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|Trimethoprim/Sulfamethoxazole |
Drugs search, click the first letter of a drug name: | A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | 1 | 2 | 3 | 4 | 5 | 6 | 8 | 9 Home Trimethoprim/Sulfamethoxazole( Co-trimoxazole ) Pronouncation: (try-METH-oh-prim/suhl-fuh-meth-OX-uh-zole)Class: Antibiotic combination Trade Names: Trade Names: Trade Names: Trade Names: Trade Names: Trade Names: Trade Names: Trade Names: Trade Names: Trade Names: Trade Names: Trade Names: Trade Names: Bactrim Roche (Canada) Novo-Trimel (Canada) Novo-Trimel D.S. (Canada) Nu-Cotrimox (Canada) Septra Injection (Canada) Mechanism of ActionPharmacologySulfamethoxazole inhibits bacterial synthesis of dihydrofolic acid by competing with PABA. Trimethoprim blocks production of tetrahydrofolic acid by inhibiting the enzyme dihydrofolate reductase. This combination blocks 2 consecutive steps in bacterial biosynthesis of essential nucleic acids and proteins and is usually bactericidal. PharmacokineticsAbsorptionTrimethoprim/sulfamethoxazole is rapidly absorbed following PO administration. T max is 1 to 4 hr. Steady state is achieved after 3 days. Distribution70% of sulfamethoxazole and 44% of trimethoprim is protein bound. Trimethoprim/sulfamethoxazole is distributed to sputum, vaginal fluid, and middle ear fluid. Trimethoprim/sulfamethoxazole passes the placental barrier and is excreted in human milk. MetabolismMetabolism of sulfamethoxazole is primarily by N 4 -acetylation. The principal metabolites of trimethoprim are the 1- and 3-oxides and the 3- and 4-hydroxy derivatives. The free forms are considered therapeutically active. EliminationSerum t ½ of sulfamethoxazole and trimethoprim is 10 hr and 8 to 10 hr, respectively. Trimethoprim/sulfamethoxazole is primarily eliminated by kidneys through glomerular filtration and tubular secretion. Urine concentrations are higher than blood concentrations. OnsetOnset of action is 24 hr after administration. Special PopulationsRenal Function ImpairmentPatients with severely impaired renal function exhibit an increase in the half lives of both components, requiring dosage adjustments. Indications and UsagePO/ParenteralTreatment of UTIs caused by susceptible strains of bacteria, shigellosis enteritis, and Pneumocystis carinii pneumonitis. POTreatment of acute otitis media and acute exacerbations of chronic bronchitis; treatment of traveler"s diarrhea. Unlabeled UsesTreatment of cholera, salmonella-type infections and nocardiosis; prevention of recurrent UTIs in women; prophylaxis of bacterial infections in susceptible patients; treatment of prostatitis; prophylaxis of Pneumocystis carinii pneumonitis. ContraindicationsHypersensitivity to sulfonamides; megaloblastic anemia caused by folate deficiency; pregnancy at term; lactation; infants less than 2 mo. Dosage and AdministrationUTIs, Shigellosis, Acute Otitis MediaAdults PO 160 mg trimethoprim/800 mg sulfamethoxazole q 12 hr for 10 to 14 days and 5 days for shigellosis. IV 8 to 10 mg/kg/day (based on trimethoprim) in 2 to 4 divided doses q 6 to 12 hr for up to 14 days for severe UTIs and 5 days for shigellosis. Children over 2 moPO 8 mg/kg trimethoprim/40 mg/kg sulfamethoxazole daily in 2 divided doses q 12 hr for 10 days and 5 days for shigellosis. Pneumocystis carinii PneumonitisAdults PO 20 mg/kg trimethoprim/100 mg/kg sulfamethoxazole daily in divided doses q 6 hr for 14 days. IV 15 to 20 mg/kg/day (based on trimethoprim) in 3 to 4 divided doses for up to 14 days. Traveler"s DiarrheaAdults PO 160 mg trimethoprim/800 mg sulfamethoxazole q 12 hr for 5 days. Exacerbation of Chronic BronchitisAdults PO 160 mg trimethoprim/800 mg sulfamethoxazole q 12 hr for 14 days. General Advice
Storage/StabilityStore IV solution at room temperature. Do not refrigerate. Discard prepared IV solution if not used within 2 hr (75 mL) or 6 hr (125 mL). Store tablets or suspension at room temperature in a tight, light-resistant container. Drug InteractionsCyclosporineMay cause decrease in therapeutic effect of cyclosporine and increased risk of nephrotoxicity. MethotrexateMay displace methotrexate from protein-binding sites, thus increasing free methotrexate levels. PhenytoinTrimethoprim may inhibit metabolism of phenytoin or other hydantoins. ProcainamideTrimethoprim may inhibit renal elimination of procainamide and its metabolites. SulfonylureasMay increase hypoglycemic response to sulfonylureas because of displacement from protein-binding sites or inhibition of hepatic metabolism. WarfarinMay cause prolonged PT. IncompatibilityDo not mix with other drugs or solutions other than D5W. Laboratory Test InteractionsCan interfere with serum methotrexate assay as determined by competitive binding protein technique when bacterial dihydrofolate reductase is used as binding protein. May interfere with Jaffe alkaline picrate reaction assay for creatinine, resulting in overestimations. PrecautionsPregnancyCategory C . Do not use at term because of risk of neonatal kernicterus. LactationUndetermined. Not recommended during nursing because sulfonamides are excreted in breast milk and may cause kernicterus. Premature infants and infants with hyperbilirubinemia or G-6-PD deficiency are also at risk for adverse effects. ChildrenNot recommended for infants less than 2 mo. ElderlyAre at increased risk of severe adverse reactions. Renal FunctionUse drug with caution. Dosage adjustment may be required. Hepatic FunctionUse drug with caution. Dosage adjustment may be required. Special Risk PatientsUse drug with caution in patients with possible folate deficiency (eg, elderly patients, chronic alcoholics, patients undergoing anticonvulsant therapy, patients with malabsorption syndromes or malnutrition), patients with severe allergy or bronchial asthma, patients who have sulfite sensitivity and G-6-PD-deficient individuals. UlcerationTake tablets with water or food to prevent lodging in esophagus and subsequent ulceration. Hematologic effectsSulfonamide-associated deaths, although rare, have occurred from hypersensitivity of respiratory tract, Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, and other blood dyscrasias. Both components can interfere with hematopoiesis. IV use at high doses for extended periods of time may cause bone marrow depression. Patients with AIDSIncidence of side effects, especially rash, fever, and leukopenia, is greatly increased. Streptococcal pharyngitisDo not use for streptococcal pharyngitis. SulfonamidesAre chemically similar to some goitrogens, diuretics (acetazolamide and the thiazides), and oral hypoglycemic agents. Goiter production, diuresis, and hypoglycemia occur rarely in patients receiving sulfonamides. Cross-sensitivity may occur. OverdosageSymptomsAnorexia, colic, nausea, vomiting, dizziness, headache, drowsiness, depression, confusion, altered mental status, fever, hematuria, crystalluria, blood dyscrasias, jaundice, bone marrow depression. Patient Information
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