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Drug Interactions between Cotrim Pediatric and hyoscyamine / methenamine / methylene blue / phenyl salicylate

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

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Interactions between your drugs

Major

methenamine sulfamethoxazole

Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate and Cotrim Pediatric (sulfamethoxazole / trimethoprim)

CONTRAINDICATED: Some sulfonamides can form an insoluble precipitate with formaldehyde, which is generated from the hydrolysis of methenamine in acidic urine maintained by the presence of hippuric acid.

MANAGEMENT: Methenamine preparations should not be given to patients taking sulfonamides due to the risk of crystalluria. An alkalinizing agent should not be added because this may render methenamine less effective.

References

  1. "Product Information. Urised (methenamine)." Polymedica Pharmaceuticals USA Inc PROD (2001):
  2. "Product Information. Hiprex (methenamine)." Hoechst Marion Roussel PROD (2002):

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Drug and food interactions

Moderate

sulfamethoxazole food

Applies to: Cotrim 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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Moderate

hyoscyamine food

Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate

GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.

References

  1. Linnoila M "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol 6 (1973): 107-12

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Urinary anti-infectives

Therapeutic duplication

The recommended maximum number of medicines in the 'urinary anti-infectives' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'urinary anti-infectives' category:

  • Cotrim Pediatric (sulfamethoxazole/trimethoprim)
  • hyoscyamine/methenamine/methylene blue/phenyl salicylate

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

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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