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Drug Interactions between ashwaganda and Bactrim

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

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Interactions between your drugs

Moderate

sulfamethoxazole ashwagandha

Applies to: Bactrim (sulfamethoxazole / trimethoprim) and ashwaganda

MONITOR: Concomitant use of ashwagandha with other agents that are known to induce hepatotoxicity may theoretically increase the risk of hepatotoxicity. There are case reports of adverse effects on liver functions associated with ashwagandha use. In a case report, a 20-year-old man in Japan developed liver dysfunction and hyperbilirubinemia after using ashwagandha in combination with multiple antianxiety drugs. In additional case reports, three men and two women, age range 21 to 62 years who reportedly took supplements containing 450 to 1,350 mg ashwagandha daily over the course of one week to four months when signs of liver injury, such as jaundice, pruritus, nausea, lethargy, abdominal discomfort, and hyperbilirubinemia, appeared.

MANAGEMENT: Liver function tests should be monitored, and patients should be advised to report any symptoms such as abdominal pain, jaundice, dark urine, light stools, fever, or unusual fatigue.

References (6)
  1. (2024) "Product Information. Ashwagandha (ashwagandha)." Now Foods, 1
  2. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health Office of Dietary Supplements Ashwagandha https://www.nccih.nih.gov/health/ashwagandha
  3. inagaki k, mori n, honda y, takaki k, tsuji k (2017) "A case of drug-induced liver injury with prolonged severe intrahepatic cholestasis induced by Ashwagandha" Kanzo, 58, p. 448-454
  4. Bjornsson HK, Bjornsson ES, Avula B, Khan IA, Jonasson JG (2020) "Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network" Liver Int, 40, p. 825-829
  5. Lubarska M, Halasinski P, Hryhorowicz S, et al. (2023) "Liver Dangers of Herbal Products" Int J Environ Res Public Health, 20, p. 3921
  6. Ireland PJ, Hardy T, burt ad, Donnelly MC (2021) "Drug-induced hepatocellular injury due to herbal supplement ashwagandha" J R Coll Surg Edinb, 51, p. 363-365

Drug and food interactions

Moderate

sulfamethoxazole food

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

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.

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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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