Drug Interaction Report

GENERALLY AVOID: Coadministration of chloramphenicol with other agents that can cause bone marrow depression, aplastic anemia, or agranulocytosis may increase the risk and/or severity of hematologic toxicity. Serious and fatal blood dyscrasias (aplastic anemia, hypoplastic anemia, thrombocytopenia, granulocytopenia, and bone marrow depression) have been reported after short-term and long-term systemic therapy with chloramphenicol.

MANAGEMENT: Concurrent use of chloramphenicol with other agents that can cause bone marrow depression, aplastic anemia, or agranulocytosis, such as sulfonamides, nucleoside reverse transcriptase inhibitors, procainamide, phenylbutazone, clozapine, and depot formulations of antipsychotic drugs, should be avoided.

MONITOR: Two cases have been reported in which patients on sulfamethoxazole-trimethoprim therapy, after consuming beer, reported flushing, heart palpitations, dyspnea, headache, and nausea (disulfiram - alcohol type reactions). First-generation sulfonylureas have been reported to cause facial flushing when administered with alcohol by inhibiting acetaldehyde dehydrogenase and subsequently causing acetaldehyde accumulation. Since sulfamethoxazole is chemically related to first-generation sulfonylureas, a disulfiram-like reaction with products containing sulfamethoxazole is theoretically possible. However, pharmacokinetic/pharmacodynamic data are lacking and in addition, the two reported cases cannot be clearly attributed to the concomitant use of sulfamethoxazole-trimethoprim and alcohol.

MANAGEMENT: Patients should be alerted to the potential for this interaction and although the risk for this interaction is minimal, caution is recommended while taking sulfamethoxazole-trimethoprim concomitantly with alcohol.