Drug Interactions between Bactrim and fecal microbiota spores, live

ADJUST DOSING INTERVAL: There are no data regarding the effects of concurrent administration of oral fecal microbiota spores with food.

MANAGEMENT: The manufacturer of the oral formulation of fecal microbiota recommends that patients should have no food or drink except for a small amount of water for at least 8 hours prior to the first dose of fecal microbiota spores. The second and third doses of fecal microbiota spores should be taken on an empty stomach prior to the first meal of the day.

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.