Can you take Chloramphenicol / hydrocortisone / polymyxin b ophthalmic with Obinutuzumab?

The chloramphenicol ophthalmic in chloramphenicol / hydrocortisone / polymyxin b ophthalmic has a major potential interaction with 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.

Obinutuzumab has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

Severe neutropenia, thrombocytopenia, and anemia have been documented with the use of anti-CD20 antibodies. Monitor complete blood counts during and after therapy according to clinical guidelines.

The hydrocortisone ophthalmic in chloramphenicol / hydrocortisone / polymyxin b ophthalmic has a major potential interaction with Cataract.

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.

The hydrocortisone ophthalmic in chloramphenicol / hydrocortisone / polymyxin b ophthalmic has a major potential interaction with Eye Conditions.

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.

The hydrocortisone ophthalmic in chloramphenicol / hydrocortisone / polymyxin b ophthalmic has a major potential interaction with 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.

Obinutuzumab has a major potential interaction with Infection.

Serious infections, including reactivation of viral infections, have been reported with the use of anti-CD20 antibodies. JC virus infections resulting in progressive multifocal leukoencephalopathy (PML) have been reported in patients treated with these agents. A diagnosis of PML should be considered in any patient presenting with new-onset neurological manifestations, and a consultation with a neurologist is recommended. Care should be exercised when giving these drugs to patients with a history of recurring or chronic infections as they are at an increased risk of infections. Do not start therapy in patients with an active infection.

Obinutuzumab has a major potential interaction with Infectious Hepatitis.

The use of anti-CD20 antibodies has caused reactivation of hepatitis B virus, in some cases with fatal outcomes. It is recommended to screen all patients for hepatitis B virus infection before initiating treatment. Monitor patients during, and after several months for hepatitis B virus infection according to clinical practice. Discontinue these agents immediately and institute appropriate treatment if patients develop reactivation of hepatitis B virus while on therapy.

Obinutuzumab has a moderate potential interaction with Pulmonary Impairment.

Patients with a prior history of cardiac or pulmonary disease should be closely monitored during and after the infusion of anti-CD20 antibodies as they can increase the risk of presenting a severe and life-threatening infusion reaction. Therapy with these agents should be permanently discontinued in patients presenting any Grade 4 infusion reactions and for those presenting Grade 3, interrupt therapy and institute treatment according to clinical guidelines. The rate of infusion should be reduced for those patients presenting Grade 1, or 2 reactions.

Obinutuzumab has a major potential interaction with Tumor Lysis Syndrome.

Tumor lysis syndrome (TLS), which may be life-threatening or fatal, has occurred in patients receiving certain monoclonal antibodies. Patients with high tumor burden and/or high circulating lymphocyte counts (greater than 25 x 10[9]/L) are at greater risk for developing TLS. Tumor lysis prophylaxis with anti-hyperuricemics and hydration prior to infusion may be recommended or should be considered. Electrolyte abnormalities should be corrected, and renal function and fluid balance should be monitored in patients who develop TLS. It is recommended to monitor for signs/symptoms of TLS, and temporary interruption or discontinuation of therapy might be required.