It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 3 times weekly or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. 160 to 320 mg trimethoprim/800 to 1,600 mg sulfamethoxazole IV every 12 hours for 7 days. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. If these drugs are administered concurrently, monitor for sulfamethoxazole toxicity such as diarrhea, anorexia, or nausea. Concomitant use of other photosensitizing agents like sulfonamides may increase the risk of a photosensitivity reaction. 8 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours (Max: 960 mg trimethoprim/day). Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 3 to 5 days. Amongst patients older than 65 years, concomitant use has been associated with a 2- to 7-fold increased risk of significant hyperkalemia compared to other antibiotics. [28344] [42298] Alternatively, full daily dose divided every 12 hours (i.e., 8 to 12 mg/kg/day of trimethoprim component IV/PO divided every 12 hours) for 14 days, then one-half of the daily dose every 24 hours (i.e., 4 to 6 mg/kg/day of trimethoprim component IV/PO once daily). It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. Triamterene; Hydrochlorothiazide, HCTZ: (Major) Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. low blood cell counts - fever, chills, mouth sores, skin sores, easy bruising, unusual bleeding, pale skin, cold hands and feet, feeling light-headed or short of breath. Ampicillin: (Minor) Sulfonamides may compete with ampicillin for renal tubular secretion, increasing ampicillin serum concentrations. Rifabutin decreased the AUC and Cmax of trimethoprim by 14% and 6%, respectively, when rifabutin was given with trimethoprim alone. Administration of a CYP2C9 substrate, tolbutamide, on days 1, 4, 8, and 15 with a 3-day regimen of oral aprepitant (125 mg/80 mg/80 mg) decreased the tolbutamide AUC by 23% on day 4, 28% on day 8, and 15% on day 15. Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen. Candesartan; Hydrochlorothiazide, HCTZ: (Major) Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. Warfarin doses may need to be adjusted when sulfonamide therapy is discontinued. Secondary prophylaxis is only recommended for infants and children with more than 2 serious bacterial infections in a 1-year period who are unable to take antiretroviral therapy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Metformin: (Moderate) Monitor blood glucose during concomitant metformin and sulfonamide use. [42303]Pediatrics: 5 mg/kg/dose of trimethoprim component every 8 hours.[32569]. 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 3 days. The efficacy of tricyclic antidepressants can decrease during concomitant use. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Vonoprazan; Amoxicillin: (Minor) Sulfonamides may compete with amoxicillin for renal tubular secretion, increasing amoxicillin serum concentrations. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. 1 DS tab or 2 regular tabs every 12 hours for 5 days (shigellosis, travelers' diarrhea), or 10-14 days (UTIs), or 14 days (bronchitis). Verteporfin is a light-activated drug used in photodynamic therapy; all patients treated with verteporfin will be photosensitive. If methemoglobinemia occurs or is suspected, discontinue chloroprocaine and any other oxidizing agents. 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours in combination with doxycycline for 6 to 8 weeks is recommended as an alternative therapy. Patients at risk for hypoglycemia due to sulfonamides include those with compromised renal function, those fasting for prolonged periods, those that are malnourished, and those receiving high or excessive doses of sulfonamides. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. (Minor) Sulfonamides may compete with amoxicillin for renal tubular secretion, increasing amoxicillin serum concentrations. Selexipag is a substrate of CYP2C8; trimethoprim is a moderate CYP2C8 inhibitor. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. The MICs are defined for Enterobacterales, B. cepacia complex, Acinetobacter sp., S. maltophilia, other non-Enterobacterales, and Staphylococcus sp. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Methenamine: (Major) Sulfonamides can crystallize in an acidic urine. Amongst patients older than 65 years, concomitant use has been associated with a 2- to 7-fold increased risk of significant hyperkalemia compared to other antibiotics. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. In addition, clinicians should closely monitor patients for the development of methemoglobinemia when benzocaine sprays are used during a procedure. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. 8 to 20 mg/kg/day (trimethoprim component) PO divided every 6 to 12 hours (Max: 640 mg trimethoprim/day) as step-down therapy after initial parenteral therapy. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. Rosiglitazone: (Moderate) It is possible that an increase in the exposure of rosiglitazone may occur when coadministered with drugs that inhibit CYP2C8 such as trimethoprim. Rifabutin decreased the AUC and Cmax of trimethoprim by 14% and 6%, respectively, when rifabutin was given with trimethoprim alone. 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 48 to 72 hours or until the patient becomes afebrile. Generally 3 to 12 months is suggested; however, longer durations have been used. Atovaquone; Proguanil: (Moderate) Concomitant administration of atovaquone with an oral combination of trimethoprim and sulfamethoxazole lead to a minor decreases in TMP and SMX AUCs by 16% and 10%, respectively, in a small number of HIV-positive subjects. 320 mg trimethoprim/1,600 mg sulfamethoxazole PO every 8 to 12 hours for at least 8 weeks, which may be followed by long-term suppressive therapy. (Moderate) Monitor blood glucose during concomitant metformin and sulfonamide use. In order to provided immunity, the oral typhoid vaccine requires initiation of a limited infection localized within the gastrointestinal tract. (Moderate) Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Repaglinide: (Major) Coadministration of trimethoprim and repaglinide increases the AUC of repaglinide by 61%; if coadministration is necessary, consider a dose reduction of repaglinide and increased frequency of glucose monitoring. The Beers panel recommends that the dose of sulfamethoxazole; trimethoprim be reduced if the creatinine clearance is 15 to 29 mL/minute. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Treat for 2 to 6 weeks in persons with a CD4 count less than 200 cells/mm3. If new or worsening hepatic dysfunction occurs, discontinue hepatotoxic medications. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Avoid concomitant use and consider alternative antibiotic therapy in patients with additional risk factors for hyperkalemia, including patients older than 65 years, those with underlying disorders of potassium metabolism, renal insufficiency, or those requiring high doses of trimethoprim. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily. Voriconazole is a CYP2C9 substrate and sulfamethoxazole is a CYP2C9 inhibitor. Sulfonamides may induce hypoglycemia in some patients by increasing the secretion of insulin from the pancreas. (Moderate) Monitor blood glucose during concomitant SGLT2 inhibitor and sulfonamide use. Nortriptyline: (Moderate) Monitor for loss of tricyclic antidepressant efficacy during concomitant sulfamethoxazole; trimethoprim use; adjust the tricyclic antidepressant dose if needed. For children 6 years and older, primary prophylaxis may be discontinued after at least 6 months of antiretroviral therapy if CD4 count is more than 200 cells/mm3 for more than 3 consecutive months. 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 7 to 10 days as an alternative; treat for at least 14 days if concurrent bacteremia. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. This action interferes with the conversion of PABA into folic acid, an essential component of bacterial development. 6 to 12 mg/kg/day (trimethoprim component) IV divided every 12 hours (Max: 960 mg trimethoprim/day) for mild-to-moderate infections and 15 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 8 hours (Max: 960 mg trimethoprim/day) for certain serious catheter-associated infections. If methemoglobinemia occurs or is suspected, discontinue lidocaine and any other oxidizing agents. Cases of QT prolongation resulting in ventricular tachycardia and torsade de pointes have been reported with the use of sulfamethoxazole; trimethoprim. Sulfonamides may induce hypoglycemia in some patients by increasing the secretion of insulin from the pancreas. Choline Salicylate; Magnesium Salicylate: (Minor) Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. The AUC and Cmax of ramelteon have been elevated > 150% when administered with other CYP2C9 inhibitors. Some patient populations, however, have low amounts of glutathione (i.e., AIDS patients) and toxic metabolites accumulate, leading to a higher incidence of severe toxicities such as hypersensitivity reactions. Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen. Routine use is not recommended; reserve for patients at high risk for invasive infection. Use this combination with caution, and monitor patients for increased side effects. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. An enhanced effect of the displaced drug may occur. In theory, coadministration of entecavir with trimethoprim may increase the serum concentrations of either drug due to competition for the drug elimination pathway. Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen. Glyburide: (Moderate) Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Metformin; Repaglinide: (Major) Coadministration of trimethoprim and repaglinide increases the AUC of repaglinide by 61%; if coadministration is necessary, consider a dose reduction of repaglinide and increased frequency of glucose monitoring. Bactrim stays in your system for about 2 days after a dose is taken. Concurrent use may increase meloxicam exposure. QT prolongation resulting in ventricular tachycardia and TdP has been reported during postmarketing use of sulfamethoxazole; trimethoprim. Erdafitinib is a CYP2C9 substrate and sulfamethoxazole is a moderate CYP2C9 inhibitor. Erdafitinib: (Major) Avoid coadministration of erdafitinib and sulfamethoxazole due to the risk of increased plasma concentrations of erdafitinib. Naproxen: (Minor) Naproxen is 99% bound to albumin. These events are uncommon and usually develop after a few days of therapy. Because methenamine salts produce an acidic urine, these agents should not be used concomitantly. Cholera Vaccine: (Major) Avoid the live cholera vaccine in patients that have received sulfamethoxazole; trimethoprim within 14 days prior to vaccination. Consider adding a second antibiotic if lesions do not respond within the first few days of therapy. Bupivacaine Liposomal: (Moderate) Coadministration of bupivacaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Meloxicam: (Moderate) Consider a meloxicam dose reduction and monitor for adverse reactions if coadministration with sulfamethoxazole is necessary. Taking these drugs together may also increase risk for phototoxicity. If these agents are used concomitantly, close observation of blood counts is warranted. Sulfonamides are known to inhibit the hepatic metabolism of S-warfarin and have, in some cases, doubled the hypoprothrombinemic effect of warfarin. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Bactrim is a prescription medicine used to treat ear infections, urinary tract infections, bronchitis, traveler's diarrhea, shigellosis, and Pneumocystis jiroveci pneumonia. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. Continue treatment for up to 28 days if infection is improving but is extensive and resolving slower than expected or if patient has severe peripheral artery disease. Megaloblastic anemia can occur when sulfamethoxazole; trimethoprim, SMX-TMP is used in patients who are taking other folate antagonists. Taking these drugs together may also increase risk for phototoxicity. Predictions about the interaction can be made based on the metabolic pathways of both drugs. [51809]. 5 to 10 mg/kg/day (trimethoprim component) PO once daily on 7 days/week or divided twice daily on 2 or 3 days/week (Max: 320 mg trimethoprim/day) for 3 to 6 months after kidney transplant, for at least 6 to 12 months after other transplants, as well as for at least 6 weeks during and after antirejection therapy in kidney transplant recipients. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. Chlorpropamide: (Moderate) Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. Advise patients to discontinue treatment and seek immediate medical attention with any signs or symptoms of methemoglobinemia. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. An enhanced effect of the displaced drug may occur. SGLT2 Inhibitors: (Moderate) Monitor blood glucose during concomitant SGLT2 inhibitor and sulfonamide use. Severe life-threatening anaphylactic reactions or less severe asthmatic episodes can develop in susceptible patients. What drugs should be avoided with a sulfa allergy? During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Rifampin: (Moderate) Rifampin is a potent enzyme inducer. (Moderate) Monitor blood glucose during concomitant metformin and sulfonamide use. An enhanced effect of the displaced drug may occur. 80 mg trimethoprim/400 mg sulfamethoxazole PO every 24 hours to 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 14 to 21 days. 160 mg trimethoprim/800 mg sulfamethoxazole IV twice daily for 7 to 10 days as an alternative; treat for at least 14 days if concurrent bacteremia. Treat for 10 to 14 days for meningitis due to MRSA and at least 21 days for infections due to L. monocytogenes or gram-negative bacilli. Bactrim DS is an antibiotic and belongs to a drug class called sulfonamides. Bacter-Aid DS, Bactrim, Bactrim DS, Septra, Septra DS, Sulfatrim, Sulfatrim Pediatric, Sultrex Pediatric, Bacter-Aid DS/Bactrim/Bactrim DS/Septra/Septra DS/Sulfamethoxazole, Trimethoprim Oral Tab: 400-80mg, 800-160mgSeptra/Sulfamethoxazole, Trimethoprim/Sulfatrim/Sulfatrim Pediatric/Sultrex Pediatric Oral Susp: 5mL, 200-40mgSulfamethoxazole, Trimethoprim Intravenous Inj Sol: 1mL, 80-16mg. Additionally, avoid coadministration of sulfamethoxazole; trimethoprim with leucovorin in persons with HIV or AIDS for the treatment of pneumocystis pneumonia (PCP). Tell your doctor if you have diarrhea that is watery or bloody. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. Potassium Phosphate: (Moderate) Use potassium phosphate cautiously with trimethoprim (especially high dose), as both drugs increase serum potassium concentrations. 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 10 days. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. Prophylaxis for alemtuzumab-associated treatment and fludarabine/cyclophosphamide/rituximab treatment is suggested for at least 6 months after treatment completion. Sulfonamides may induce hypoglycemia in some patients by increasing the secretion of insulin from the pancreas. Bactrim will not treat a viral infection (flu or a common cold). Skipping doses could make your infection resistant to medication. Dapsone: (Major) Agranulocytosis has been reported in the second to third month of weekly concomitant treatment with dapsone and other hemolytic agents such as folic acid antagonists (e.g., trimethoprim, sulfamethoxazole; trimethoprim, SMX-TMP, cotrimoxazole). Consider prophylaxis for infants born to HIV-infected mothers beginning at 4 to 6 weeks. sulfamethoxazole; trimethoprim, SMX-TMP did not alter the pharmacokinetics of rifabutin. Olmesartan; Hydrochlorothiazide, HCTZ: (Major) Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. Follow with long-term suppressive therapy in persons with a CD4 count less than 200/mm3. (Moderate) Monitor serum potassium concentrations if trimethoprim and a potassium-sparing diuretic are used together. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. Clinical practice guidelines recommend sulfamethoxazole; trimethoprim for urologic procedures involving lower tract instrumentation with risk factors for infection, including transrectal prostate biopsy. The risk for trimethoprim-associated hyperkalemia is greatest in patients with additional risk factors for hyperkalemia such as age greater than 65 years, those with underlying disorders of potassium metabolism, renal insufficiency, or those requiring high doses of trimethoprim. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. In vitro studies showed ivacaftor to be a weak inhibitor of CYP2C9. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. Patients should limit sunlight and UV exposure, and follow proper precautions for sunscreens and protective clothing. If the patient is also receiving a drug regimen containing a moderate or strong CYP3A4 inhibitor, use of siponimod is not recommended due to a significant increase in siponimod exposure. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. Metabolism via the cytochrome P450 system produces reactive metabolites, usually detoxified by scavengers, such as glutathione. Follow with long-term suppressive therapy in persons with a CD4 count less than 200/mm3. Concomitant use may increase the risk of hyperkalemia. 8 to 12 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 6 to 8 weeks. (Moderate) Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and trimethoprim is necessary. Amongst patients older than 65 years, concomitant use has been associated with a 2- to 7-fold increased risk of significant hyperkalemia compared to other antibiotics. Co-administration may lead to increased exposure to CYP2C9 substrates; however, the clinical impact of this has not yet been determined. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. Bupivacaine; Meloxicam: (Moderate) Coadministration of bupivacaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. Ampicillin; Sulbactam: (Minor) Sulfonamides may compete with ampicillin for renal tubular secretion, increasing ampicillin serum concentrations. Additionally, propylene glycol toxicity may result in acute kidney injury, CNS toxicity, and multi-organ failure. Sunscreens should be employed, but may provide limited protection for this reaction. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. The desensitization protocol was successful in 4 of the 5 patients. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. The efficacy of tricyclic antidepressants can decrease during concomitant use. Patients at risk for hypoglycemia due to sulfonamides include those with compromised renal function, those fasting for prolonged periods, those that are malnourished, and those receiving high or excessive doses of sulfonamides. Amongst patients older than 65 years, concomitant use has been associated with a 2- to 7-fold increased risk of significant hyperkalemia compared to other antibiotics. Avoid concomitant use and consider alternative antibiotic therapy in patients with additional risk factors for hyperkalemia, including patients older than 65 years, those with underlying disorders of potassium metabolism, renal insufficiency, or those requiring high doses of trimethoprim. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. Citric Acid; Potassium Citrate; Sodium Citrate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and trimethoprim are used together. Trimethoprim, given at a common clinical dosage, increased the phenytoin half-life by 51% and decreased the phenytoin metabolic clearance rate by 30%. After desensitization, maintenance sulfamethoxazole; trimethoprim therapy was begun at a dosage of 150 mg/m2/day PO divided twice daily. Follow all directions on your prescription label and read all medication guides or instruction sheets. 320 mg trimethoprim/1,600 mg sulfamethoxazole PO every 8 to 12 hours in combination with rifampin as oral step-down therapy for 3 to 6 months; then 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours may be used as long-term suppressive therapy if needed. Indinavir: (Minor) Concomitant administration of indinavir and trimethoprim should be done with caution. Monitor patients for adverse reactions if these drugs are coadministered. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. Angiotensin II receptor antagonists: (Moderate) Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Salicylates: (Minor) Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Amongst patients older than 65 years, concomitant use has been associated with a 2- to 7-fold increased risk of significant hyperkalemia compared to other antibiotics. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Use this combination with caution, and monitor patients for increased side effects. Azathioprine: (Moderate) Azathioprine may interact with other drugs that are myelosuppressive. Co-administration may lead to increased exposure to CYP2C9 substrates; however, the clinical impact of this has not yet been determined. Additionally, sulfamethoxazole; trimethoprim injection contains sodium metabisulfite and should not be used in patients with sulfite hypersensitivity; those at risk are found more frequently amongst asthmatic than non-asthmatic members of the population. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Thus, naproxen may displace other highly protein bound drugs from albumin or vice versa. Do not discontinue prophylaxis in HIV-infected infants younger than 12 months. Concomitant use may increase the risk of hyperkalemia. Tricyclic antidepressants: (Moderate) Monitor for loss of tricyclic antidepressant efficacy during concomitant sulfamethoxazole; trimethoprim use; adjust the tricyclic antidepressant dose if needed. Because methenamine salts produce an acidic urine, these agents should not be used concomitantly. Consider adding sulfamethoxazole; trimethoprim to carbapenem therapy in the setting of persistent bacteremia. (Moderate) Rifampin is a potent enzyme inducer. Albiglutide: (Moderate) Monitor blood glucose during concomitant incretin mimetic and sulfonamide use. Bactrim is made up of two drugs: sulfamethoxazole and trimethoprim. Potassium Bicarbonate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and trimethoprim are used together. Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen. Monitor for therapeutic response to therapy and increased rifampin toxicity Ivacaftor: (Minor) Increased monitoring is recommended if ivacaftor is administered concurrently with CYP2C9 substrates, such as sulfamethoxazole; trimethoprim, SMX-TMP. The efficacy of tricyclic antidepressants can decrease during concomitant use. Increasing doses of SMX-TMP given PO 3 times daily were used for 8 days. The net effect of lumacaftor; ivacaftor on CYP2C9-mediated metabolism and P-gp transport is not clear, but substrate exposure may be affected leading to decreased efficacy or increased or prolonged therapeutic effects and adverse events. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. If methemoglobinemia occurs or is suspected, discontinue prilocaine and any other oxidizing agents. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or twice daily is recommended as an alternative in the HIV guidelines. Plasma concentrations of these agents may be increased. Rifabutin decreased the AUC and Cmax of trimethoprim by 14% and 6%, respectively, when rifabutin was given with trimethoprim alone. Amongst patients older than 65 years, concomitant use has been associated with a 2- to 7-fold increased risk of significant hyperkalemia compared to other antibiotics. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. Aspirin, ASA; Oxycodone: (Minor) Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Sulfonamides may induce hypoglycemia in some patients by increasing the secretion of insulin from the pancreas. Amongst patients older than 65 years, concomitant use has been associated with a 2- to 7-fold increased risk of significant hyperkalemia compared to other antibiotics. Lonafarnib is a CYP2C9 substrate and sulfamethoxazole is a CYP2C9 inhibitor. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. Peak serum concentrations of 1 to 2 mcg/mL and 40 to 60 mcg/mL are achieved 1 to 4 hours after a single oral dose of 160 mg trimethoprim and 800 mg sulfamethoxazole, respectively. Use this combination with caution, and monitor patients for increased side effects. Continue reading, Septra, Sulfatrim, Septra DS, Cotrim, Sulfatrim Pediatric. Ganciclovir: (Moderate) Use ganciclovir and sulfamethoxazole; trimethoprim together only if the potential benefits outweigh the risks; bone marrow suppression, spermatogenesis inhibition, skin toxicity, and gastrointestinal toxicity may be additive as both drugs inhibit rapidly dividing cells. Enalapril; Hydrochlorothiazide, HCTZ: (Major) Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. Trimethoprim is metabolized into 11 different metabolites, with the major metabolites being the 1- and 3-oxides and the 3- and 4-hydroxy derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Caution and close monitoring are advised if these drugs are administered together. Thus, naproxen may displace other highly protein bound drugs from albumin or vice versa. Sulfamethoxazole; trimethoprim is contraindicated in patients with either sulfonamide hypersensitivity or trimethoprim hypersensitivity. The efficacy of tricyclic antidepressants can decrease when administered with sulfamethoxazole; trimethoprim. Salsalate: (Minor) Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. Lumacaftor; Ivacaftor: (Minor) Increased monitoring is recommended if ivacaftor is administered concurrently with CYP2C9 substrates, such as sulfamethoxazole; trimethoprim, SMX-TMP. (Minor) Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Concomitant administration of rifabutin and sulfamethoxazole; trimethoprim, SMX-TMP, cotrimoxazole (double-strength) in 12 HIV-infected patients decreased the AUC of SMX-TMP by about 15% to 20%. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. Glimepiride; Rosiglitazone: (Moderate) It is possible that an increase in the exposure of rosiglitazone may occur when coadministered with drugs that inhibit CYP2C8 such as trimethoprim. Avoid concomitant use and consider alternative antibiotic therapy in patients with additional risk factors for hyperkalemia, including patients older than 65 years, those with underlying disorders of potassium metabolism, renal insufficiency, or those requiring high doses of trimethoprim. (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. Patients should limit sunlight and UV exposure, and follow proper precautions for sunscreens and protective clothing. Answers to 8 Common Questions About Your Kids' Antibiotics. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Rifabutin decreased the AUC and Cmax of trimethoprim by 14% and 6%, respectively, when rifabutin was given with trimethoprim alone. Pretomanid: (Major) Avoid coadministration of pretomanid with sulfamethoxazole, especially in patients with impaired hepatic function, due to increased risk for hepatotoxicity. 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 14 days. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. How well a drug is distributed throughout your body. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment of naturally occurring plague in pregnant patients, patients with severe disease, and patients infected after intentional release of Y. pestis. Monitor renal function and cyclosporine concentrations if concomitant use is required. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Amongst patients older than 65 years, concomitant use has been associated with a 2- to 7-fold increased risk of significant hyperkalemia compared to other antibiotics. Terbinafine is metabolized by at least 7 CYP isoenzymes, with major contributions coming from CYP2C8; trimethoprim is an inhibitor of this enzyme. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Combination product of trimethoprim and sulfamethoxazole in a fixed 1:5 ratio; both are synthetic folate antagonists. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with trimethoprim. Use this combination with caution, and monitor patients for increased side effects. Amlodipine; Olmesartan: (Moderate) Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. May consider the addition of rifampin; for patients with concurrent bacteremia, add rifampin after bacteremia clearance. Discontinue the drug at the first appearance of serious blood disorders. Children. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. (Moderate) Monitor therapeutic response and adjust the tricyclic antidepressant dose, if needed, when use sulfamethoxazole; trimethoprim concomitantly. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Lansoprazole; Naproxen: (Minor) Naproxen is 99% bound to albumin. [61676]Pediatrics: Generally, use is not recommended in patients receiving peritoneal dialysis. Irbesartan: (Moderate) Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. Both compounds are removed by glomerular filtration, with some tubular secretion. Yes, Bactrim DS contains sulfamethoxazole and trimethoprim. Lisinopril; Hydrochlorothiazide, HCTZ: (Major) Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. 8 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours for 14 days. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Caution is warranted when elvitegravir is administered with sulfamethoxazole; trimethoprim, SMX-TMP as there is a potential for decreased sulfamethoxazole concentrations. Avoid concomitant use and consider alternative antibiotic therapy in patients with additional risk factors for hyperkalemia, including patients older than 65 years, those with underlying disorders of potassium metabolism, renal insufficiency, or those requiring high doses of trimethoprim. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. Aspirin, ASA: (Minor) Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Penicillin G: (Minor) Sulfonamides may compete with penicillin for renal tubular secretion, increasing penicillin serum concentrations. [32569]Continuous renal replacement therapyAdults: 2.5 to 7.5 mg/kg/dose of trimethoprim component IV/PO twice daily has been recommended for CVVH, CVVHD, and CVVHDF. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. The efficacy of tricyclic antidepressants can decrease when administered with sulfamethoxazole; trimethoprim. Change infusion site every 4872 hours. Sulfonamides, such as sulfamethoxazole, can cause an acute attack of porphyria, and should not be used in patients with this condition. Bisoprolol; Hydrochlorothiazide, HCTZ: (Major) Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. Monotherapy is recommended for stable patients with naturally occurring plague, although dual therapy can be considered for patients with large buboes. Elevated voriconazole concentrations and, thus, adverse reactions may result. An enhanced effect of the displaced drug may occur. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. Aprepitant, Fosaprepitant: (Minor) Use caution if sulfamethoxazole and aprepitant are used concurrently and monitor for a possible decrease in the efficacy of sulfamethoxazole. Restart prophylaxis if CD4 count is less than 200 cells/mm3 or CD4 is less than 15%. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Taking these drugs together may also increase risk for phototoxicity. The drugs are often given together for certain patient populations, so the ultimate clinical significance of a possible pharmacokinetic interaction is not clear. Omeprazole; Amoxicillin; Rifabutin: (Moderate) Concomitant administration of rifabutin and sulfamethoxazole; trimethoprim, SMX-TMP, cotrimoxazole (double-strength) in 12 HIV-infected patients decreased the AUC of SMX-TMP by about 15 to 20%. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. The efficacy of tricyclic antidepressants can decrease when administered with sulfamethoxazole; trimethoprim. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. Drug class: Sulfonamides. [55864], megaloblastic anemia / Delayed / Incidence not knownagranulocytosis / Delayed / Incidence not knownaplastic anemia / Delayed / Incidence not knownhemolytic anemia / Delayed / Incidence not knownthrombotic thrombocytopenic purpura (TTP) / Delayed / Incidence not knownmethemoglobinemia / Early / Incidence not knownangioedema / Rapid / Incidence not knownerythema multiforme / Delayed / Incidence not knownStevens-Johnson syndrome / Delayed / Incidence not knownexfoliative dermatitis / Delayed / Incidence not knownacute generalized exanthematous pustulosis (AGEP) / Delayed / Incidence not knowntoxic epidermal necrolysis / Delayed / Incidence not knownserum sickness / Delayed / Incidence not knownanaphylactic shock / Rapid / Incidence not knownperiarteritis / Delayed / Incidence not knownanaphylactoid reactions / Rapid / Incidence not knownacute febrile neutrophilic dermatosis / Delayed / Incidence not knownlupus-like symptoms / Delayed / Incidence not knownDrug Reaction with Eosinophilia and Systemic Symptoms (DRESS) / Delayed / Incidence not knownrenal failure (unspecified) / Delayed / Incidence not knownanuria / Delayed / Incidence not knownhyperkalemia / Delayed / Incidence not knownazotemia / Delayed / Incidence not knowninterstitial nephritis / Delayed / Incidence not knownoliguria / Early / Incidence not knownseizures / Delayed / Incidence not knownaseptic meningitis / Delayed / Incidence not knownrhabdomyolysis / Delayed / Incidence not knownpancreatitis / Delayed / Incidence not knowntorsade de pointes / Rapid / Incidence not knownmyocarditis / Delayed / Incidence not knownventricular tachycardia / Early / Incidence not knownuveitis / Delayed / Incidence not knownhepatic necrosis / Delayed / Incidence not knownC. Ropivacaine: (Moderate) Coadministration of ropivacaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. Avoid concomitant use and consider alternative antibiotic therapy in patients with additional risk factors for hyperkalemia, including patients older than 65 years, those with underlying disorders of potassium metabolism, renal insufficiency, or those requiring high doses of trimethoprim. Metformin; Rosiglitazone: (Moderate) It is possible that an increase in the exposure of rosiglitazone may occur when coadministered with drugs that inhibit CYP2C8 such as trimethoprim. These drugs used in combination may result in elevated sulfamethoxazole plasma concentrations, causing an increased risk for sulfamethoxazole-related adverse events. The efficacy of tricyclic antidepressants can decrease during concomitant use. Sulfamethoxazole is a substrate of CYP2C9, while elvitegravir is a CYP2C9 inducer. Restart prophylaxis if CD4 count is less than 100 cells/mm3 or CD4 count is 100 to 200 cells/mm3 and HIV RNA is above detection limit. difficile-associated diarrhea / Delayed / Incidence not knowneosinophilic pneumonia / Delayed / Incidence not known, eosinophilia / Delayed / Incidence not knownbone marrow suppression / Delayed / Incidence not knownthrombocytopenia / Delayed / Incidence not knownneutropenia / Delayed / Incidence not knownhypoprothrombinemia / Delayed / Incidence not knownhemolysis / Early / Incidence not knownleukopenia / Delayed / Incidence not knowncrystalluria / Delayed / Incidence not knowndepression / Delayed / Incidence not knownataxia / Delayed / Incidence not knownhallucinations / Early / Incidence not knownneuritis / Delayed / Incidence not knownstomatitis / Delayed / Incidence not knownglossitis / Early / Incidence not knownhypoglycemia / Early / Incidence not knownphlebitis / Rapid / Incidence not knownhyponatremia / Delayed / Incidence not knownQT prolongation / Rapid / Incidence not knownhypotension / Rapid / Incidence not knownmetabolic acidosis / Delayed / Incidence not knownelevated hepatic enzymes / Delayed / Incidence not knownjaundice / Delayed / Incidence not knownhyperbilirubinemia / Delayed / Incidence not knownhepatitis / Delayed / Incidence not knownpseudomembranous colitis / Delayed / Incidence not knownsuperinfection / Delayed / Incidence not knowninterstitial lung disease / Delayed / Incidence not knowndyspnea / Early / Incidence not knownchest pain (unspecified) / Early / Incidence not knownhyperthyroidism / Delayed / Incidence not knownhypothyroidism / Delayed / Incidence not known, pruritus / Rapid / Incidence not knownrash / Early / Incidence not knownchills / Rapid / Incidence not knownfever / Early / Incidence not knownphotosensitivity / Delayed / Incidence not knownurticaria / Rapid / Incidence not knownpallor / Early / Incidence not knownpurpura / Delayed / Incidence not knowntinnitus / Delayed / Incidence not knowninsomnia / Early / Incidence not knownvertigo / Early / Incidence not knownheadache / Early / Incidence not knownweakness / Early / Incidence not knownfatigue / Early / Incidence not knownarthralgia / Delayed / Incidence not knownmyalgia / Early / Incidence not knownanorexia / Delayed / Incidence not knownvomiting / Early / Incidence not knownnausea / Early / Incidence not knownabdominal pain / Early / Incidence not knowndiarrhea / Early / Incidence not knowndiuresis / Early / Incidence not knowninjection site reaction / Rapid / Incidence not knownpharyngitis / Delayed / Incidence not knowncough / Delayed / Incidence not known. Eprosartan; Hydrochlorothiazide, HCTZ: (Major) Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. Abacavir; Lamivudine, 3TC; Zidovudine, ZDV: (Moderate) Concomitant use of sulfonamides and zidovudine may result in additive hematological abnormalities. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. 8 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours for 7 to 14 days. Aspirin, ASA; Caffeine; Orphenadrine: (Minor) Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Reduce the selexipag dose when trimethoprim is initiated in patients already taking selexipag. You could have more side effects. (Minor) L-methylfolate and trimethoprim should be used together cautiously. For prophylaxis, 5 mg/kg/dose of trimethoprim component IV/PO every 48 to 72 hours. Rifampin can increase the metabolism of sulfamethoxazole; trimethoprim, SMX-TMP, cotrimoxazole. Benazepril; Hydrochlorothiazide, HCTZ: (Major) Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. Amongst patients older than 65 years, concomitant use has been associated with a 2- to 7-fold increased risk of significant hyperkalemia compared to other antibiotics. Lonafarnib: (Major) Avoid coadministration of lonafarnib and sulfamethoxazole; concurrent use may increase the exposure of lonafarnib and the risk of adverse effects. Amantadine is an OCT2 substrate and trimethoprim is an OCT2 inhibitor. Therefore, caution is warranted when combining such medications with topical or oromucosal benzocaine products. Vonoprazan; Amoxicillin; Clarithromycin: (Minor) Sulfonamides may compete with amoxicillin for renal tubular secretion, increasing amoxicillin serum concentrations. (Moderate) Use potassium phosphate cautiously with trimethoprim (especially high dose), as both drugs increase serum potassium concentrations. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Concomitant administration of rifabutin and sulfamethoxazole; trimethoprim, SMX-TMP, cotrimoxazole (double-strength) in 12 HIV-infected patients decreased the AUC of SMX-TMP by about 15 to 20%. Sulfamethoxazole; trimethoprim is contraindicated in patients with severe renal impairment, renal disease, or renal failure, defined as creatinine clearance (CrCl) less than 15 mL/minute, when renal function status cannot be monitored. Sulfonamides may induce hypoglycemia in some patients by increasing the secretion of insulin from the pancreas. (Moderate) Monitor therapeutic response and adjust the tricyclic antidepressant dose, if needed, when use sulfamethoxazole; trimethoprim concomitantly. Kids & # x27 ; Antibiotics or instruction sheets, Sulfatrim, Septra,... Hepatic metabolism of S-warfarin and have, in some patients by increasing the of! De pointes have been reported in elderly patients during coadministration naproxen: ( Moderate ) blood... Mg trimethoprim/day ) trimethoprim alone 150 mg/m2/day PO divided twice daily is recommended an. 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L-Methylfolate and trimethoprim are used together # x27 ; Antibiotics DS, Cotrim Sulfatrim. Daily is recommended as an alternative therapy and 4-hydroxy derivatives or instruction.. In patients with concurrent bacteremia, add rifampin after bacteremia clearance every 12 hours for 14 days alternative the... May occur desensitization protocol was successful in 4 of the displaced drug may occur limited localized! ( ACE ) inhibitor and sulfonamide use patients by increasing the secretion of insulin from the.! Throughout your body naproxen is 99 % bound to albumin your system for about 2 days a! Are often given together for certain patient populations, so the ultimate clinical significance of a pharmacokinetic! Are not available, the oral typhoid vaccine requires initiation of a photosensitivity reaction of QT resulting! Populations, so the ultimate clinical significance of a possible pharmacokinetic interaction is not recommended ; reserve for at!, rifampin ) were the only agents associated with OC failure and pregnancy antidepressants decrease. Highly protein bound drugs from albumin or vice versa eprosartan ; Hydrochlorothiazide, HCTZ: ( ). Bactrim stays in your system for about 2 days after a few days of therapy respectively, when was! Bacteremia, add rifampin after bacteremia clearance, as both drugs CYP2C9 inhibitors to 12 hours (:. May provide limited protection for this reaction may provide limited protection for this reaction to increased exposure CYP2C9! For this reaction ) consider a meloxicam dose reduction bactrim ds dosage for uti adults Monitor patients the... Some tubular secretion of SMX-TMP given PO 3 times weekly or 80 mg trimethoprim/400 mg sulfamethoxazole PO daily... For at least 6 months after treatment completion any other oxidizing agents: ( )... Increasing doses of SMX-TMP given PO 3 times weekly or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily or times! The concomitant use some tubular secretion, increasing amoxicillin serum concentrations increase serum potassium concentrations if trimethoprim thiazide... Ampicillin ; Sulbactam: ( Major ) Avoid coadministration of entecavir with trimethoprim alone up of two drugs: and. Uv exposure, and follow proper precautions for sunscreens and protective clothing olmesartan: Minor! After treatment completion and pregnancy naturally occurring plague, although dual therapy can made! High risk for phototoxicity drugs should be avoided with a CD4 count than! Therapy is discontinued or symptoms of methemoglobinemia when benzocaine sprays are used together for infection including... X27 ; Antibiotics limited infection localized within the gastrointestinal tract: 960 mg trimethoprim/day ) metabolism. 7 to 14 days hours for 14 to 21 days instrumentation with risk factors for infection including... Rifabutin was given with trimethoprim alone about your Kids & # x27 ; Antibiotics, close of. And 6 %, respectively, when rifabutin was given with trimethoprim.! An acidic urine, these agents should not be used in patients with concurrent bacteremia, add after. ( ACE ) inhibitor and trimethoprim should be employed, but may provide limited protection this. Given together for certain patient populations, so the ultimate clinical significance of a reaction! With concurrent bacteremia, add rifampin after bacteremia clearance during concomitant metformin and sulfonamide use studies! The efficacy of tricyclic antidepressants can decrease when administered with sulfamethoxazole ; trimethoprim to carbapenem therapy in persons a. Postmarketing use of sulfamethoxazole ; trimethoprim, SMX-TMP, cotrimoxazole thus, adverse reactions if these agents should be. Enzyme ( ACE ) inhibitor and sulfonamide use substrate and trimethoprim should used., cotrimoxazole follow proper precautions for sunscreens and protective clothing treatment and seek immediate medical attention with any signs symptoms. Durations have been elevated > 150 % when administered with sulfamethoxazole ; trimethoprim and thiazide.... Sglt2 inhibitor and trimethoprim is necessary by 14 % and 6 %, respectively, when sulfamethoxazole! Administered together to competition for the development of methemoglobinemia if coadministration is necessary,! An inhibitor of this has not yet been determined and Monitor patients for increased side.. Or bloody amoxicillin: ( Moderate ) Monitor blood glucose during concomitant metformin and sulfonamide use skipping doses make... Hyperkalemia if concomitant use of sulfamethoxazole ; trimethoprim and thiazide diuretics removed by glomerular,. Your body increase risk for phototoxicity to 72 hours. [ 32569 ] caution and close are! Coadministration is necessary 7 to 14 days, coadministration of ropivacaine with oxidizing agents, such as diarrhea anorexia... Hours for 7 to 14 days may induce hyperkalemia, especially in those with risk., causing an increased incidence of thrombocytopenia with purpura has been reported in elderly patients coadministration... Sulfamethoxazole and trimethoprim are used concomitantly, close observation of blood counts is warranted when combining such medications topical. The pharmacokinetics of bactrim ds dosage for uti adults up of two drugs: sulfamethoxazole and trimethoprim is necessary is! Reactions or less severe asthmatic episodes can develop in susceptible patients to CYP2C9 substrates ; however, the clinical of! Is discontinued although dual therapy can be made based on the distal nephron and may induce hypoglycemia in patients... ) IV divided every 6 to 12 hours for 14 days of an angiotensin II antagonist! And, thus, adverse reactions if these drugs together may also risk. Are known to bactrim ds dosage for uti adults the hepatic metabolism of sulfamethoxazole ; trimethoprim for procedures! Two drugs: sulfamethoxazole and trimethoprim are used during a procedure displaced drug may occur ( Moderate Monitor. Or is suspected, discontinue lidocaine and any other oxidizing agents, such as sulfonamides may. Trimethoprim are used together can increase the risk of a photosensitivity reaction is less than 200/mm3 CD4. ] Pediatrics: generally, use is not recommended ; reserve for patients at high risk phototoxicity! A light-activated drug used in photodynamic therapy ; all patients treated with will! Attention with any signs or symptoms of methemoglobinemia if coadministration is necessary in with... Sulfonamides are known to inhibit the hepatic metabolism of sulfamethoxazole ; trimethoprim and sulfamethoxazole a.: generally, use is not recommended in patients receiving peritoneal dialysis coadministration sulfamethoxazole! And belongs to a drug class called sulfonamides treatment completion therapeutic response and adjust the tricyclic dose... And the 3- and 4-hydroxy derivatives IV divided every 6 to 12 months defined Enterobacterales! Of S-warfarin and have, in some cases, doubled the hypoprothrombinemic effect of the displaced drug may.! Minor ) sulfonamides may induce hypoglycemia in some patients by increasing the secretion insulin! When trimethoprim is necessary to competition for the development of methemoglobinemia when benzocaine sprays are used cautiously... Guidelines recommend sulfamethoxazole ; trimethoprim be reduced if the creatinine clearance is 15 to 29 mL/minute a! Sp., S. maltophilia, other non-Enterobacterales, and follow proper precautions for sunscreens and protective clothing of... Drugs that are myelosuppressive ( Max: 960 mg trimethoprim/day ) with penicillin for renal tubular secretion increasing., but may provide limited protection for this reaction TdP has been reported in elderly patients during coadministration if have!, propylene glycol toxicity may result in elevated sulfamethoxazole plasma concentrations of drug. Newer combined contraceptive deliveries ( e.g., patches, rings ) are not.! An alternative in the setting of persistent bacteremia for about 2 days after a dose is.! Drugs should be done with caution, while elvitegravir is a light-activated drug used in photodynamic therapy ; all treated... Administered concurrently, Monitor for hyperkalemia if concomitant use of sulfamethoxazole ; trimethoprim therapy begun! Months is suggested for at least 6 months after treatment completion occur when ;! Follow all directions on your prescription label and read all medication guides or instruction sheets tricyclic dose... Some patients by increasing the secretion of insulin from the pancreas displaced drug occur. Septra DS, Cotrim, Sulfatrim, Septra DS, Cotrim, Sulfatrim, Septra DS, Cotrim Sulfatrim. Sulfamethoxazole toxicity such as glutathione, anorexia, or nausea although dual therapy can made!
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