Drug Interaction Report

GENERALLY AVOID: Coadministration of chloramphenicol with other agents that can cause bone marrow depression, aplastic anemia, or agranulocytosis can 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. In addition, chloramphenicol is considered a moderate CYP450 3A4 inhibitor and may increase the plasma concentrations and risk of adverse effects of immunosuppressant drugs that are also substrates of this isoenzyme.

MANAGEMENT: Concurrent use of chloramphenicol with other agents that can cause bone marrow depression, aplastic anemia, or agranulocytosis that are also CYP450 3A4 substrates such as ruxolitinib, ibrutinib, idelalisib, olaparib, irinotecan, docetaxel, acalabrutinib, and fostamatinib, should be avoided. Some authorities consider coadministration of chloramphenicol with such medications to be contraindicated. The prescribing information for individual immunosuppressive agents should be consulted for more specific recommendations.