(Moderate) Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. 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. Sulfonamides may induce hypoglycemia in some patients by increasing the secretion of insulin from the pancreas. Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and trimethoprim are used together. Indinavir: (Minor) Concomitant administration of indinavir and trimethoprim should be done with caution. Peritonitis, spontaneous bacterial (prevention) (off-label use): High-risk patients (eg, hospitalized patients with Child-Pugh class B or C cirrhosis and active GI bleeding): Oral: One double-strength tablet twice daily (Runyon 2017). (Moderate) Rifampin is a potent enzyme inducer. 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. How Trimethoprim and Sulfamethoxazole Work Rifabutin decreased the AUC and Cmax of trimethoprim by 14% and 6%, respectively, when rifabutin was given with trimethoprim alone. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Bismuth Subsalicylate: (Minor) Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Sofosbuvir; Velpatasvir: (Moderate) Use caution when administering velpatasvir with trimethoprim. Sulfonamide Antibiotics may decrease the serum concentration of CycloSPORINE (Systemic). Penicillin G Benzathine; Penicillin G Procaine: (Moderate) Coadministration of penicillin G procaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. Bosentan: (Moderate) Sulfamethoxazole potently inhibits CYP2C9 and may theoretically lead to elevated plasma concentrations of bosentan when coadministered. (Moderate) Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and trimethoprim is necessary. Specifically, the risk of myoclonus and/or delirium may be increased. Monitor for evidence of hepatotoxicity if coadministration is necessary. 8 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours for 14 days. 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%. Clinical trial data indicate that ziprasidone causes QT prolongation; there are postmarketing reports of torsade de pointes (TdP) in patients with multiple confounding factors. Thus, fenoprofen may displace other highly protein bound drugs from albumin or vice versa. If you are using the oral suspension, make sure to shake well before use. Trimethoprim may increase the serum concentration of Procainamide. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Clinical practice guidelines recommend sulfamethoxazole; trimethoprim for urologic procedures involving lower tract instrumentation with risk factors for infection, including transrectal prostate biopsy. Concomitant use may increase the risk of hyperkalemia. 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. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. 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. (Moderate) Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. If you observe any side effects of the medication in your cat, stop giving the medicine and contact your veterinarian immediately. 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 7 to 10 days. Monitor therapy, Antidiabetic Agents: May enhance the hypoglycemic effect of Hypoglycemia-Associated Agents. However, other studies such as the Collaborative Perinatal Project, which included 1,455 mothers with first trimester sulfonamide exposure and 5,689 with exposure anytime during pregnancy, found no evidence to suggest a relationship between sulfonamide use and fetal malformations. 8 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Two species infect cats: . IV: 8 to 20 mg/kg/day (TMP component) divided every 6 to 12 hours. Acetohexamide: (Moderate) Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Secondary prophylaxis (chronic maintenance therapy) (alternative agent): Oral: One double-strength tablet twice daily or, alternatively, one double-strength tablet once daily (lower dose may be associated with increased relapse risk). Prosthetic joint infection (off-label use): Treatment (following pathogen-specific IV therapy in patients undergoing 1-stage exchange or debridement with retention of prosthesis): Oral: Note: Duration of therapy ranges from a minimum of 3 months to indefinitely, depending on patient specific factors (Berbari 2018). Manufacturer recommended dilutions and stability of parenteral admixture at room temperature (25C): Studies have also confirmed limited stability in NS; detailed references should be consulted. High doses of trimethoprim may increase the risk for hyperkalemia especially in patients with additional risk factors such as renal insufficiency. 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. Alternative or additional contraception may be advisable. Concomitant use may increase the risk of hyperkalemia. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. (Moderate) Monitor therapeutic response and adjust the tricyclic antidepressant dose, if needed, when use sulfamethoxazole; trimethoprim concomitantly. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Concomitant use may increase phenytoin concentrations. 4 mg/kg/dose (trimethoprim component) IV every 8 to 12 hours (Max: 960 mg trimethoprim/day) for at least 8 weeks, which may be followed by long-term suppressive therapy. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. This article is a comprehensive guide about Sulfamethoxazole and Trimethoprim For Felines. Once daily therapy may be associated with an increased risk of relapse; therefore, a gradual transition from acute therapy may be beneficial, utilizing the twice daily dose for 4 to 6 weeks before switching to once daily dosing. Shigellosis (widespread resistance [alternative agent if susceptibility is documented]): Oral: One double-strength tablet twice daily for 5 to 7 days (Agha 2017). Prophylaxis is recommended in high-risk patients, which includes infants and children with recurrent febrile UTI and infants and children with reflux grade of III or higher. Propranolol; Hydrochlorothiazide, HCTZ: (Major) Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. Consider therapy modification, Increased creatinine (Jaff alkaline picrate reaction); increased serum methotrexate by dihydrofolate reductase method, Cardiovascular: Allergic myocarditis, periarteritis nodosa (rare), Central nervous system: Apathy, aseptic meningitis, ataxia, chills, depression, fatigue, hallucination, headache, insomnia, nervousness, peripheral neuritis, seizure, vertigo, Dermatologic: Erythema multiforme (rare), exfoliative dermatitis (rare), pruritus, skin photosensitivity, skin rash, Stevens-Johnson syndrome (rare), toxic epidermal necrolysis (rare), urticaria, Endocrine & metabolic: Hyperkalemia (generally at high dosages), hypoglycemia (rare), hyponatremia, Gastrointestinal: Abdominal pain, anorexia, diarrhea, glottis edema, kernicterus (in neonates), nausea, pancreatitis, pseudomembranous colitis, stomatitis, vomiting, Genitourinary: Crystalluria, diuresis (rare), nephrotoxicity (in association with cyclosporine), toxic nephrosis (with anuria and oliguria), Hematologic & oncologic: Agranulocytosis, anaphylactoid purpura (IgA vasculitis; rare), aplastic anemia, eosinophilia, hemolysis (with G6PD deficiency), hemolytic anemia, hypoprothrombinemia, leukopenia, megaloblastic anemia, methemoglobinemia, neutropenia, thrombocytopenia, Hepatic: Cholestatic jaundice, hepatotoxicity (including hepatitis, cholestasis, and hepatic necrosis), hyperbilirubinemia, increased transaminases, Hypersensitivity: Anaphylaxis, angioedema, hypersensitivity reaction, serum sickness, Neuromuscular & skeletal: Arthralgia, myalgia, rhabdomyolysis (mainly in AIDS patients), systemic lupus erythematosus (rare), weakness, Ophthalmic: Conjunctival injection, injected sclera, uveitis, Renal: Increased blood urea nitrogen, increased serum creatinine, interstitial nephritis, renal failure, Respiratory: Cough, dyspnea, pulmonary infiltrates, <1%, postmarketing, and/or case reports: Acute respiratory distress syndrome (Miller 2019), dysgeusia (Syed 2016), immune thrombocytopenia (formerly known as idiopathic thrombocytopenic purpura), metabolic acidosis, prolonged Q-T interval on ECG, thrombotic thrombocytopenic purpura. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. If youre considering adopting a new kitty, please check out some of our breeder pages here. [42300] [42332] A pharmacokinetic study demonstrated that 44% of the administered trimethoprim and 57% of the administered sulfamethoxazole dose was removed during hemodialysis, suggesting that 50% of the usual dose be administered after the dialysis session. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. (Minor) Inhibitors of the hepatic CYP2C9 isoenzyme, such as sulfonamides, have potential to inhibit the conversion of losartan to its active metabolite. The typical dose is 75 mg/kg to 100 mg/kg of sulfamethoxazole and 15 mg/kg to 20 of mg/kg trimethoprim, divided into four doses and taken by mouth every 6 hours for 2 to 3 weeks days. [43888] According to the Beers Criteria, use sulfamethoxazole; trimethoprim with caution in geriatric patients taking an ACE inhibitor or angiotensin receptor blocker (ARB) in the presence of renal impairment due to an increased risk of hyperkalemia. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Duration after lung transplant: Lifelong therapy should be considered (Martin 2013; Palmer 2017). Chlorpropamide: (Moderate) Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. 2 to 4 mg/kg/dose (trimethoprim component) IV every 12 hours (Max: 960 mg trimethoprim/day) for 6 weeks. Trimethoprim, given at a common clinical dosage, increased the phenytoin half-life by 51% and decreased the phenytoin metabolic clearance rate by 30%. Trimethoprim is an inhibitor of the renal cation transport system and decreases the active tubular secretion of dofetilide. Sulfonamides may also compete with penicillin for renal tubular secretion, increasing penicillin serum concentrations. Metformin: (Moderate) Monitor blood glucose during concomitant metformin and sulfonamide use. For the lower limit dose (15 mg/kg trimethoprim and 75 mg/kg sulfamethoxazole per 24 hours) administer 75% of the dose in the above table . Traveler's diarrhea Specifically, the risk of myoclonus and/or delirium may be increased. 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. Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Major) Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. 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. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. An enhanced effect of the displaced drug may occur. Methotrexate measurements by a radioimmunoassay are not affected. Thiazolidinediones: (Moderate) Monitor blood glucose during concomitant thiazolidinedione and sulfonamide use. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Keep your pet well hydrated during the treatment period. Routine use is not recommended; reserve for patients at high risk for invasive infection. Citric Acid; Potassium Citrate; Sodium Citrate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and trimethoprim are used together. 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. Consider adding sulfamethoxazole; trimethoprim to carbapenem therapy in setting of persistent bacteremia. Selexipag is a substrate of CYP2C8; trimethoprim is a moderate CYP2C8 inhibitor. 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily as an alternative for at least 3 weeks and until all lesions have completely healed. Monitor therapy, Digoxin: Trimethoprim may increase the serum concentration of Digoxin. 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. This rapid protocol was studied in HIV infected patients who required SMX-TMP therapy. Monitor therapy, Phenytoin: Trimethoprim may increase the serum concentration of Phenytoin. 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. Ensure to administrate the safe dose of the tablet, suspension, or injectable form. Use this combination with caution, and monitor patients for increased side effects. 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. No intraoperative redosing and a duration of prophylaxis less than 24 hours for most procedures are recommended by clinical practice guidelines. An enhanced effect of the displaced drug may occur. Make sure to inform your vet earlier if your kitty falls in any of the below categories. AIDS patients: Incidence of adverse effects appears to be increased in patients with AIDS. 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. Oritavancin: (Moderate) Sulfamethoxazole is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. This product is available in the following dosage forms: Solution . Specifically, the risk for cholestasis may be increased. 2.5 to 5 mg/kg/dose (trimethoprim component) PO twice daily or 2 or 3 times weekly or 5 to 10 mg/kg/dose (trimethoprim component) PO once daily (Max: 320 mg trimethoprim/day). Frequently reported side effects of this drug. The AUC and Cmax of ramelteon have been elevated > 150% when administered with other CYP2C9 inhibitors. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. 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. Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however, they should not be used prophylactically. (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. Metformin; Saxagliptin: (Moderate) Monitor blood glucose during concomitant metformin and sulfonamide use. 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. However, As with other medications, Sulfamethoxazole and Trimethoprim also have minor to severe side effects. Chlordiazepoxide; Amitriptyline: (Moderate) Monitor for loss of tricyclic antidepressant efficacy during concomitant sulfamethoxazole; trimethoprim use; adjust the tricyclic antidepressant dose if needed. 160 to 320 mg trimethoprim/800 to 1,600 mg sulfamethoxazole PO every 12 hours for 5 to 10 days plus incision and drainage. In addition, clinical experience suggests the utility of sulfamethoxazole/trimethoprim in the treatment of acute and chronic bacterial prostatitis Lipsky 2010. (Minor) The concomitant use of leucovorin with sulfamethoxazole; trimethoprim, for the acute treatment of Pneumocystis carinii pneumonia in patients with HIV infection was associated with an increased risk of treatment failure and morbidity. Monitor therapy, Sulfonylureas: Sulfonamide Antibiotics may enhance the hypoglycemic effect of Sulfonylureas. 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. 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