Co-administration of Bactrim and leucovorin should be avoided with P. Electrolyte Abnormalities High dosage of trimethoprim, as used in patients with P. Even treatment with recommended doses may cause hyperkalemia when trimethoprim is administered to patients with underlying disorders of potassium metabolism, with renal insufficiency, or if drugs known to induce hyperkalemia are given concomitantly. Close monitoring of serum potassium is warranted in these patients. Severe and symptomatic hyponatremia can occur in patients receiving Bactrim, particularly for the treatment of P.
Evaluation for hyponatremia and appropriate correction is necessary in symptomatic patients to prevent life-threatening complications. During treatment, adequate fluid intake and urinary output should be ensured to prevent crystalluria. Patients who are "slow acetylators" may be more prone to idiosyncratic reactions to sulfonamides. Information for Patients: Patients should be counseled that antibacterial drugs including Bactrim sulfamethoxazole and trimethoprim tablets should only be used to treat bacterial infections. They do not treat viral infections e.
When Bactrim sulfamethoxazole and trimethoprim tablets are prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may 1 decrease the effectiveness of the immediate treatment and 2 increase the likelihood that bacteria will develop resistance and will not be treatable by Bactrim sulfamethoxazole and trimethoprim tablets or other antibacterial drugs in the future. Patients should be instructed to maintain an adequate fluid intake in order to prevent crystalluria and stone formation.
Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools with or without stomach cramps and fever even as late as two or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible. Laboratory Tests: Complete blood counts should be done frequently in patients receiving Bactrim; if a significant reduction in the count of any formed blood element is noted, Bactrim should be discontinued.
Urinalyses with careful microscopic examination and renal function tests should be performed during therapy, particularly for those patients with impaired renal function. Drug Interactions: Sulfamethoxazole is an inhibitor of CYP2C9. In elderly patients concurrently receiving certain diuretics, primarily thiazides, an increased incidence of thrombocytopenia with purpura has been reported. It has been reported that Bactrim may prolong the prothrombin time in patients who are receiving the anticoagulant warfarin a CYP2C9 substrate.
This interaction should be kept in mind when Bactrim is given to patients already on anticoagulant therapy, and the coagulation time should be reassessed. Bactrim may inhibit the hepatic metabolism of phenytoin a CYP2C9 substrate. When administering these drugs concurrently, one should be alert for possible excessive phenytoin effect. Sulfonamides can also displace methotrexate from plasma protein binding sites and can compete with the renal transport of methotrexate, thus increasing free methotrexate concentrations. There have been reports of marked but reversible nephrotoxicity with coadministration of Bactrim and cyclosporine in renal transplant recipients.
Increased digoxin blood levels can occur with concomitant Bactrim therapy, especially in elderly patients. Serum digoxin levels should be monitored. Increased sulfamethoxazole blood levels may occur in patients who are also receiving indomethacin. Occasional reports suggest that patients receiving pyrimethamine as malaria prophylaxis in doses exceeding 25 mg weekly may develop megaloblastic anemia if Bactrim is prescribed. The efficacy of tricyclic antidepressants can decrease when coadministered with Bactrim. Bactrim potentiates the effect of oral hypoglycemics that are metabolized by CYP2C8 e.
Additional monitoring of blood glucose may be warranted. Cases of interactions with other OCT2 substrates, memantine and metformin, have also been reported. Bactrim, specifically the trimethoprim component, can interfere with a serum methotrexate assay as determined by the competitive binding protein technique CBPA when a bacterial dihydrofolate reductase is used as the binding protein. No interference occurs, however, if methotrexate is measured by a radioimmunoassay RIA. Carcinogenesis, Mutagenesis, Impairment of Fertility: In vitro reverse mutation bacterial tests according to the standard protocol have not been performed with sulfamethoxazole and trimethoprim in combination.
Observations of leukocytes obtained from patients treated with sulfamethoxazole and trimethoprim revealed no chromosomal abnormalities. Sulfamethoxazole alone was positive in an in vitro reverse mutation bacterial assay and in in vitro micronucleus assays using cultured human lymphocytes. Trimethoprim alone was negative in in vitro reverse mutation bacterial assays and in in vitro chromosomal aberration assays with Chinese Hamster ovary or lung cells with or without S9 activation. In in vitro Comet, micronucleus and chromosomal damage assays using cultured human lymphocytes, trimethoprim was positive. In mice following oral administration of trimethoprim, no DNA damage in Comet assays of liver, kidney, lung, spleen, or bone marrow was recorded.
Impairment of Fertility: While there are no large, well-controlled studies on the use of sulfamethoxazole and trimethoprim in pregnant women, Brumfitt and Pursell, 10 in a retrospective study, reported the outcome of 186 pregnancies during which the mother received either placebo or sulfamethoxazole and trimethoprim. The incidence of congenital abnormalities was 4. There were no abnormalities in the 10 children whose mothers received the drug during the first trimester. In a separate survey, Brumfitt and Pursell also found no congenital abnormalities in 35 children whose mothers had received oral sulfamethoxazole and trimethoprim at the time of conception or shortly thereafter.
Common Bactrim side effects may include: This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. Bactrim side effects in more detail What other drugs will affect Bactrim? You may need more frequent check- ups or medical tests if you also use medicine to treat depression , diabetes, seizures , or HIV. Many drugs can interact, and some drugs should not be used together. Tell your doctor about all your current medicines, especially: This list is not complete and many other drugs may interact with sulfamethoxazole and trimethoprim.
This includes prescription and over-the-counter medicines, vitamins , and herbal products. Not all possible drug interactions are listed here. Bactrim drug interactions in more detail Further information Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Bactrim only for the indication prescribed. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Copyright 1996-2019 Cerner Multum, Inc.
Related questions. Sulfamethoxazole Trisul tablets 480mg competes with para-aminobenzoic acid PABA which the bacterial cells use to make an important metabolite dihydrofolic acid. These combined actions of trimethoprim and sulfamethoxazole block bacterial folate biosynthesis, needed for making nucleic acids and proteins, which prevents replication of the bacteria by bacteriostasis, which limits the growth of the bacteria and stops the spread of infection. What are the side effects of Trisul? The most commonly reported side effects when taking Trisul tablets 480mg include: When should Trisul not be used?
You should not use Trisul tablets 480mg if you: Several medications interact with Trisul and should either not be taken while you are taking Trisul or only after discussion and instruction from your doctor: Drugs that cause a serious reaction with Trisul: You should take your Trisul tablets 480mg with food, to reduce risk of upset stomach. The dose you day and how often depends on what you are being treated for. You should continue to take your Trisul tablets 480mg for as long as recommended by your doctor, which may be for a few days, but at least 5 days for most infections or for longer if necessary for the infection to clear.
How long should you take Trisul?
Treating bacterial infection with Trisul Trisul tablets 480mg contain cotrimoxazole, a combination of two antibiotics that are use to treat a variety of infections caused by susceptible bacteria in various parts of the body, when a single antibiotic has not eliminated the infection. Trimethoprim and sulfamethoxazole in Trisul tablets 480mg block two consecutive steps in the biosynthetic pathway needed for bacterial DNA and protein synthesis. Sulfamethoxazole Trisul tablets 480mg competes with para-aminobenzoic acid PABA which the bacterial cells use to make an important metabolite dihydrofolic acid.
These combined actions of trimethoprim and sulfamethoxazole block bacterial folate biosynthesis, needed for making nucleic acids and proteins, which prevents replication of the bacteria by bacteriostasis, which limits the growth of the bacteria and stops the spread of infection. What are the side effects of Trisul? The most commonly reported side effects when taking Trisul tablets 480mg include: When should Trisul not be used? You should not use Trisul tablets 480mg if you: Several medications interact with Trisul and should either not be taken while you are taking Trisul or only after discussion and instruction from your doctor: Drugs that cause a serious reaction with Trisul: You should take your Trisul tablets 480mg with food, to reduce risk of upset stomach.
The dose you day and how often depends on what you are being treated for. These studies are further limited by recall, selection, and information biases, and by limited generalizability of their findings. Lastly, outcome measures varied between studies, limiting cross-study comparisons. Animal Data: These doses are approximately 5 and 6 times the recommended human total daily dose on a body surface area basis. In some rabbit studies, an overall increase in fetal loss dead and resorbed conceptuses was associated with doses of trimethoprim 6 times the human therapeutic dose based on body surface area. Nonteratogenic Effects: Nursing Mothers: Caution should be exercised when Bactrim is administered to a nursing woman, especially when breastfeeding, jaundiced, ill, stressed, or premature infants because of the potential risk of bilirubin displacement and kernicterus.
Pediatric Use: Geriatric Use: Clinical studies of Bactrim did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. There may be an increased risk of severe adverse reactions in elderly patients, particularly when complicating conditions exist, e. In those concurrently receiving certain diuretics, primarily thiazides, an increased incidence of thrombocytopenia with purpura has been reported. Hematological changes indicative of folic acid deficiency may occur in elderly patients. The trimethoprim component of Bactrim may cause hyperkalemia when administered to patients with underlying disorders of potassium metabolism, with renal insufficiency or when given concomitantly with drugs known to induce hyperkalemia, such as angiotensin converting enzyme inhibitors.
Discontinuation of Bactrim treatment is recommended to help lower potassium serum levels. Bactrim Tablets contain 1. Bactrim DS Tablets contain 3. Pharmacokinetics parameters for sulfamethoxazole were similar for geriatric subjects and younger adult subjects. Geriatric Pharmacokinetics. Adverse Reactions The most common adverse effects are gastrointestinal disturbances nausea, vomiting, anorexia and allergic skin reactions such as rash and urticaria. Agranulocytosis, aplastic anemia, thrombocytopenia, leukopenia, neutropenia, hemolytic anemia, megaloblastic anemia, hypoprothrombinemia, methemoglobinemia, eosinophilia.
Allergic Reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis, allergic myocarditis, erythema multiforme, exfoliative dermatitis, angioedema, drug fever, chills, Henoch-Schoenlein purpura, serum sickness-like syndrome, generalized allergic reactions, generalized skin eruptions, photosensitivity, conjunctival and scleral injection, pruritus, urticaria and rash. In addition, periarteritis nodosa and systemic lupus erythematosus have been reported. Hepatitis including cholestatic jaundice and hepatic necrosis , elevation of serum transaminase and bilirubin, pseudomembranous enterocolitis, pancreatitis, stomatitis, glossitis, nausea, emesis, abdominal pain, diarrhea, anorexia.
Renal failure, interstitial nephritis, BUN and serum creatinine elevation, toxic nephrosis with oliguria and anuria, crystalluria and nephrotoxicity in association with cyclosporine. Metabolic and Nutritional: Electrolyte Abnormalities. Aseptic meningitis, convulsions, peripheral neuritis, ataxia, vertigo, tinnitus, headache. Hallucinations, depression, apathy, nervousness. The sulfonamides bear certain chemical similarities to some goitrogens, diuretics acetazolamide and the thiazides and oral hypoglycemic agents.
Cross-sensitivity may exist with these agents. Diuresis and hypoglycemia have occurred rarely in patients receiving sulfonamides. Arthralgia and myalgia. Weakness, fatigue, insomnia. Postmarketing Experience The following adverse reactions have been identified during post-approval use of trimethoprim-sulfamethoxazole. Because these reactions were reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or establish a causal relationship to drug exposure: Thrombotic thrombocytopenia purpura QT prolongation resulting in ventricular tachycardia and torsade de pointes Overdosage Acute: The amount of a single dose of Bactrim that is either associated with symptoms of overdosage or is likely to be life-threatening has not been reported.
Signs and symptoms of overdosage reported with sulfonamides include anorexia, colic, nausea, vomiting, dizziness, headache, drowsiness and unconsciousness. Pyrexia, hematuria and crystalluria may be noted. Blood dyscrasias and jaundice are potential late manifestations of overdosage. Signs of acute overdosage with trimethoprim include nausea, vomiting, dizziness, headache, mental depression, confusion and bone marrow depression. General principles of treatment include the institution of gastric lavage or emesis, forcing oral fluids, and the administration of intravenous fluids if urine output is low and renal function is normal.
Acidification of the urine will increase renal elimination of trimethoprim. The patient should be monitored with blood counts and appropriate blood chemistries, including electrolytes. If a significant blood dyscrasia or jaundice occurs, specific therapy should be instituted for these complications. Peritoneal dialysis is not effective and hemodialysis is only moderately effective in eliminating sulfamethoxazole and trimethoprim. If signs of bone marrow depression occur, the patient should be given leucovorin 5 to 15 mg daily until normal hematopoiesis is restored. Bactrim Dosage and Administration Bactrim is contraindicated in pediatric patients less than 2 months of age. Drink plenty of fluids to prevent kidney stones while you are using this medicine.
Sulfamethoxazole and trimethoprim doses are based on weight in children. Use only the recommended dose when giving this medicine to a child. Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. This medicine will not treat a viral infection such as the flu or a common cold. You may need frequent medical tests. This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using Bactrim. Store at room temperature away from moisture, heat, and light. See also: Bactrim dosage information in more detail What happens if I miss a dose?
Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.
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8/1/ · Bactrim may inhibit the hepatic metabolism of phenytoin (a CYP2C9 substrate). Bactrim, given at a common clinical dosage, increased the phenytoin half-life by 39% and decreased the phenytoin metabolic clearance rate by 27%. When administering these drugs concurrently, one should be alert for possible excessive phenytoin effect. Bactrim pills or liquid must be stored at a room temperature in a dry and dark place away from the reach of children. Bactrim without prescription is sold in online drug stores, but make sure you are not using expired product. For online pharmacies customers who buy Bactrim no prescription is required. 4/9/ · Bactrim (sulfamethoxazole and trimethoprim) is an antibiotic used to treat ear infections, urinary tract and other infections. Includes Bactrim side effects, interactions and indications.
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