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Drug Interactions between fosphenytoin and sulfamethoxazole

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

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Interactions between your drugs

Moderate

sulfamethoxazole fosphenytoin

Applies to: sulfamethoxazole and fosphenytoin

MONITOR: Some sulfonamides may inhibit the hepatic metabolism of hydantoins. Serum hydantoin levels and risk of toxicity may be increased. Data are available for sulfadiazine, sulfaphenazole, and sulfamethizole.

MANAGEMENT: Monitoring for clinical and laboratory evidence of altered efficacy and safety is recommended. Hydantoin dosage adjustments or an alternate antimicrobial may be required if an interaction is suspected. Patients should be advised to notify their physician if they experience symptoms of hydantoin toxicity (e.g., drowsiness, visual disturbances, change in mental status, seizures, nausea, or ataxia).

References (2)
  1. Lumholtz B, Siersbaek-Nielsen K, Skovsted L, Kampmann J, Hansen JM (1975) "Sulfamethizole-induced inhibition of diphenylhydantoin, tolbutamide, and warfarin metabolism." Clin Pharmacol Ther, 17, p. 731-4
  2. Hansen JM, Kampmann JP, Siersback-Nielsen K, et al. (1979) "The effect of different sulfonamides on phenytoin metabolism in man." Acta Med Scand Suppl, 624, p. 106-10

Drug and food interactions

Moderate

sulfamethoxazole food

Applies to: sulfamethoxazole

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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