METHOXAPRIM

Susceptible infections,Respiratory tract infections,Urinary tract infections,Gastrointestinal infections,Pneumocystis (carinii) jiroveci pneumonia,Prophylaxis of susceptible infections in AIDS patients

Oral Susceptible infections Adult: 960 mg bid, up to 2.88 g daily given in 2 divided doses in severe cases. Child: 6 wk-5 mth: 120 mg bid; 6 mth-5 yr: 240 mg bid; 6-12 yr: 480 mg bid. Renal impairment: Dosage reduction for adults and children >12 yr: CrCl (ml/min)Dosage Recommendation 15-30Half the standard dose. <15Not recommended. Hepatic impairment: Avoid in severe impairment.  Oral Respiratory tract infections Adult: 960 mg bid, up to 2.88 g daily given in 2 divided doses in severe cases. Child: 6 wk-5 mth: 120 mg bid; 6 mth-5 yr: 240 mg bid; 6-12 yr: 480 mg bid. Renal impairment: Dosage reduction for adults and children >12 yr: CrCl (ml/min)Dosage Recommendation 15-30Half the standard dose. <15Not recommended. Hepatic impairment: Avoid in severe impairment.  Oral Urinary tract infections Adult: 960 mg bid, up to 2.88 g daily given in 2 divided doses in severe cases. Child: 6 wk-5 mth: 120 mg bid; 6 mth-5 yr: 240 mg bid; 6-12 yr: 480 mg bid. Renal impairment: Dosage reduction for adults and children >12 yr: CrCl (ml/min)Dosage Recommendation 15-30Half the standard dose. <15Not recommended. Hepatic impairment: Avoid in severe impairment.  Oral Gastrointestinal infections Adult: 960 mg bid, up to 2.88 g daily given in 2 divided doses in severe cases. Child: 6 wk-5 mth: 120 mg bid; 6 mth-5 yr: 240 mg bid; 6-12 yr: 480 mg bid. Renal impairment: Dosage reduction for adults and children >12 yr: CrCl (ml/min)Dosage Recommendation 15-30Half the standard dose. <15Not recommended. Hepatic impairment: Avoid in severe impairment.  Oral Pneumocystis (carinii) jiroveci pneumonia Adult: Up to 120 mg/kg/day in 2-4 divided doses for 14-21 days. Child: >4 wk: Up to 120 mg/kg daily given in 2-4 divided doses for 14-21 days.  Renal impairment: Dosage reduction for adults and children,>12 yr: CrCl (ml/min)Dosage Recommendation 15-30Half the standard dose. <15Not recommended. Hepatic impairment: Avoid in severe impairment.  Oral Prophylaxis of susceptible infections in AIDS patients Adult: 960 mg daily. Child: 450 mg/m 2  (max: 960 mg) bid for 3 days in each wk, either consecutively or on alternate days. Renal impairment: Dosage reduction for adults and children >12 yr: CrCl (ml/min)Dosage Recommendation 15-30Half the standard dose. <15Not recommended. Hepatic impairment: Avoid in severe impairment.

Nausea, vomiting, diarrhoea, mental depression, confusion, facial swelling, headache, bone marrow depression and slight elevations of serum transaminases. Empty stomach immediately by inducing emesis or by lavage. Treatment is supportive and symptomatic w

Hypersensitivity; severe renal or hepatic insufficiency; infants <4 wk; megaloblastic anaemia; pregnancy and lactation.

Hypersensitivity; severe renal or hepatic insufficiency; infants <4 wk; megaloblastic anaemia; pregnancy and lactation.

Renal failure, nausea, vomiting, diarrhoea, anorexia; skin rashes, urticaria. Potentially Fatal: Stevens-Johnson syndrome, agranulocytosis, toxic epidermal necrolysis, hepatic necrosis.

Reduced ciclosporin concentrations in blood when used concurrently. Increases toxicity of methotrexate. Inhibits phenytoin clearance. Potentiates warfarin and oral hypoglycaemics. Potentially Fatal: Co-admin with pyrimethamine causes megaloblastic anaemia. Enhancement of renal damage by ciclosporin.

Reduced ciclosporin concentrations in blood when used concurrently. Increases toxicity of methotrexate. Inhibits phenytoin clearance. Potentiates warfarin and oral hypoglycaemics. Potentially Fatal: Co-admin with pyrimethamine causes megaloblastic anaemia. Enhancement of renal damage by ciclosporin.

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Oral: Store at 15-25°C.

Co-trimoxazole exhibits the synergistic actions of its components (sulfamethoxazole and trimethoprim) by 10-fold. Sulfamethoxazole inhibits dihydrofolic acid formation from PABA, thus interfering with synthesis and growth of bacterial folic acid. Trimethoprim inhibits enzymes folic acid pathway, preventing the reaction of the dihydrolic acid to tetrahydrofolate. Co-trimoxazole possesses bactericidal effects against E coli, Klebsiellaspp, Enterobacter spp, M morganii, P mirabilis, P vulgaris, H influenzae, Strep pneumoniae, Pneumocystis (carinii) jiroveci, Cyclospora spp. Absorption: Oral: Almost complete (90-100%). Time to peak, serum: Within 1-4 hr. Distribution: Protein binding: Sulfamethoxazole: 68%; Trimethoprim: 45%. Metabolism: Sulfamethoxazole: N-acetylated and glucuronidated; Trimethoprim: Metabolised to oxide and hydroxylated metabolites. Excretion: Both are removed in urine as metabolites and unchanged drug.

Antibacterial Combinations

J01EA01 - trimethoprim; Belongs to the class of trimethoprim and derivatives. Used in the treatment of systemic infections. J01EC01 - sulfamethoxazole; Belongs to the class of intermediate-acting sulfonamides. Used in the treatment of systemic infections.

*sulfamethoxazole + trimethoprim information: Note that there are some more drugs interacting with sulfamethoxazole + trimethoprim sulfamethoxazole + trimethoprim sulfamethoxazole + trimethoprim brands available in India Always prescribe with Generic Name : sulfamethoxazole + trimethoprim, formulation, and dose (along with brand name if required)