Drug General Information (ID: DDIEY5KIZX)
Drug Name			Chloramphenicol		Drug Info		Tolazamide		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antibiotics				Antidiabetic Agents
Structure

Mechanism of Chloramphenicol-Tolazamide Interaction (Severity Level: Moderate)
Competitive binding of plasma proteins Click to Show/Hide Mechanism Graph
Drug Name		Chloramphenicol				Tolazamide
Mechanism		Competition for plasma protein binding sites				Competition for plasma protein binding sites
Key Mechanism Factor 1
		Factor Name		Plasma protein binding
		Factor Description		Plasma protein binding refers to the degree of binding of a drug to proteins in the blood, and the lower the degree of binding, the more efficiently the drug can cross cell membranes or diffuse. Plasma protein binding alters the distribution and therapeutic characteristics of the drugs.
Mechanism Description		Increased plasma concentration of Tolazamide and Chloramphenicol due to competitive binding of plasma proteins

Recommended Action
Management		Patients should be monitored for hypoglycemia when chloramphenicol is added to a sulfonylurea regimen, and for hyperglycemia when chloramphenicol is discontinued. The sulfonylurea dosage may require adjustment in affected patients. Patients receiving this combination should be advised to regularly monitor their blood sugar, counseled on how to recognize and treat hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, tremor, hunger, weakness, or palpitations) and to notify their physician if it occurs.

References
1	Brunova E, Slabochova Z, Platilova H, Pavlik F, Grafnetterova J, Dvoracek K "Interaction of tolbutamide and chloramphenicol in diabetic patients." Int J Clin Pharmacol 15 (1977): 7-12. [PMID: 838527]
2	Petitpierre B, Fabre J "Chlorpropamide and chloramphenicol." Lancet 1 (1970): 789. [PMID: 4191301]