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Drug Interactions between Folotyn and Sulfatrim Pediatric

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

trimethoprim PRALAtrexate

Applies to: Sulfatrim Pediatric (sulfamethoxazole / trimethoprim) and Folotyn (pralatrexate)

MONITOR: Coadministration with drugs that are subject to substantial renal clearance such as trimethoprim/sulfamethoxazole and nonsteroidal anti-inflammatory drugs (NSAIDs) may result in delayed clearance of pralatrexate. The mechanism is competitive inhibition of renal excretion, as approximately 34% of pralatrexate is eliminated unchanged by the kidney.

MANAGEMENT: Caution is advised if pralatrexate is prescribed in combination with trimethoprim/sulfamethoxazole or NSAIDs. Complete blood cell counts as well as renal and hepatic function should be closely monitored. Treatment interruption or dose reduction of pralatrexate may be required if toxicities such as mucositis, myelosuppression, or liver enzyme abnormalities develop. Patients should be advised to contact their physician if they develop oral ulcers, painful swallowing, vomiting, diarrhea, and/or signs and symptoms of myelosuppression such as pallor, dizziness, fatigue, lethargy, fainting, easy bruising or bleeding, or signs of infection such as fever, chills, sore throat, body aches, and other influenza-like symptoms.

References

  1. "Product Information. Folotyn (pralatrexate)." Allos Therapeutics (2009):

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Drug and food interactions

Moderate

sulfamethoxazole food

Applies to: Sulfatrim Pediatric (sulfamethoxazole / trimethoprim)

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.

References

  1. Heelon MW, White M "Disulfiram-cotrimoxazole reaction." Pharmacotherapy 18 (1998): 869-70
  2. Mergenhagen KA, Wattengel BA, Skelly MK, Clark CM, Russo TA "Fact versus fiction: a review of the evidence behind alcohol and antibiotic interactions." Antimicrob Agents Chemother 64 (2020): e02167-19

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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