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Co-trimoxazole Disease Interactions

There are 12 disease interactions with Co-trimoxazole (sulfamethoxazole / trimethoprim).

Major

Antibiotics (applies to Co-trimoxazole) colitis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Colitis/Enteritis (Noninfectious)

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

References

  1. (2002) "Product Information. Omnipen (ampicillin)." Wyeth-Ayerst Laboratories
  2. (2002) "Product Information. Ceftin (cefuroxime)." Glaxo Wellcome
  3. (2002) "Product Information. Zinacef (cefuroxime)." Glaxo Wellcome
  4. (2002) "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn
  5. (2002) "Product Information. Macrobid (nitrofurantoin)." Procter and Gamble Pharmaceuticals
  6. (2002) "Product Information. Macrodantin (nitrofurantoin)." Procter and Gamble Pharmaceuticals
  7. (2001) "Product Information. Amoxil (amoxicillin)." SmithKline Beecham
  8. (2001) "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals
  9. (2001) "Product Information. Coly-Mycin M Parenteral (colistimethate)." Parke-Davis
  10. (2001) "Product Information. Lincocin (lincomycin)." Pharmacia and Upjohn
  11. (2003) "Product Information. Cubicin (daptomycin)." Cubist Pharmaceuticals Inc
  12. (2004) "Product Information. Xifaxan (rifaximin)." Salix Pharmaceuticals
  13. (2007) "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical
  14. (2009) "Product Information. Penicillin G Procaine (procaine penicillin)." Monarch Pharmaceuticals Inc
  15. (2009) "Product Information. Vibativ (telavancin)." Theravance Inc
  16. (2010) "Product Information. Teflaro (ceftaroline)." Forest Pharmaceuticals
  17. (2022) "Product Information. Penicillin G Sodium (penicillin G sodium)." Sandoz Inc
  18. (2014) "Product Information. Dalvance (dalbavancin)." Durata Therapeutics, Inc.
  19. (2014) "Product Information. Orbactiv (oritavancin)." The Medicines Company
  20. (2017) "Product Information. Bicillin C-R (benzathine penicillin-procaine penicillin)." A-S Medication Solutions
  21. (2017) "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc.
  22. (2022) "Product Information. Polymyxin B Sulfate (polymyxin B sulfate)." AuroMedics Pharma LLC
  23. (2018) "Product Information. Zemdri (plazomicin)." Achaogen
  24. (2018) "Product Information. Seysara (sarecycline)." Allergan Inc
  25. (2018) "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc.
  26. (2018) "Product Information. Aemcolo (rifamycin)." Aries Pharmaceuticals, Inc.
  27. (2019) "Product Information. Fetroja (cefiderocol)." Shionogi USA Inc
  28. (2019) "Product Information. Biaxin (clarithromycin)." AbbVie US LLC, SUPPL-61
  29. (2021) "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group, LAB-0372-7.0
  30. (2018) "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals, SUPPL-74
  31. (2020) "Product Information. Priftin (rifapentine)." sanofi-aventis, SUPPL-18
  32. (2021) "Product Information. Xerava (eravacycline)." Tetraphase Pharmaceuticals, Inc
  33. (2023) "Product Information. Xacduro (durlobactam-sulbactam)." La Jolla Pharmaceutical
  34. (2024) "Product Information. Exblifep (cefepime-enmetazobactam)." Allecra Therapeutics
  35. (2021) "Product Information. Maxipime (cefepime)." Hospira Inc, SUPPL-46
View all 35 references
Major

Sulfonamides (applies to Co-trimoxazole) hematologic toxicity

Major Potential Hazard, Moderate plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts, G-6-PD Deficiency

The use of sulfonamides has been associated with hematologic toxicity, including methemoglobinemia, sulfhemoglobinemia, leukopenia, granulocytopenia, eosinophilia, hemolytic anemia, aplastic anemia, purpura, clotting disorder, thrombocytopenia, hypofibrinogenemia, and hypoprothrombinemia. Acute dose-related hemolytic anemia may occur during the first week of therapy due to sensitization, while chronic hemolytic anemia may occur with prolonged use. Patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency should be observed closely for signs of hemolytic anemia. Therapy with sulfonamides should be administered cautiously in patients with preexisting blood dyscrasias or bone marrow suppression. Complete blood counts should be obtained regularly, especially during prolonged therapy (>2 weeks), and patients should be instructed to immediately report any signs or symptoms suggestive of blood dyscrasia such as fever, sore throat, local infection, bleeding, pallor, dizziness, or jaundice.

References

  1. Barak S, Shaked Y, Bar A, Samra Y (1989) "Drug-induced post-surgical hemorrhage resulting from trimethoprim-sulphamethoxazole." Int J Oral Maxillofac Surg, 18, p. 206-7
  2. Chan M, Beale D, Moorhead J (1980) "Acute megaloblastosis due to cotrimoxazole." Br J Clin Pract, 34, p. 87-8
  3. Damergis J, Stoker J, Abadie J (1983) "Methemoglobinemia after sulfamethoxazole and trimethoprim therapy." JAMA, 249, p. 590-1
  4. Finland M, Strauss E, Peterson O (1984) "Sulfadiazine." JAMA, 251, p. 1467-74
  5. Kuipers EJ, Vellenga E, de Wolf JT, Hazenberg BP (1992) "Sulfasalazine induced agranulocytosis treated with GM-CSF." J Rheumatol, 19, p. 621-2
  6. Youssef PP, Bertouch JV (1992) "Sulphasalazine induced aplastic anaemia." Aust N Z J Med, 22, p. 391-2
  7. Keisu M, Ekman E (1992) "Sulfasalazine associated agranulocytosis in sweden 1972-1989: clinical features, and estimation of its incidence." Eur J Clin Pharmacol, 43, p. 215-8
  8. "Product Information. Gantranol (sulfamethoxazole)." Roche Laboratories, Nutley, NJ.
  9. (2001) "Product Information. Gantrisin (sulfisoxazole)." Roche Laboratories
  10. (2001) "Product Information. Sulfadiazine (sulfadiazine)." Eon Labs Manufacturing Inc
  11. Peppercorn MA (1984) "Sulfasalazine. Pharmacology, clinical use, toxicity, and related new drug development." Ann Intern Med, 101, p. 377-86
  12. Jacobson IM, Kelsey PB, Blyden GT, Demirjian ZN, Isselbacher KJ (1985) "Sulfasalazine-induced agranulocytosis." Am J Gastroenterol, 80, p. 118-21
  13. Wheelan KR, Cooper B, Stone MJ (1982) "Multiple haematologic abnormalities associated with sulfasalazine." Ann Intern Med, 97, p. 726-7
  14. Pena JM, Gonzalez-Garcia JJ, Garcia-Alegria J, Barbado FJ, Vazquez JJ (1985) "Thrombocytopenia and sulfasalazine." Ann Intern Med, 102, p. 277-8
  15. Davies GE, Palek J (1980) "Selective erythroid and magakaryocytic aplasia after sulfasalazine administration." Arch Intern Med, 140, p. 1122
  16. Guillemin F, Aussedat R, Guerci A, Lederlin P, Trechot P, Pourel J (1989) "Fatal agranulocytosis in sulfasalazine treated rheumatoid arthritis." J Rheumatol, 16, p. 1166-7
  17. Mitrane MP, Singh A, Seibold JR (1986) "Cholestasis and fatal agranulocytosis complicating sulfasalazine therapy: case report and review of the literature." J Rheumatol, 13, p. 969-72
  18. Mechanick JI (1985) "Coombs' positive hemolytic anemia following sulfasalazine therapy in ulcerative colitis: case reports, review, and discussion of pathogenesis." Mt Sinai J Med, 52, p. 667-70
  19. Betkowski AS, Lubin A (1993) "Sulfamethoxazole-related antiplatelet antibody." Blood, 82, p. 1683
  20. Gales BJ, Gales MA (1993) "Granulocyte-colony stimulating factor for sulfasalazine-induced agranulocytosis." Ann Pharmacother, 27, p. 1052-4
  21. (2001) "Product Information. Azulfidine (sulfasalazine)." Pharmacia and Upjohn
  22. Bates CM (1996) "HIV medicine: drug side effects and interactions." Postgrad Med J, 72, p. 30-6
  23. (2001) "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals
  24. Hopkinson ND, Garcia FS, Gumpel JM (1989) "Haematological side-effects pf sulphasalazine in inflammatory arthritis." Br J Rheumatol, 28, p. 414-7
  25. Logan EC, Williamson LM, Ryrie DR (1986) "Sulphasalazine associated pancytopenia may be caused by acute folate deficiency." Gut, 27, p. 868-72
View all 25 references
Major

Sulfonamides (applies to Co-trimoxazole) hypersensitivity reactions

Major Potential Hazard, Moderate plausibility. Applicable conditions: Asthma, HIV Infection, Allergies

The use of sulfonamides is associated with large increases in the risk of Stevens-Johnson syndrome, toxic epidermal necrolysis and other serious dermatologic reactions, although these phenomena are rare as a whole. Hepatitis, pneumonitis, and interstitial nephritis have also occurred in association with sulfonamide hypersensitivity. Therapy with sulfonamides should be administered cautiously in patients with severe allergies, bronchial asthma or AIDS, since these patients may be at increased risk for potentially severe hypersensitivity reactions. Patients should be instructed to promptly report signs and symptoms that may precede the onset of cutaneous manifestations of the Stevens-Johnson syndrome, such as high fever, severe headache, stomatitis, conjunctivitis, rhinitis, urethritis, and balanitis. Sulfonamide therapy should be stopped at once if a rash develops.

References

  1. Johnson M, Goodwin D, Shands J (1990) "Trimethoprim-sulfamethoxazole anaphylactoid reactions in patients with AIDS: case reports and literature review." Pharmacotherapy, 10, p. 413-16
  2. Hofer T, Becker EW, Weigand K, Berg PA (1992) "Demonstration of sensititzed lymphocytes to trimethoprim/sulfamethoxazole and ofloxacin in a patient with cholestatic hepatitis." J Hepatol, 15, p. 262-3
  3. Stevenson D, Christie D, Haas J (1978) "Hepatic injury in a child caused by trimethoprim-sulfamethoxazole." Pediatrics, 61, p. 864-6
  4. Smith E, Light J, Filo R, Yum M (1980) "Interstitial nephritis caused by trimethoprim-sulfamethoxazole in renal transplant recipients." JAMA, 244, p. 360-1
  5. Fischl M, Dickinson G, LaVoie L (1988) "Safety and efficacy of sulfamethoxazole and trimethoprim chemoprophylaxis for pneumocystis carinii pneumonia in AIDS." JAMA, 259, p. 1185-9
  6. Whittington R (1989) "Toxic epidermal necrolysis and co-trimoxazole." Lancet, 2, p. 574
  7. Kelly W, Dooley D, Lattuada C, Smith C (1992) "A severe, unusual reaction to trimethoprim-sulfamethoxazole in patients infected with human immunodeficiency virus." Clin Infect Dis, 14, p. 1034-9
  8. Horak J, Mertl L, Hrabal P (1984) "Severe liver injuries due to sulfamethoxazole-trimethoprim and sulfamethoxydiazine." Hepatogastroenterology, 31, p. 199-200
  9. Gibson J (1982) "Recurrent trimethoprim-associated fixed skin eruption." Br Med J, 284, p. 1529-30
  10. Holdcroft C, Ellison R (1991) "Trimethoprim-sulfamethoxazole reaction simulating pneumocystis carinii pneumonia." AIDS, 5, p. 1029-42
  11. Steinbrecher U, Mishkin S (1981) "Sulfamethoxazole-induced hepatic injury." Dig Dis Sci, 26, p. 756-9
  12. Rudra T, Webb D, Evans A (1989) "Acute tubular necrosis following co-trimoxazole therapy." Nephron, 53, p. 85-6
  13. Ulstad D, Ampel N, Shon B, Galgiani JN, Cutcher AB (1989) "Reaction after re-exposure to trimethoprim-sulfamethoxazole." Chest, 95, p. 937-8
  14. Heer M, Altorfer J, Burger H, Walti M (1985) "Bullous esophageal lesions due to co-trimoxazole: an immune-mediated process?" Gastroenterology, 88, p. 1954-7
  15. Pisanty S, Brayer L (1965) "Erythema multiforme-like eruption due to sulfadiazine." J Dent Med, 20, p. 154-7
  16. Robson M, Levi J, Dolberg L, Rosenfeld J (1970) "Acute tubulo-interstitial nephritis following sulfadiazine therapy." Isr J Med Sci, 6, p. 561-6
  17. Finland M, Strauss E, Peterson O (1984) "Sulfadiazine." JAMA, 251, p. 1467-74
  18. Goadsby P, Donaghy A, Lloyd A, Wakefield D (1987) "Acquired immunodeficiency syndrome (AIDS) and sulfadiazine-associated acute renal failure." Ann Intern Med, 107, p. 783-4
  19. Carbone L, Bendixen B, Appel G (1988) "Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome." Am J Kidney Dis, 12, p. 72-5
  20. Tenant-Flowers M, Boyle M, Carey D, et al. (1991) "Sulphadiazine desenitization in patients with AIDS and cerebral toxoplasmosis." AIDS, 5, p. 311-5
  21. Leroux JL, Ghezail M, Chertok P, Blotman F (1992) "Hypersensitivity reactions to sulfasalazine: skin rash, fever, hepatitis and activated lymphocytes." Clin Exp Rheumatol, 10, p. 427
  22. "Product Information. Gantranol (sulfamethoxazole)." Roche Laboratories, Nutley, NJ.
  23. (2001) "Product Information. Gantrisin (sulfisoxazole)." Roche Laboratories
  24. (2001) "Product Information. Sulfadiazine (sulfadiazine)." Eon Labs Manufacturing Inc
  25. Peppercorn MA (1984) "Sulfasalazine. Pharmacology, clinical use, toxicity, and related new drug development." Ann Intern Med, 101, p. 377-86
  26. Kanner RS, Tedesco FJ, Kalser MH (1978) "Azulfidine- (sulfasalazine-) induced hepatic injury." Am J Dig Dis, 23, p. 956-8
  27. Losek JD, Werlin SL (1981) "Sulfasalazine hepatotoxicity." Am J Dis Child, 135, p. 1070-2
  28. Fich A, Schwartz J, Braverman D, Zifroni A, Rachmilewitz D (1984) "Sulfasalazine hepatotoxicity." Am J Gastroenterol, 79, p. 401-2
  29. Yaffe BH, Korelitz BI (1983) "Sulfasalazine pneumonitis." Am J Gastroenterol, 78, p. 493-4
  30. Ribe J, Benkov KJ, Thung SN, Shen SC, LeLeiko NS (1986) "Fatal massive hepatic necrosis: a probable hypersensitivity reaction to sulfasalazine." Am J Gastroenterol, 81, p. 205-8
  31. Averbuch M, Halpern Z, Hallak A, Topilsky M, Levo Y (1985) "Sulfasalazine pneumonitis." Am J Gastroenterol, 80, p. 343-5
  32. Gabazza EC, Taguchi O, Yamakami T, Machishi M, Ibata H, Suzuki S, Matsumoto K, Kitagawa T, Yamamoto J (1992) "Pulmonary infiltrates and skin pigmentation associated with sulfasalazine." Am J Gastroenterol, 87, p. 1654-7
  33. Poland GA, Love KR (1986) "Marked atypical lymphocytosis, hepatitis, and skin rash in sulfasalazine drug allergy." Am J Med, 81, p. 707-8
  34. Hamadeh MA, Atkinson J, Smith LJ (1992) "Sulfasalazine-induced pulmonary disease." Chest, 101, p. 1033-7
  35. Williams T, Eidus L, Thomas P (1982) "Fibrosing alveolitis, bronchiolitis obliterans, and sulfasalazine therapy." Chest, 81, p. 766-8
  36. Valcke Y, Pauwels R, Van der Straeten M (1987) "Bronchoalveolar lavage in acute hypersensitivity pneumonitis caused by sulfasalazine." Chest, 92, p. 572-3
  37. Taffet SL, Das KM (1983) "Sulfasalazine. Adverse effects and desensitization." Dig Dis Sci, 28, p. 833-42
  38. Pearl RK, Nelson RL, Prasad ML, Orsay CP, Abcarian H (1986) "Serious complications of sulfasalazine." Dis Colon Rectum, 29, p. 201-2
  39. Sotolongo RP, Neefe LI, Rudzki C, Ishak KG (1978) "Hypersensitivity reaction to sulfasalazine with severe hepatotoxicity." Gastroenterology, 75, p. 95-9
  40. Wang KK, Bowyer BA, Fleming CR, Schroeder KW (1984) "Pulmonary infiltrates and eosinophilia associated with sulfasalazine." Mayo Clin Proc, 59, p. 343-6
  41. Haines JD, Jr (1986) "Hepatotoxicity after treatment with sulfasalazine." Postgrad Med, 79, 193-4,
  42. Faintuch J, Mott CB, Machado MC (1985) "Pancreatitis and pancreatic necrosis during sulfasalazine therapy." Int Surg, 70, p. 271-2
  43. Marinos G, Riley J, Painter DM, McCaughan GW (1992) "Sulfasalazine-induced fulminant hepatic failure." J Clin Gastroenterol, 14, p. 132-5
  44. Namias A, Bhalotra R, Donowitz M (1981) "Reversible sulfasalazine-induced granulomatous hepatitis." J Clin Gastroenterol, 3, p. 193-8
  45. Gremse DA, Bancroft J, Moyer MS (1989) "Sulfasalazine hypersensitivity with hepatotoxicity, thrombocytopenia, and erythroid hypoplasia." J Pediatr Gastroenterol Nutr, 9, p. 261-3
  46. Marinac JS, Stanford JF (1993) "A severe hypersensitive reaction to trimethoprim-sulfamethoxazole in a patient infected with human immunodeficiency virus." Clin Infect Dis, 16, p. 178-9
  47. Rubin R (1994) "Sulfasalazine-induced fulminant hepatic failure and necrotizing pancreatitis." Am J Gastroenterol, 89, p. 789-91
  48. (2001) "Product Information. Azulfidine (sulfasalazine)." Pharmacia and Upjohn
  49. Roujeau JC, Kelly JP, Naldi L, et al. (1995) "Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis." N Engl J Med, 333, p. 1600-7
  50. Bates CM (1996) "HIV medicine: drug side effects and interactions." Postgrad Med J, 72, p. 30-6
  51. Kawada A, Kobayashi T, Noguchi H, Hiruma M, Ishibashi A, Marshall J (1996) "Fixed drug eruption induced by sulfasalazine." Contact Dermatitis, 34, p. 155-6
  52. Moore RD, Fortgang I, Keruly J, Chaisson RE (1996) "Adverse events from drug therapy for human immunodeficiency virus disease." Am J Med, 101, p. 34-40
  53. (2001) "Product Information. Zonegran (zonisamide)." Elan Pharmaceuticals
View all 53 references
Major

Sulfonamides (applies to Co-trimoxazole) liver disease

Major Potential Hazard, Moderate plausibility.

Hepatotoxicity, including jaundice, diffuse hepatocellular necrosis, hypersensitivity hepatitis and hepatic failure, has rarely been reported in patients receiving sulfonamides. In addition, sulfonamides are partially metabolized by the liver and may accumulate in patients with hepatic impairment. Therapy with sulfonamides should be administered cautiously in patients with liver disease.

References

  1. Kowdley K, Keeffe E, Fawaz K (1992) "Prolonged cholestasis due to trimethoprim-sulfamethoxazole." Gastroenterology, 102, p. 2148-50
  2. Basista MP (1991) "Randomized study to evaluate efficacy and safety of ofloxacin vs trimethoprim and sulfamethoxazole in treatment of uncomplicated urinary tract infection." Urology, 37, p. 21-7
  3. Hofer T, Becker EW, Weigand K, Berg PA (1992) "Demonstration of sensititzed lymphocytes to trimethoprim/sulfamethoxazole and ofloxacin in a patient with cholestatic hepatitis." J Hepatol, 15, p. 262-3
  4. Stevenson D, Christie D, Haas J (1978) "Hepatic injury in a child caused by trimethoprim-sulfamethoxazole." Pediatrics, 61, p. 864-6
  5. Horak J, Mertl L, Hrabal P (1984) "Severe liver injuries due to sulfamethoxazole-trimethoprim and sulfamethoxydiazine." Hepatogastroenterology, 31, p. 199-200
  6. Steinbrecher U, Mishkin S (1981) "Sulfamethoxazole-induced hepatic injury." Dig Dis Sci, 26, p. 756-9
  7. Alberti-Flor JJ, Hernandez ME, Ferrer JP, Howell S, Jeffers L (1989) "Fulminant liver failure and pancreatitis associated with the use of sulfamethoxazole-trimethoprim." Am J Gastroenterol, 84, p. 1577-9
  8. Ransohoff D, Jacobs G (1981) "Terminal hepatic failure following a small dose of sulfamethoxazole-trimethoprim." Gastroenterology, 80, p. 816-9
  9. Finland M, Strauss E, Peterson O (1941) "Sulfadiazine." JAMA, 116, p. 2641-7
  10. Hekster C, Vree T (1982) "Clinical pharmacokinetics of sulphonamides and their N4-acetyl derivatives." Antibiot Chemother, 31, p. 22-118
  11. Madsen S (1966) "A comparative study of the excretion of sulfonamide-metabolites in cases of renal failure and hepatitis." Chemotherapy, 11, p. 1-9
  12. Andreasen F, Elsborg L, Husted S, Thomsen O (1978) "Pharmacokinetics of sulfadiazine and trimethoprim in man." Eur J Clin Pharmacol, 14, p. 57-67
  13. Ortengren B, Fellner H, Bergan T (1979) "Development of sulphonamide-trimethoprim combinations for urinary tract infections. Part 2: Comparative pharmacokinetics of five sulphonamides." Infection, 7 Suppl 4, s367-70
  14. Stachowska B, Senczuk W (1987) "Studies on kinetics of sulfadiazine and trimethoprim excretion in man." Int J Clin Pharmacol Ther Toxicol, 25, p. 81-5
  15. Mannisto PT, Mantyla R, Mattila J, Nykanen S, Lamminsivu U (1982) "Comparison of pharmacokinetics of sulphadiazine and sulphamethoxazole after intravenous infusion." J Antimicrob Chemother, 9, p. 461-70
  16. Ortengren B, Magni L, Bergan T (1979) "Development of sulphonamide-trimethoprim combinations for urinary tract infections. part 3: pharmacokinetic characterization of sulphadiazine and sulphamethoxazole." Infection, 7, s371-81
  17. Bergan T, Brodwall EK (1972) "Human pharmacokinetics of a sulfamethoxazole-trimethoprim combination." Acta Med Scand, 192, p. 483-92
  18. Kremers P, Duvivier J, Heusghem C (1974) "Pharmacokinetic studies of co-trimoxazole in man after single and repeated doses." J Clin Pharmacol, 14, p. 112-7
  19. Patel RB, Welling PG (1980) "Clinical pharmacokinetics of co-trimoxazole (trimethoprim-sulphamethoxazole)." Clin Pharmacokinet, 5, p. 405-23
  20. Gleckman R, Gantz NM, Joubert DW (1981) "Intravenous sulfamethoxazole-trimethoprim: pharmacokinetics, therapeutic indications, and adverse reactions." Pharmacotherapy, 1, p. 206-11
  21. Vergin H, Ferber H, Zimmermann I, Neurath GB (1981) "Single and multiple dose kinetics of co-tetroxazine and co-trimoxazole in patients." Int J Clin Pharmacol Ther Toxicol, 19, p. 350-7
  22. Boisvert A, Barbeau G, Belanger PM (1984) "Pharmacokinetics of sulfisoxazole in young and elderly subjects." Gerontology, 30, p. 125-31
  23. Kaplan SA, Weinfeld RE, Abruzzo CW, Lewis M (1972) "Pharmacokinetic profile of sulfisoxazole following intravenous, intramuscular, and oral administration to man." J Pharm Sci, 61, p. 773-8
  24. Oie S, Gambertoglio JG, Fleckenstein L (1982) "Comparison of the disposition of total and unbound sulfisoxazole after single and multiple dosing." J Pharmacokinet Biopharm, 10, p. 157-72
  25. Khan AK, Truelove SC, Aronson JK (1982) "The disposition and metabolism of sulphasalazine (salicylazosulphapyridine) in man." Br J Clin Pharmacol, 13, p. 523-8
  26. Klotz U (1985) "Clinical pharmacokinetics of sulphasalazine, its metabolites and other prodrugs of 5-aminosalicylic acid." Clin Pharmacokinet, 10, p. 285-302
  27. Leroux JL, Ghezail M, Chertok P, Blotman F (1992) "Hypersensitivity reactions to sulfasalazine: skin rash, fever, hepatitis and activated lymphocytes." Clin Exp Rheumatol, 10, p. 427
  28. "Product Information. Gantranol (sulfamethoxazole)." Roche Laboratories, Nutley, NJ.
  29. (2001) "Product Information. Gantrisin (sulfisoxazole)." Roche Laboratories
  30. (2001) "Product Information. Sulfadiazine (sulfadiazine)." Eon Labs Manufacturing Inc
  31. Peppercorn MA (1984) "Sulfasalazine. Pharmacology, clinical use, toxicity, and related new drug development." Ann Intern Med, 101, p. 377-86
  32. Das KM, Chowdhury JR, Zapp B, Fara JW (1979) "Small bowel absorption of sulfasalazine and its hepatic metabolism in human beings, cats, and rats." Gastroenterology, 77, p. 280-4
  33. Kanner RS, Tedesco FJ, Kalser MH (1978) "Azulfidine- (sulfasalazine-) induced hepatic injury." Am J Dig Dis, 23, p. 956-8
  34. Losek JD, Werlin SL (1981) "Sulfasalazine hepatotoxicity." Am J Dis Child, 135, p. 1070-2
  35. Fich A, Schwartz J, Braverman D, Zifroni A, Rachmilewitz D (1984) "Sulfasalazine hepatotoxicity." Am J Gastroenterol, 79, p. 401-2
  36. Ribe J, Benkov KJ, Thung SN, Shen SC, LeLeiko NS (1986) "Fatal massive hepatic necrosis: a probable hypersensitivity reaction to sulfasalazine." Am J Gastroenterol, 81, p. 205-8
  37. Poland GA, Love KR (1986) "Marked atypical lymphocytosis, hepatitis, and skin rash in sulfasalazine drug allergy." Am J Med, 81, p. 707-8
  38. Taffet SL, Das KM (1983) "Sulfasalazine. Adverse effects and desensitization." Dig Dis Sci, 28, p. 833-42
  39. Sotolongo RP, Neefe LI, Rudzki C, Ishak KG (1978) "Hypersensitivity reaction to sulfasalazine with severe hepatotoxicity." Gastroenterology, 75, p. 95-9
  40. Haines JD, Jr (1986) "Hepatotoxicity after treatment with sulfasalazine." Postgrad Med, 79, 193-4,
  41. Marinos G, Riley J, Painter DM, McCaughan GW (1992) "Sulfasalazine-induced fulminant hepatic failure." J Clin Gastroenterol, 14, p. 132-5
  42. Namias A, Bhalotra R, Donowitz M (1981) "Reversible sulfasalazine-induced granulomatous hepatitis." J Clin Gastroenterol, 3, p. 193-8
  43. Gremse DA, Bancroft J, Moyer MS (1989) "Sulfasalazine hypersensitivity with hepatotoxicity, thrombocytopenia, and erythroid hypoplasia." J Pediatr Gastroenterol Nutr, 9, p. 261-3
  44. Rubin R (1994) "Sulfasalazine-induced fulminant hepatic failure and necrotizing pancreatitis." Am J Gastroenterol, 89, p. 789-91
  45. Schroder H, Campbell DE (1972) "Absorption, metabolism, and excretion of salicylazosulfapyridine in man." Clin Pharmacol Ther, 13, p. 539-51
  46. (2001) "Product Information. Azulfidine (sulfasalazine)." Pharmacia and Upjohn
  47. Simma B, Meister B, Deutsch J, Sperl W, Fend F, Ofner D, Margreiter R, Vogel W (1995) "Fulminant hepatic failure in a child as a potential adverse effect of trimethoprim-sulphamethoxazole." Eur J Pediatr, 154, p. 530-3
  48. Bates CM (1996) "HIV medicine: drug side effects and interactions." Postgrad Med J, 72, p. 30-6
View all 48 references
Major

Sulfonamides (applies to Co-trimoxazole) porphyria

Major Potential Hazard, High plausibility.

The use of sulfonamides is contraindicated in patients with porphyria, since these drugs can precipitate an acute attack.

References

  1. (2001) "Product Information. Azulfidine (sulfasalazine)." Pharmacia and Upjohn
  2. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD (1998) "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division
Major

Sulfonamides (applies to Co-trimoxazole) renal dysfunction

Major Potential Hazard, High plausibility.

Sulfonamides and their metabolites are eliminated by the kidney. Patients with renal impairment may be at greater risk for adverse effects from sulfonamides due to decreased drug clearance. Dosage adjustments may be necessary and modifications should be based on the degree of renal impairment and severity of infection. Additionally, sulfonamides may cause renal toxicity secondary to crystalluria, including uro- and nephrolithiasis, nephritis, toxic nephrosis, hematuria, proteinuria, and elevated BUN and creatinine. Hydration (8 oz. glass of water with each dose and throughout the day) and adequate urinary output (> 1.5 L/day) should be maintained during sulfonamide administration. Renal function tests and urinalysis should be performed weekly or as often as indicated by the patient's status. Rarely, alkalinization of the urine is necessary.

References

  1. Smith E, Light J, Filo R, Yum M (1980) "Interstitial nephritis caused by trimethoprim-sulfamethoxazole in renal transplant recipients." JAMA, 244, p. 360-1
  2. Rudra T, Webb D, Evans A (1989) "Acute tubular necrosis following co-trimoxazole therapy." Nephron, 53, p. 85-6
  3. Cryst C, Hammar S (1988) "Acute granulomatous interstitial nephritis due to co-trimoxazole." Am J Nephrol, 8, p. 483-8
  4. Robson M, Levi J, Dolberg L, Rosenfeld J (1970) "Acute tubulo-interstitial nephritis following sulfadiazine therapy." Isr J Med Sci, 6, p. 561-6
  5. Finland M, Strauss E, Peterson O (1984) "Sulfadiazine." JAMA, 251, p. 1467-74
  6. Goadsby P, Donaghy A, Lloyd A, Wakefield D (1987) "Acquired immunodeficiency syndrome (AIDS) and sulfadiazine-associated acute renal failure." Ann Intern Med, 107, p. 783-4
  7. Sahai J, Heimberger R, Collins K, Kaplowitz L, Polk R (1988) "Sulfadiazine-induced crystalluria in a patient with the acquired immunodeficiency syndrome: a reminder." Am J Med, 84, p. 791-2
  8. Carbone L, Bendixen B, Appel G (1988) "Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome." Am J Kidney Dis, 12, p. 72-5
  9. Christin S, Baumelou A, Bahri S, Ben Hmida M, Deray G, Jacobs C (1990) "Acute renal failure due to sulfadiazine in patients with AIDS." Nephron, 55, p. 233-4
  10. Simon D, Brosius F, Rothstein D (1990) "Sulfadiazine crystalluria revisited." Arch Intern Med, 150, p. 2379-84
  11. Molina J, Belenfant X, Doco-Lecompte T, et al. (1991) "Sulfadiazine-induced crystalluria in AIDS patients with toxoplasma encephalitis." AIDS, 5, p. 587-9
  12. Marques L, Silva M, Madeira E, Santos O (1992) "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron, 62, p. 361
  13. Hekster C, Vree T (1982) "Clinical pharmacokinetics of sulphonamides and their N4-acetyl derivatives." Antibiot Chemother, 31, p. 22-118
  14. Adam W, Dawborn J (1970) "Urinary excretion and plasma levels of sulphonamides in patients with renal impairment." Australas Ann Med, 19, p. 250-4
  15. Madsen S (1966) "A comparative study of the excretion of sulfonamide-metabolites in cases of renal failure and hepatitis." Chemotherapy, 11, p. 1-9
  16. Andreasen F, Elsborg L, Husted S, Thomsen O (1978) "Pharmacokinetics of sulfadiazine and trimethoprim in man." Eur J Clin Pharmacol, 14, p. 57-67
  17. Bergan T, Brodwall E, Vik-Mo H, Anstad U (1979) "Pharmacokinetics of sulphadiazine, sulphamethoxazole and trimethoprim in patients with varying renal function." Infection, 7, s382-7
  18. Ortengren B, Fellner H, Bergan T (1979) "Development of sulphonamide-trimethoprim combinations for urinary tract infections. Part 2: Comparative pharmacokinetics of five sulphonamides." Infection, 7 Suppl 4, s367-70
  19. Stachowska B, Senczuk W (1987) "Studies on kinetics of sulfadiazine and trimethoprim excretion in man." Int J Clin Pharmacol Ther Toxicol, 25, p. 81-5
  20. Mannisto PT, Mantyla R, Mattila J, Nykanen S, Lamminsivu U (1982) "Comparison of pharmacokinetics of sulphadiazine and sulphamethoxazole after intravenous infusion." J Antimicrob Chemother, 9, p. 461-70
  21. Ohnhaus EE, Spring P (1975) "Elimination kinetics of sulfadiazine in patients with normal and impaired renal function." J Pharmacokinet Biopharm, 3, p. 171-9
  22. Ortengren B, Magni L, Bergan T (1979) "Development of sulphonamide-trimethoprim combinations for urinary tract infections. part 3: pharmacokinetic characterization of sulphadiazine and sulphamethoxazole." Infection, 7, s371-81
  23. Bergan T, Brodwall EK (1972) "Human pharmacokinetics of a sulfamethoxazole-trimethoprim combination." Acta Med Scand, 192, p. 483-92
  24. Adam WR, Henning M, Dawborn JK (1973) "Excretion of trimethoprim and sulphamethoxazole in patients with renal failure." Aust N Z J Med, 3, p. 383-7
  25. Kremers P, Duvivier J, Heusghem C (1974) "Pharmacokinetic studies of co-trimoxazole in man after single and repeated doses." J Clin Pharmacol, 14, p. 112-7
  26. Rieder J, Schwartz DE, Fernex M, et al. (1974) "Pharmacokinetics of the antibacterial combination sulfamethoxazole plus trimethoprim in patients with normal or impaired kidney function." Antibiot Chemother, 18, p. 148-98
  27. Bergan T, Brodwall EK, Vik-Mo H, Anstad U (1979) "Pharmacokinetics of sulphadiazine, sulphamethoxazole and trimethoprim in patients with varying renal function." Infection, 7, s382-7
  28. Patel RB, Welling PG (1980) "Clinical pharmacokinetics of co-trimoxazole (trimethoprim-sulphamethoxazole)." Clin Pharmacokinet, 5, p. 405-23
  29. Gleckman R, Gantz NM, Joubert DW (1981) "Intravenous sulfamethoxazole-trimethoprim: pharmacokinetics, therapeutic indications, and adverse reactions." Pharmacotherapy, 1, p. 206-11
  30. Vergin H, Ferber H, Zimmermann I, Neurath GB (1981) "Single and multiple dose kinetics of co-tetroxazine and co-trimoxazole in patients." Int J Clin Pharmacol Ther Toxicol, 19, p. 350-7
  31. Cohen M, Pocelinko R (1973) "Renal transport mechanisms for the excretion of sulfisoxazole." J Pharmacol Exp Ther, 185, p. 703-12
  32. Shermantine M, Gambertoglio J, Amend W, Vincenti F, Oie S (1985) "Pharmacokinetics of sulfisoxazole in renal transplant patients." Antimicrob Agents Chemother, 28, p. 535-9
  33. Boisvert A, Barbeau G, Belanger PM (1984) "Pharmacokinetics of sulfisoxazole in young and elderly subjects." Gerontology, 30, p. 125-31
  34. Kaplan SA, Weinfeld RE, Abruzzo CW, Lewis M (1972) "Pharmacokinetic profile of sulfisoxazole following intravenous, intramuscular, and oral administration to man." J Pharm Sci, 61, p. 773-8
  35. Klotz U (1985) "Clinical pharmacokinetics of sulphasalazine, its metabolites and other prodrugs of 5-aminosalicylic acid." Clin Pharmacokinet, 10, p. 285-302
  36. Dwarakanath AD, Michael J, Allan RN (1992) "Sulphasalazine-induced renal failure." Gut, 33, p. 1006-7
  37. Marques LP, Silva MT, Madeira EP, Santos OR (1992) "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron, 62, p. 361
  38. "Product Information. Gantranol (sulfamethoxazole)." Roche Laboratories, Nutley, NJ.
  39. (2001) "Product Information. Gantrisin (sulfisoxazole)." Roche Laboratories
  40. Sasson JP, Dratch PL, Shortsleeve MJ (1992) "Renal US findings in sulfadiazine-induced crystalluria." Radiology, 185, p. 739-40
  41. (2001) "Product Information. Sulfadiazine (sulfadiazine)." Eon Labs Manufacturing Inc
  42. Farinas MC, Echevarria S, Sampedro I, Gonzalez A, Perez del Molino A, Gonzalez-Macias J (1993) "Renal failure due to sulphadiazine in AIDS patients with cerebral toxoplasmosis." J Intern Med, 233, p. 365-7
  43. Hein R, Brunkhorst R, Thon WF, Schedel I, Schmidt RE (1993) "Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases." Clin Nephrol, 39, p. 254-6
  44. Erturk E, Casemento JB, Guertin KR, Kende AS (1994) "Bilateral acetylsulfapyridine nephrolithiasis associated with chronic sulfasalazine therapy." J Urol, 151, p. 1605-6
  45. Schroder H, Campbell DE (1972) "Absorption, metabolism, and excretion of salicylazosulfapyridine in man." Clin Pharmacol Ther, 13, p. 539-51
  46. (2001) "Product Information. Azulfidine (sulfasalazine)." Pharmacia and Upjohn
  47. Becker K, Jablonowski H, Haussinger D (1996) "Sulfadiazine-associated nephrotoxicity in patients with the acquired immunodeficiency syndrome." Medicine, 75, p. 185-94
View all 47 references
Major

Trimethoprim (applies to Co-trimoxazole) folate deficiency

Major Potential Hazard, High plausibility. Applicable conditions: Anemia Associated with Folate Deficiency, Folic Acid/Cyanocobalamin Deficiency, Renal Dysfunction, Hemolytic Anemia, Alcoholism, Malnourished

The use of trimethoprim is contraindicated in patients with documented megaloblastic anemia due to folate deficiency. Trimethoprim inhibits dihydrofolate reductase, an enzyme necessary in the synthesis of tetrahydrofolic acid, or the metabolically active form of folic acid. Thrombocytopenia, neutropenia, megaloblastic anemia, and methemoglobinemia have been reported rarely. However, the risk is increased in the presence of folate deficiency, chronic hemolytic anemia and/or renal impairment, as well as during prolonged therapy (e.g., > 6 months) with high dosages. Therapy with trimethoprim should be administered cautiously under these conditions and in patients with suspected folate depletion (e.g., elderly, alcoholic, malnourished or debilitated patients). Folic acid supplementation, if necessary, may be administered concomitantly without interfering with the antibacterial action of trimethoprim. Patients should be instructed to immediately report any signs or symptoms suggestive of hematologic toxicity such as fever, sore throat, local infection, bleeding, pallor, dizziness, or jaundice. Leucovorin (folinic acid) should be administered if bone marrow depression is detected.

References

  1. Chan M, Beale D, Moorhead J (1980) "Acute megaloblastosis due to cotrimoxazole." Br J Clin Pract, 34, p. 87-8
  2. Sheehan J (1981) "Trimethoprim-associated marrow toxicity." Lancet, 2, p. 692
  3. (2001) "Product Information. Trimpex (trimethoprim)." Roche Laboratories
  4. (2001) "Product Information. Proloprim (trimethoprim)." Glaxo Wellcome
View all 4 references
Moderate

Sulfonamides (applies to Co-trimoxazole) crystalluria

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Dehydration, Diarrhea, Vomiting

Crystalluria can occur during sulfonamide therapy due to precipitation of the sulfonamide and/or its N4-acetyl metabolite in the urinary tract. Renal toxicity such as uro- and nephrolithiasis, nephritis, toxic nephrosis, hematuria, proteinuria, and elevated BUN and creatinine has been reported. Hydration (8 oz. glass of water with each dose and throughout the day) and adequate urinary output (> 1.5 L/day) should be maintained during sulfonamide administration. Patients who are dehydrated (e.g., due to severe diarrhea or vomiting) may be at increased risk for the development of crystalluria and lithiasis and should be encouraged to consume additional amounts of liquid or given intravenous fluid. Renal function tests and urinalysis should be performed weekly during prolonged therapy (> 2 weeks). Rarely, alkalinization of the urine is necessary.

References

  1. Robson M, Levi J, Dolberg L, Rosenfeld J (1970) "Acute tubulo-interstitial nephritis following sulfadiazine therapy." Isr J Med Sci, 6, p. 561-6
  2. Finland M, Strauss E, Peterson O (1984) "Sulfadiazine." JAMA, 251, p. 1467-74
  3. Sahai J, Heimberger R, Collins K, Kaplowitz L, Polk R (1988) "Sulfadiazine-induced crystalluria in a patient with the acquired immunodeficiency syndrome: a reminder." Am J Med, 84, p. 791-2
  4. Simon D, Brosius F, Rothstein D (1990) "Sulfadiazine crystalluria revisited." Arch Intern Med, 150, p. 2379-84
  5. Molina J, Belenfant X, Doco-Lecompte T, et al. (1991) "Sulfadiazine-induced crystalluria in AIDS patients with toxoplasma encephalitis." AIDS, 5, p. 587-9
  6. "Product Information. Gantranol (sulfamethoxazole)." Roche Laboratories, Nutley, NJ.
  7. (2001) "Product Information. Gantrisin (sulfisoxazole)." Roche Laboratories
  8. Sasson JP, Dratch PL, Shortsleeve MJ (1992) "Renal US findings in sulfadiazine-induced crystalluria." Radiology, 185, p. 739-40
  9. (2001) "Product Information. Sulfadiazine (sulfadiazine)." Eon Labs Manufacturing Inc
  10. Hein R, Brunkhorst R, Thon WF, Schedel I, Schmidt RE (1993) "Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases." Clin Nephrol, 39, p. 254-6
  11. Erturk E, Casemento JB, Guertin KR, Kende AS (1994) "Bilateral acetylsulfapyridine nephrolithiasis associated with chronic sulfasalazine therapy." J Urol, 151, p. 1605-6
  12. (2001) "Product Information. Azulfidine (sulfasalazine)." Pharmacia and Upjohn
View all 12 references
Moderate

Sulfonamides (applies to Co-trimoxazole) hemodialysis

Moderate Potential Hazard, High plausibility.

The sulfonamides, sulfadiazine, sulfamethoxazole, and sulfisoxazole, are partially removed by hemodialysis and should be administered after dialysis.

References

  1. Adam W, Dawborn J (1970) "Urinary excretion and plasma levels of sulphonamides in patients with renal impairment." Australas Ann Med, 19, p. 250-4
  2. Patel RB, Welling PG (1980) "Clinical pharmacokinetics of co-trimoxazole (trimethoprim-sulphamethoxazole)." Clin Pharmacokinet, 5, p. 405-23
  3. Nissenson AR, Wilson C, Holazo A (1987) "Pharmacokinetics of intravenous trimethoprim-sulfamethoxazole during hemodialysis." Am J Nephrol, 7, p. 270-4
  4. "Product Information. Gantranol (sulfamethoxazole)." Roche Laboratories, Nutley, NJ.
  5. (2001) "Product Information. Gantrisin (sulfisoxazole)." Roche Laboratories
  6. (2001) "Product Information. Sulfadiazine (sulfadiazine)." Eon Labs Manufacturing Inc
View all 6 references
Moderate

Sulfonamides (applies to Co-trimoxazole) urinary obstruction

Moderate Potential Hazard, High plausibility. Applicable conditions: Urinary Retention

Sulfonamides are excreted and concentrated in the urine. Therapy with sulfonamides should be administered cautiously in patients with urinary obstruction or retention, since excessive drug accumulation may occur. These patients may also be at increased risk for sulfonamide crystalluria, which may be associated with renal toxicity such as uro- and nephrolithiasis, nephritis, toxic nephrosis, hematuria, proteinuria, and elevated BUN and creatinine. A urinary output of at least 1.5 L/day should be maintained during sulfonamide administration. Renal function tests and urinalysis should be performed weekly, especially during prolonged therapy (> 2 weeks).

References

  1. Sahai J, Heimberger R, Collins K, Kaplowitz L, Polk R (1988) "Sulfadiazine-induced crystalluria in a patient with the acquired immunodeficiency syndrome: a reminder." Am J Med, 84, p. 791-2
  2. Carbone L, Bendixen B, Appel G (1988) "Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome." Am J Kidney Dis, 12, p. 72-5
  3. Simon D, Brosius F, Rothstein D (1990) "Sulfadiazine crystalluria revisited." Arch Intern Med, 150, p. 2379-84
  4. Molina J, Belenfant X, Doco-Lecompte T, et al. (1991) "Sulfadiazine-induced crystalluria in AIDS patients with toxoplasma encephalitis." AIDS, 5, p. 587-9
  5. Marques L, Silva M, Madeira E, Santos O (1992) "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron, 62, p. 361
  6. Marques LP, Silva MT, Madeira EP, Santos OR (1992) "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron, 62, p. 361
  7. "Product Information. Gantranol (sulfamethoxazole)." Roche Laboratories, Nutley, NJ.
  8. (2001) "Product Information. Gantrisin (sulfisoxazole)." Roche Laboratories
  9. Sasson JP, Dratch PL, Shortsleeve MJ (1992) "Renal US findings in sulfadiazine-induced crystalluria." Radiology, 185, p. 739-40
  10. (2001) "Product Information. Sulfadiazine (sulfadiazine)." Eon Labs Manufacturing Inc
  11. Hein R, Brunkhorst R, Thon WF, Schedel I, Schmidt RE (1993) "Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases." Clin Nephrol, 39, p. 254-6
  12. Erturk E, Casemento JB, Guertin KR, Kende AS (1994) "Bilateral acetylsulfapyridine nephrolithiasis associated with chronic sulfasalazine therapy." J Urol, 151, p. 1605-6
  13. (2001) "Product Information. Azulfidine (sulfasalazine)." Pharmacia and Upjohn
View all 13 references
Moderate

Trimethoprim (applies to Co-trimoxazole) dialysis

Moderate Potential Hazard, High plausibility. Applicable conditions: hemodialysis

Trimethoprim is moderately removed by hemodialysis. Doses should either be scheduled for administration after dialysis or supplemental doses be given after dialysis.

References

  1. Patel RB, Welling PG (1980) "Clinical pharmacokinetics of co-trimoxazole (trimethoprim-sulphamethoxazole)." Clin Pharmacokinet, 5, p. 405-23
  2. Nissenson AR, Wilson C, Holazo A (1987) "Pharmacokinetics of intravenous trimethoprim-sulfamethoxazole during hemodialysis." Am J Nephrol, 7, p. 270-4
  3. (2001) "Product Information. Trimpex (trimethoprim)." Roche Laboratories
  4. (2001) "Product Information. Proloprim (trimethoprim)." Glaxo Wellcome
View all 4 references
Moderate

Trimethoprim (applies to Co-trimoxazole) renal dysfunction

Moderate Potential Hazard, High plausibility.

Trimethoprim is primarily eliminated by the kidney. The serum concentration of trimethoprim may be increased and the half-life prolonged in patients with impaired renal function. Dosage adjustments may be necessary and modifications should be based on the degree of renal impairment as well as severity of infection. The manufacturers recommend a dosage of 50 mg every 12 hours in patients with creatinine clearance between 15 to 30 mL/min and not using the drug in patients with creatinine clearance below 15 mL/min.

References

  1. Andreasen F, Elsborg L, Husted S, Thomsen O (1978) "Pharmacokinetics of sulfadiazine and trimethoprim in man." Eur J Clin Pharmacol, 14, p. 57-67
  2. Bergan T, Brodwall E, Vik-Mo H, Anstad U (1979) "Pharmacokinetics of sulphadiazine, sulphamethoxazole and trimethoprim in patients with varying renal function." Infection, 7, s382-7
  3. Adam WR, Henning M, Dawborn JK (1973) "Excretion of trimethoprim and sulphamethoxazole in patients with renal failure." Aust N Z J Med, 3, p. 383-7
  4. Rieder J, Schwartz DE, Fernex M, et al. (1974) "Pharmacokinetics of the antibacterial combination sulfamethoxazole plus trimethoprim in patients with normal or impaired kidney function." Antibiot Chemother, 18, p. 148-98
  5. Nolte H, Buttner H (1973) "Pharmacokinetics of trimethoprim and its combination with sulfamethoxazole in man after single and chronic oral administration." Chemotherapy, 18, p. 274-84
  6. Bergan T, Brodwall EK (1972) "Kidney transport in man of sulfamethoxazole and trimethoprim." Chemotherapy, 17, p. 320-33
  7. Odlind B, Hartvig P, Fjellstrom KE, Lindstrom B, Bengtsson S (1984) "Steady state pharmacokinetics of trimethoprim 300 mg once daily in healthy volunteers assessed by two independent methods." Eur J Clin Pharmacol, 26, p. 393-7
  8. Ahlmen J, Brorson J-E (1982) "Pharmacokinetics of trimethoprim given in single daily doses for three days." Scand J Infect Dis, 14, p. 143-5
  9. Hengstmann JH (1982) "Pharmacokinetics of trimethoprim and tetroxoprim: a review." Antibiot Chemother, 31, p. 211-24
  10. Watson ID, Stewart MJ, Wiles A, McIntosh SJ (1983) "Pharmacokinetics of two dosage levels of trimethoprim to "steady-state" in normal volunteers." J Int Med Res, 11, p. 137-44
  11. (2001) "Product Information. Trimpex (trimethoprim)." Roche Laboratories
View all 11 references

Co-trimoxazole drug interactions

There are 417 drug interactions with Co-trimoxazole (sulfamethoxazole / trimethoprim).

Co-trimoxazole alcohol/food interactions

There is 1 alcohol/food interaction with Co-trimoxazole (sulfamethoxazole / trimethoprim).


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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.