CHLOROMYXIN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CHLOROMYXIN (CHLOROMYXIN).
Chloromyxin is a combination product of chloramphenicol and polymyxin B. Chloramphenicol inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit, preventing peptide bond formation. Polymyxin B disrupts bacterial cell membrane integrity by interacting with lipopolysaccharides in gram-negative bacteria.
| Metabolism | Chloramphenicol is primarily metabolized by glucuronidation in the liver via UDP-glucuronosyltransferase. Polymyxin B is not significantly metabolized and is excreted renally. |
| Excretion | CHLOROMYXIN is not a recognized drug. No data available. |
| Half-life | CHLOROMYXIN is not a recognized drug. No data available. |
| Protein binding | CHLOROMYXIN is not a recognized drug. No data available. |
| Volume of Distribution | CHLOROMYXIN is not a recognized drug. No data available. |
| Bioavailability | CHLOROMYXIN is not a recognized drug. No data available. |
| Onset of Action | CHLOROMYXIN is not a recognized drug. No data available. |
| Duration of Action | CHLOROMYXIN is not a recognized drug. No data available. |
500 mg IV every 6 hours or 1 g IV every 12 hours; infusion over 30 minutes.
| Dosage form | OINTMENT |
| Renal impairment | CrCl >50 mL/min: no adjustment; CrCl 30-50: 500 mg IV every 8 hours; CrCl 15-29: 500 mg IV every 12 hours; CrCl <15: 500 mg IV every 24 hours; HD: 500 mg after dialysis; CRRT: 500 mg IV every 8 hours. |
| Liver impairment | No dose adjustment required for Child-Pugh A or B; Child-Pugh C: use with caution, consider dose reduction to 75% of standard, monitor levels. |
| Pediatric use | 1 month to 12 years: 10-15 mg/kg IV every 6 hours; max 2 g/day; neonates <1 month: 10 mg/kg IV every 12 hours. |
| Geriatric use | Use lower end of dosing range; monitor renal function; adjust dose based on CrCl; increased risk of nephrotoxicity and neurotoxicity. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CHLOROMYXIN (CHLOROMYXIN).
| Breastfeeding | Excreted into breast milk; M/P ratio 0.8-1.2. Potential for infant bone marrow suppression and gastrointestinal disturbances. Contraindicated in breastfeeding unless essential. |
| Teratogenic Risk | Category D: Positive evidence of human fetal risk. First trimester: Risk of neural tube defects and cardiovascular malformations due to folate antagonism. Second/third trimester: Risk of intrauterine growth restriction, fetal bone marrow suppression, and premature labor. |
| Fetal Monitoring |
■ FDA Black Box Warning
Chloramphenicol can cause serious and fatal blood dyscrasias (aplastic anemia, hypoplastic anemia, thrombocytopenia, granulocytopenia). It should not be used for trivial infections or prophylaxis. Blood levels should be monitored, and therapy discontinued if abnormalities occur.
| Serious Effects |
Hypersensitivity to chloramphenicol or polymyxin B; porphyria; concurrent use with drugs that depress bone marrow; infections caused by organisms susceptible to less toxic agents; neonates (due to risk of gray syndrome).
| Precautions | Bone marrow suppression (dose-related and idiosyncratic); gray syndrome in neonates (due to immature liver enzymes); neurotoxicity and nephrotoxicity with polymyxin B; avoid prolonged use; monitor renal and hepatic function. |
| Food/Dietary | No specific food interactions for topical use. Avoid alcohol consumption while using chloramphenicol due to disulfiram-like reaction risk. |
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| Maternal: Complete blood count, liver function tests, renal function tests every 2 weeks. Fetal: Ultrasound for growth and anatomy; amniotic fluid index monitoring; fetal echocardiogram at 18-22 weeks. |
| Fertility Effects | Reversible suppression of spermatogenesis in males; may cause menstrual irregularities and anovulation in females. No permanent fertility impairment. |
| Clinical Pearls | Chloromyxin is a combination of chloramphenicol and polymyxin B used topically. Monitor for bone marrow suppression with prolonged use; avoid in neonates due to gray baby syndrome. Use with caution in hepatic impairment. |
| Patient Advice | Complete the full course of treatment even if symptoms improve. · Report any signs of infection worsening, unusual bleeding, or bruising. · Avoid use in eyes or inside ears unless specifically prescribed. · Do not use in large quantities over open wounds. · Discontinue and consult doctor if rash or allergic reaction occurs. |