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Chloramphenicol / hydrocortisone / polymyxin b ophthalmic Disease Interactions

There are 3 disease interactions with chloramphenicol / hydrocortisone / polymyxin b ophthalmic:

Major

Chloramphenicol (Includes Chloramphenicol/hydrocortisone/polymyxin b ophthalmic) ↔ Bone Marrow Suppression

Severe Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

Chloramphenicol may cause bone marrow depression and other hematologic toxicities, which can be irreversible or reversible. The former type is independent of dose and results in aplastic anemia with a high rate of mortality, generally from hemorrhage or infection. It has been reported following both systemic and topical administration of chloramphenicol and has an estimated incidence of 1 in 25,000 to 1 in 40,000 courses of therapy. Bone marrow aplasia or hypoplasia may occur after a single dose but more often develops weeks or months after the drug has been discontinued. A reversible myelosuppression occurs much more frequently and is characterized by anemia, vacuolation of red blood cells, decreased reticulocyte count, leukopenia, thrombocytopenia, increased serum iron concentrations, and increased serum iron-binding capacity. It is dose-dependent, occurring regularly at chloramphenicol dosages exceeding 4 g/day (in adults) or at plasma drug concentrations >= 25 mcg/mL, and usually responds to withdrawal of the drug. Therapy with chloramphenicol should be administered cautiously, if at all, in patients with preexisting blood dyscrasias and/or bone marrow depression. Complete blood counts and differential reticulocyte counts should be performed in all patients prior to initiating therapy and approximately every 2 days during therapy. Marked depression of blood counts and/or development of other hematologic abnormalities may be indication for withdrawal of chloramphenicol therapy.

References

  1. Fraunfelder FT, Bagby GC, Kelly DJ "Fatal aplastic anemia following topical administration of ophthalmic chloramphenicol." Am J Ophthalmol 93 (1982): 356-60
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. Doona M, Walsh JB "Use of chloramphenicol as topical eye medication: time to cry halt? bone marrow aplasia also occurs with ocular use." BMJ 310 (1995): 1217-8
  4. Del Giacco GS, Petrini MT, Jannelli S, Carcassi U "Fatal bone marrow hypoplasia in a shepherd using chloramphenicol spray." Lancet 1 (1981): 945
  5. West BC, DeVault GA Jr, Clement JC, Williams DM "Aplastic anemia associated with parenteral chloramphenicol: review of 10 cases, including the second case of possible increased risk with cimetidine." Rev Infect Dis 10 (1988): 1048-51
  6. Abrams SM, Degnan TJ, Vinciguerra V "Marrow aplasia following topical application of chloramphenicol eye ointment." Arch Intern Med 140 (1980): 576-7
  7. Calderwood SB, Moellering RC "Common adverse effects of antibacterial agents on major organ systems." Surg Clin North Am 60 (1980): 65-81
  8. Alavi JB "Aplastic anemia associated with intravenous chloramphenicol." Am J Hematol 15 (1983): 375-9
  9. "Product Information. Chloromycetin (chloramphenicol)." Parke-Davis, Morris Plains, NJ.
  10. Farber BF, Brody JP "Rapid development of aplastic anemia after intravenous chloramphenicol and cimetidine therapy." South Med J 74 (1981): 1257-8
View all 10 references
Major

Ophthalmic Corticosteroids (Includes Chloramphenicol/hydrocortisone/polymyxin b ophthalmic) ↔ Ocular Infections

Severe Potential Hazard, High plausibility

Applies to: Ocular Infection

The use of ophthalmic corticosteroids is contraindicated in most viral diseases of the cornea and conjunctiva, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella; fungal diseases of ocular structures; mycobacterial infections, including tuberculosis, of the eye; and any acute, purulent, untreated ocular infections. Corticosteroids may decrease host resistance to infectious agents, thus prolonging the course and/or exacerbating the severity of the infection while encouraging the development of new or secondary infection. In addition, administration of ophthalmic corticosteroids in severe ocular disease, especially acute herpes simplex keratitis, may lead to excessive corneal and scleral thinning, increasing the risk for perforation. In less serious ocular infections, therapy with ophthalmic corticosteroids may be administered but only with caution and accompanied by appropriate antimicrobial agents. Besides compromising host immune response, corticosteroids may also mask the symptoms of infection, thus hindering the recognition of potential ineffectiveness of the antibiotic therapy. If infection does not improve or becomes worse during administration of an ophthalmic corticosteroid, the drug should be discontinued and other appropriate therapy initiated.

References

  1. "Product Information. FML Ophthalmic Suspension (fluoromethalone ophthalmic)." Allergan Inc, Irvine, CA.
  2. "Product Information. Decadron Ocumeter (dexamethasone ophthalmic)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Pred Forte (prednisolone ophthalmic)." Allergan Inc, Irvine, CA.
  4. "Product Information. Lotemax (loteprednol ophthalmic)." Bausch and Lomb, Tampa, FL.
  5. "Product Information. HMS (medrysone ophthalmic)." Allergan Inc, Irvine, CA.
  6. "Product Information. Vexol (rimexolone ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
View all 6 references
Major

Ophthalmic Corticosteroids (Includes Chloramphenicol/hydrocortisone/polymyxin b ophthalmic) ↔ Ocular Toxicities

Severe Potential Hazard, High plausibility

Applies to: Cataracts, Glaucoma/Intraocular Hypertension

Prolonged use of corticosteroids may cause posterior subcapsular cataracts and elevated intraocular pressure, the latter of which may lead to glaucoma and/or damage to the optic nerves. Therapy with ophthalmic corticosteroids should be administered cautiously in patients with a history of cataracts, glaucoma, or increased intraocular pressure. If these agents are used for more than 10 days, the manufacturers recommend that intraocular pressure be routinely monitored, including in children. The equatorial and posterior subcapsular portions of the lens should be examined for changes.

References

  1. Francois J "Corticosteroid glaucoma." Ann Ophthalmol 9 (1977): 1075-80
  2. Seale JP, Compton MR "Side-effects of corticosteroid agents." Med J Aust 144 (1986): 139-42
  3. Foster CS, Alter G, Debarge LR, Raizman MB, Crabb JL, Santos CI, Feiler LS, Friedlaender MH "Efficacy and safety of rimexolone 1% ophthalmic suspension vs 1% prednisolone acetate in the treatment of uveitis." Am J Ophthalmol 122 (1996): 171-82
  4. "Product Information. Vexol (rimexolone ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  5. "Product Information. Lotemax (loteprednol ophthalmic)." Bausch and Lomb, Tampa, FL.
  6. "Product Information. Pred Forte (prednisolone ophthalmic)." Allergan Inc, Irvine, CA.
  7. Butcher JM, Austin M, McGalliard J, Bourke RD "Bilateral cataracts and glaucoma induced by long term use of steroid eye drops." BMJ 309 (1994): 43
  8. "Product Information. HMS (medrysone ophthalmic)." Allergan Inc, Irvine, CA.
  9. "Product Information. FML Ophthalmic Suspension (fluoromethalone ophthalmic)." Allergan Inc, Irvine, CA.
  10. "Product Information. Decadron Ocumeter (dexamethasone ophthalmic)." Merck & Co, Inc, West Point, PA.
  11. Leibowitz HM, Bartlett JD, Rich R, Mcquirter H, Stewart R, Assil K "Intraocular pressure-raising potential of 1.0% rimexolone in patients responding to corticosteroids." Arch Ophthalmol 114 (1996): 933-7
  12. Kitazawa Y "Increased intraocular pressure induced by corticosteroids." Am J Ophthalmol 82 (1976): 492-5
  13. Godel V, Regenbogen L, Stein R "On the mechanism of corticosteroid-induced ocular hypertension." Ann Ophthalmol 10 (1978): 191-6
View all 13 references

chloramphenicol / hydrocortisone / polymyxin b ophthalmic drug Interactions

There are 12 drug interactions with chloramphenicol / hydrocortisone / polymyxin b ophthalmic

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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