polatuzumab undergoes catabolism to small peptides, amino acids, monomethyl auristatin E (MMAE), and unconjugated MMAE-related catabolites. MMAE is a CYP3A4 substrate. Coadministration of polatuzumab vedotin with a strong CYP3A4 inhibitor may increase unconjugated MMAE AUC, which may increase polatuzumab vedotin toxicities.
- primidone
chloramphenicol increases levels of primidone by decreasing metabolism. Use Caution/Monitor.
- progesterone, natural
chloramphenicol will increase the level or effect of progesterone, natural by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- quizartinib
chloramphenicol will increase the level or effect of quizartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce quizartinib dosage to 26.5 mg qDay (if current dosage is 53 mg/day) or 17.7 mg qDay (if current dosage is 26.5 mg/day or 35.4 mg/day) when coadministered with strong CYP3A inhibitors. If current dosage is 17.7 mg qDay, interrupt quizartinib for the duration of strong CYP3A inhibitor use. After discontinuation of a strong CYP3A inhibitor for 5 half-lives, resume quizartinib dose that was taken before initiating the strong inhibitor.
- repaglinide
chloramphenicol will increase the level or effect of repaglinide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ripretinib
chloramphenicol will increase the level or effect of ripretinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with a strong CYP3A inhibitor will increase systemic exposure to ripretinib and its active metabolite (DP-5439), which may increase risk of adverse reactions.
- rivaroxaban
chloramphenicol will increase the level or effect of rivaroxaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- romidepsin
chloramphenicol will increase the level or effect of romidepsin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- saquinavir
chloramphenicol will increase the level or effect of saquinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- selpercatinib
chloramphenicol will increase the level or effect of selpercatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
chloramphenicol decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- sofosbuvir/velpatasvir
chloramphenicol will increase the level or effect of sofosbuvir/velpatasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- sufentanil SL
chloramphenicol will increase the level or effect of sufentanil SL by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of sufentanil SL with any CYP3A4 inhibitor may increase sufentanil plasma concentration, and, thereby increase or prolonged adverse effects, including potentially fatal respiratory depression.
- tacrolimus ointment
chloramphenicol will increase the level or effect of tacrolimus ointment by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tasimelteon
chloramphenicol will increase the level or effect of tasimelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- terbinafine
chloramphenicol will increase the level or effect of terbinafine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tinidazole
chloramphenicol will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tisotumab vedotin
chloramphenicol increases levels of tisotumab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tisotumab vedotin?s active metabolite (MMAE) is a CYP3A4 substrate. Coadministration with strong CYP3A4 inhibitors may increase unconjugated MMAE systemic exposure and increase risk of adverse effects.
- ulipristal
chloramphenicol will increase the level or effect of ulipristal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- upadacitinib
chloramphenicol will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution if upadacitinib is coadministered with strong CYP3A4 inhibitors.
- valbenazine
chloramphenicol will increase the level or effect of valbenazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce valbenazine dose when coadministered with a strong CYP3A4 inhibitor.
- vardenafil
chloramphenicol will increase the level or effect of vardenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Vardenafil dose may need to be reduced if coadministered with moderate or strong CYP3A4 inhibitors
- velpatasvir
chloramphenicol will increase the level or effect of velpatasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- venlafaxine
chloramphenicol will increase the level or effect of venlafaxine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- verapamil
chloramphenicol will increase the level or effect of verapamil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- vinorelbine
chloramphenicol will increase the level or effect of vinorelbine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- warfarin
chloramphenicol will increase the level or effect of warfarin by Other (see comment). Use Caution/Monitor. Warfarin's less potent R-enantiomer is metabolized in part by CYP3A4 (and also CYP1A2 and CYP2C19). Monitor INR more frequently if coadministered with inhibitors of these isoenzymes and adjust warfarin dose if needed.
- zanubrutinib
chloramphenicol will increase the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce zanubrutinib (a CYP3A4 substrate) to 80 mg PO BID when coadministered with a moderate CYP3A4 inhibitor. Interrupt dose as recommended for adverse reactions. After discontinuing the CYP3A4 inhibitor, resume previous zanubrutinib dose.
- zolpidem
chloramphenicol will increase the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider reducing the zolpidem dose when zolpidem is given with a CYP3A4 inhibitor.
- zonisamide
chloramphenicol will increase the level or effect of zonisamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
Minor (42)
- amobarbital
chloramphenicol increases levels of amobarbital by decreasing metabolism. Minor/Significance Unknown.
amobarbital decreases levels of chloramphenicol by increasing metabolism. Minor/Significance Unknown. - amoxicillin
chloramphenicol decreases effects of amoxicillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- ampicillin
chloramphenicol decreases effects of ampicillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- aztreonam
chloramphenicol decreases effects of aztreonam by pharmacodynamic antagonism. Minor/Significance Unknown.
- butabarbital
chloramphenicol increases levels of butabarbital by decreasing metabolism. Minor/Significance Unknown.
butabarbital decreases levels of chloramphenicol by increasing metabolism. Minor/Significance Unknown. - butalbital
chloramphenicol increases levels of butalbital by decreasing metabolism. Minor/Significance Unknown.
butalbital decreases levels of chloramphenicol by increasing metabolism. Minor/Significance Unknown. - cefaclor
chloramphenicol decreases effects of cefaclor by pharmacodynamic antagonism. Minor/Significance Unknown.
- cefadroxil
chloramphenicol decreases effects of cefadroxil by pharmacodynamic antagonism. Minor/Significance Unknown.
- cefamandole
chloramphenicol decreases effects of cefamandole by pharmacodynamic antagonism. Minor/Significance Unknown.
- cefazolin
chloramphenicol decreases effects of cefazolin by pharmacodynamic antagonism. Minor/Significance Unknown.
- cefdinir
chloramphenicol decreases effects of cefdinir by pharmacodynamic antagonism. Minor/Significance Unknown.
- cefditoren
chloramphenicol decreases effects of cefditoren by pharmacodynamic antagonism. Minor/Significance Unknown.
- cefixime
chloramphenicol decreases effects of cefixime by pharmacodynamic antagonism. Minor/Significance Unknown.
- cefotaxime
chloramphenicol decreases effects of cefotaxime by pharmacodynamic antagonism. Minor/Significance Unknown.
- cefotetan
chloramphenicol decreases effects of cefotetan by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic agents may inhibit the effects of bactericidal agents.
- cefpirome
chloramphenicol decreases effects of cefpirome by pharmacodynamic antagonism. Minor/Significance Unknown.
- cefprozil
chloramphenicol decreases effects of cefprozil by pharmacodynamic antagonism. Minor/Significance Unknown.
- ceftazidime
chloramphenicol decreases effects of ceftazidime by pharmacodynamic antagonism. Minor/Significance Unknown.
- ceftibuten
chloramphenicol decreases effects of ceftibuten by pharmacodynamic antagonism. Minor/Significance Unknown.
- cefuroxime
chloramphenicol decreases effects of cefuroxime by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic agents may inhibit the effects of bactericidal agents.
- cephalexin
chloramphenicol decreases effects of cephalexin by pharmacodynamic antagonism. Minor/Significance Unknown.
- chlorpropamide
chloramphenicol increases levels of chlorpropamide by decreasing metabolism. Minor/Significance Unknown.
- cocaine topical
chloramphenicol will increase the level or effect of cocaine topical by affecting hepatic enzyme CYP2B6 metabolism. Minor/Significance Unknown.
- cyanocobalamin
chloramphenicol decreases effects of cyanocobalamin by pharmacodynamic antagonism. Minor/Significance Unknown.
- dicloxacillin
chloramphenicol decreases effects of dicloxacillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- ethotoin
chloramphenicol increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.
- folic acid
chloramphenicol decreases effects of folic acid by pharmacodynamic antagonism. Minor/Significance Unknown.
- ganaxolone
chloramphenicol, ganaxolone. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Changes in ganaxolone exposures when coadministered with strong, moderate, or weak CYP3A4 inhibitors are not expected to be clinically significant.
- glimepiride
chloramphenicol increases levels of glimepiride by decreasing metabolism. Minor/Significance Unknown.
- glipizide
chloramphenicol increases levels of glipizide by decreasing metabolism. Minor/Significance Unknown.
- glyburide
chloramphenicol increases levels of glyburide by decreasing metabolism. Minor/Significance Unknown.
- ospemifene
chloramphenicol increases levels of ospemifene by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.
- penicillin G aqueous
chloramphenicol decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Minor/Significance Unknown.
- penicillin VK
chloramphenicol decreases effects of penicillin VK by pharmacodynamic antagonism. Minor/Significance Unknown.
- pentobarbital
pentobarbital decreases levels of chloramphenicol by increasing metabolism. Minor/Significance Unknown.
- phenobarbital
phenobarbital decreases levels of chloramphenicol by increasing metabolism. Minor/Significance Unknown.
- primidone
primidone decreases levels of chloramphenicol by increasing metabolism. Minor/Significance Unknown.
- rifampin
rifampin decreases levels of chloramphenicol by increasing metabolism. Minor/Significance Unknown.
- secobarbital
chloramphenicol increases levels of secobarbital by decreasing metabolism. Minor/Significance Unknown.
secobarbital decreases levels of chloramphenicol by increasing metabolism. Minor/Significance Unknown. - ticarcillin
chloramphenicol decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- tolazamide
chloramphenicol increases levels of tolazamide by decreasing metabolism. Minor/Significance Unknown.
- tolbutamide
chloramphenicol increases levels of tolbutamide by decreasing metabolism. Minor/Significance Unknown.
Adverse Effects
<1%
Nightmares
Headache
Rash
Diarrhea
Stomatitis
Enterocolitis
Nausea
Vomiting
Bone marrow suppression
Aplastic anemia
Peripheral neuropathy
Optic neuritis
Gray syndrome
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
Oral or topical use
Bacterial prophylaxis
Viral infections
Cautions
Avoid, if possible, repeated courses of chloramphenicol treatment
Do not continue treatment longer than required to cure the disease with little or no risk of relapse of the disease
Impaired liver or kidney function may cause excessive blood levels of the drug at recommended dose; adjust dosage accordingly; preferably determine blood concentration at appropriate intervals
The use of antibiotics may result in overgrowth of nonsusceptible organisms, including fungi; take appropriate measures if nonsusceptible organisms appear during therapy
Gray syndrome reported in premature and neonate; characterized by abdominal distension with or without emesis, progressive pallid cyanosis, vasomotor collapse that is frequently accompanied by irregular respiration, death within a few hours of onset of these symptoms; may be associated with serum levels >50 mcg/mL after repeated doses
Blood dyscrasias
- Serious and fatal blood dyscrasias (aplastic anemia, thrombocytopenia, and granulocytopenia known to occur after administration of chloramphenicol
- Irreversible type of marrow depression leading to aplastic anemia with a high rate of mortality is characterized by appearance weeks or months after therapy of bone marrow aplastic or hypoplasia
- Peripherally, pancytopenia is most often observed but in small number of cases only one or two of the three major cell types (erythrocytes, leukocytes, platelets) may be depressed
- A reversible type of bone marrow depression, which is dose-related, may occur; this type of marrow depression is characterized by vacuolization of erythroid cells, reduction of reticulocytes and leukopenia, and responds promptly to withdrawal of therapy
- Exact determination of risk of serious and fatal blood dyscrasias not possible because of lack of accurate information regarding size of population at risk, total number of drug-associated dyscrasias, and total number of non-drug associated dyscrasias
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.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
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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Formulary
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To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
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