$Unique_ID{BRK02138}
$Pretitle{}
$Title{SULFAMETHOXAZOLE AND TRIMETHOPRIM COMBINATION}
$Subject{Bactrim (Roche)
Bactrim DS (Roche)
Bethaprim DS (Major)
Cotrim (Lemmon)
Cotrim DS (Lemmon)
Cotrim Pediatric (Lemmon)
Septra (Burroughs Wellcome)
Septra DS (Burroughs Wellcome)
sulfamethoxazole and trimethoprim (various manufacturers)
Sulfatrim (various manufacturers)
Sulfatrim DS (various manufacturers)}
$Volume{}
$Log{
Bactrim*0213801.scf}

Copyright (C) 1991 Publications International, Ltd.


SULFAMETHOXAZOLE AND TRIMETHOPRIM COMBINATION
------------------------------------------------------------------------------

BRAND NAMES (Manufacturers):
     Bactrim (Roche)
     Bactrim DS (Roche)
     Bethaprim DS (Major)
     Cotrim (Lemmon)
     Cotrim DS (Lemmon)
     Cotrim Pediatric (Lemmon)
     Septra (Burroughs Wellcome)
     Septra DS (Burroughs Wellcome)
     sulfamethoxazole and trimethoprim (various manufacturers)
     Sulfatrim (various manufacturers)
     Sulfatrim DS (various manufacturers)
TYPE OF DRUG:
     Antibiotic
INGREDIENTS:
     sulfamethoxazole and trimethoprim
DOSAGE FORMS:
     Tablets (400 mg sulfamethoxazole and 80 mg trimethoprim)
     Double-strength (DS) tablets (800 mg sulfamethoxazole and 160 mg
       trimethoprim)
     Oral suspension (200 mg sulfamethoxazole and 40 mg trimethoprim per 5-ml
       spoonful)
STORAGE:
     Sulfamethoxazole and trimethoprim combination tablets and oral suspension
       should be stored at room temperature in tightly closed, light-resistant
       containers.  The oral suspension does not need to be refrigerated.
       This medication should never be frozen.

USES

     Sulfamethoxazole and trimethoprim combination is used to treat a broad
range of infections, including urinary tract infections, certain respiratory
and gastrointestinal infections, and otitis media (middle ear infection).
Sulfamethoxazole and trimethoprim acts by preventing production of the
nutrients that are required for growth of the infecting bacteria.

TREATMENT

     It is best to take this medication with a full glass of water on an empty
stomach, either one hour before or two hours after a meal.  However, if it
causes stomach upset, check with your doctor to see if you can take it with
food or milk.
     The oral suspension form of this medication should be shaken well just
before measuring each dose.  The contents tend to settle on the bottom of the
bottle, so it is necessary to shake the container to distribute the
ingredients evenly and equalize the doses.  Each dose should then be measured
carefully with a specially designed 5-ml measuring spoon.  An ordinary kitchen
teaspoon is not accurate enough.
     This medication works best when the level of medicine in your bloodstream
(and urine) is kept constant.  It is best, therefore, to take the doses at
evenly spaced intervals day and night.  For example, if you are to take two
doses a day, the doses should be spaced 12 hours apart.  Try not to skip any
doses.
     If you miss a dose of this medication, take the missed dose immediately.
However, if you do not remember to take the missed dose until it is almost
time for your next dose, take the missed dose immediately; space the following
dose about halfway through the regular interval between doses (wait about six
hours if you are taking two doses a day); and then return to your regular
dosing schedule.
     It is important to continue to take this medication for the entire time
prescribed by your doctor (usually seven to 14 days), even if the symptoms
disappear before the end of that period.  If you stop taking the drug too
soon, resistant bacteria are given a chance to continue growing, and the
infection could recur.

SIDE EFFECTS

     Minor.

     Abdominal pain, diarrhea, dizziness, headache, loss of appetite, nausea,
sore mouth, or vomiting.  These side effects should disappear as your body
adjusts to the drug.
     Sulfamethoxazole can cause increased sensitivity to sunlight.  It is,
therefore, important to avoid prolonged exposure to sunlight and sunlamps.
Wear protective clothing and sunglasses, and use an effective sunscreen.
However, a sunscreen containing para-aminobenzoic acid (PABA) interferes with
the antibacterial activity of this medication and should NOT be used.
     If you feel dizzy, sit or lie down for a while; get up slowly from a
sitting or reclining position, and be careful on stairs.

     Major.

     Tell your doctor about any side effects that are persistent or
particularly bothersome.  IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about
bloody urine, convulsions, difficult or painful urination, difficulty in
breathing, difficulty in swallowing, fever, hallucinations, itching, joint
pain, lower back pain, pale skin, rash, ringing in the ears, sore throat,
swelling of the front part of the neck, swollen or inflamed tongue, tingling
in the hands or feet, unusual bleeding or bruising, unusual fatigue, or
yellowing of the eyes or skin.  Also, if your infection seems to be getting
worse rather than improving, contact your doctor.

INTERACTIONS

     This medicine interacts with other types of drugs:
     1. Sulfamethoxazole can increase the blood levels of oral anticoagulants
(blood thinners, such as warfarin), oral antidiabetic agents, methotrexate,
aspirin, thiopental, and phenytoin, which can lead to serious side effects.
     2. Methenamine can increase the side effects to the kidneys caused by
sulfamethoxazole.
     3. Probenecid, phenylbutazone, oxyphenbutazone, and sulfinpyrazone can
increase the blood levels of sulfamethoxazole, which can lead to an increase
in side effects.
     4. Rifampin can increase the elimination of trimethoprim from the body,
decreasing its antibacterial effects.
     5. Concurrent use of trimethoprim with antineoplastic agents (anticancer
drugs) can increase the risk of developing blood disorders.
     6. Trimethoprim can decrease the elimination of phenytoin from the body
and increase the chance of side effects.
     BE SURE TO TELL YOUR DOCTOR about any medications you are currently
taking, especially any listed above.

WARNINGS

     * Tell your doctor about unusual or allergic reactions you have had to
any medications, especially to trimethoprim, sulfamethoxazole, or other sulfa
drugs (other sulfonamide antibiotics, diuretics, dapsone, sulfoxone, oral
antidiabetic medications, oral antiglaucoma medication, or acetazolamide).
     * Tell your doctor if you now have or if you have ever had
glucose-6-phosphate dehydrogenase (G6PD) deficiency, kidney disease, liver
disease, porphyria, or megaloblastic anemia (folate-deficiency anemia).
     * This medication has been prescribed for your current infection only.
Another infection later on, or one that someone else has, may require a
different medicine.  You should not give your medicine to other people or use
it for other infections, unless your doctor specifically directs you to do so.
     * This medication should be taken with plenty of water, orange juice, or
cranberry juice in order to avoid kidney stone formation.
     * If this drug makes you dizzy, do not take part in any activity that
requires alertness, such as driving a car or operating potentially dangerous
machinery.
     * If there is no improvement in your condition several days after
starting to take this medication, check with your doctor.  This medication may
not be effective against the bacteria causing your infection.
     * Before having surgery or any other medical or dental treatment, be sure
to tell your doctor or dentist that you are taking this medication.
     * Be sure to tell your doctor if you are pregnant.  Small amounts of
sulfamethoxazole and trimethoprim cross the placenta.  Although these drugs
appear to be safe during pregnancy, extensive studies in humans have not been
conducted.  Trimethoprim has been shown to cause birth defects in the
offspring of animals that received very large doses during pregnancy.  Tell
your doctor if you are breast-feeding an infant.  Small amounts of
sulfamethoxazole pass into breast milk and may temporarily alter the bacterial
balance in the intestinal tract of the nursing infant, resulting in diarrhea.
Also, small amounts of trimethoprim pass into breast milk, and there is a
chance that it may cause anemia in the nursing infant.  This combination
medication should not be used in an infant less than two months of age (to
avoid side effects involving the liver).

----------------

The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
