Major QT prolongation resulting in ventricular tachycardia and torsade de pointes TdP have been reported during post-marketing use of sulfamethoxazole; trimethoprim. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include alfuzosin.

Major Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary.

Hyperkalemia may be more significant in patients receiving IV trimethoprim. For those patients at higher risk of hyperkalemia e. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors.

Moderate It is possible that an increase in the exposure of pioglitazone may occur when coadministered with other drugs that inhibit CYP2C8 such as trimethoprim. Monitor for changes in glycemic control if trimethoprim is coadministered with pioglitazone.

Moderate Use caution, administration of trimethoprim may result in increased serum concentrations of amantadine. Amantadine is primarily excreted unchanged in the urine by both glomerular filtration and tubular secretion. The mechanism is not certain. Renal elimination of amantadine may be mediated in part by one or more organic cation transporters independent of OCT2.

A single case of toxic delirium has been reported in the literature after coadministration of trimethoprim and amantadine.

The clinical significance to a wider population is not known. Major Trimethoprim has a potassium-sparing effect and may induce hyperkalemia, especially in patients with pre-existing risk factors for hyperkalemia e. Patients, especially those with renal dysfunction, should be carefully monitored for hyperkalemia during concomitant use of potassium-sparing diuretics and trimethoprim.

Moderate Aminobenzoate potassium should not be administered to patients taking sulfonamides or aminosalicylate sodium, aminosalicylic acid. Bacteria preferentially absorb aminobenzoate potassium instead of the antibacterial agents, decreasing their efficacy. Aminosalicylate sodium, Aminosalicylic acid: Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include amiodarone.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with sulfamethoxazole; trimethoprim include tricyclic antidepressants.

Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary. Hyperkalemia may be more signficant in patients receiving IV trimethoprim. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include clarithromycin.

Major Torsades de pointes TdP and ventricular tachycardia have been reported with anagrelide. In addition, dose-related increases in mean QTc and heart rate were observed in healthy subjects. A cardiovascular examination, including an ECG, should be obtained in all patients prior to initiating anagrelide therapy.

Monitor patients during anagrelide therapy for cardiovascular effects and evaluate as necessary. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with anagrelide include sulfamethoxazole; trimethoprim.

Angiotensin II receptor antagonists: Moderate QT prolongation resulting in ventricular tachycardia and torsade de pointes TdP have been reported during post-marketing use of sulfamethoxazole; trimethoprim.

Acute cardiotoxicity can occur during administration of daunorubicin, doxorubicin, epirubicin, or idarubicin; cumulative, dose-dependent cardiomyopathy may also occur. Sinus tachycardia is the most common arrhythmia, but other arrhythmias such as supraventricular tachycardia SVT , ventricular tachycardia, heart block, and premature ventricular contractions PVCs have been reported. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include apomorphine.

Minor Use caution if sulfamethoxazole and aprepitant are used concurrently and monitor for a possible decrease in the efficacy of sulfamethoxazole.

After administration, fosaprepitant is rapidly converted to aprepitant and shares the same drug interactions. The effects of aprepitant on tolbutamide were not considered significant. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include aripiprazole.

Major Avoid coadministration of sulfamethoxazole; trimethoprim and arsenic trioxide. QT prolongation resulting in ventricular tachycardia and torsade de pointes TdP have been reported during post-marketing use of sulfamethoxazole; trimethoprim. If possible, drugs that are known to prolong the QT interval should be discontinued prior to initiating arsenic trioxide therapy.

If concomitant drug use is unavoidable, frequently monitor electrocardiograms. QT prolongation should be expected with the administration of arsenic trioxide. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include artemether.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include asenapine. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with sulfamethoxazole; trimethoprim include atomoxetine.

QT prolongation has occurred during therapeutic use of atomoxetine and following overdose. Atomoxetine is considered a drug with a possible risk of TdP. No difference was observed in atovaquone pharmacokinetics. This may not be of any clinical significance but should be used with caution. Major Sulfonamides can crystallize in an acidic urine.

Because methenamine salts produce an acidic urine, these agents should not be used concomitantly. Moderate Azathioprine may interact with other drugs that are myelosuppressive. Drugs that may affect the production of leukocytes, including sulfamethoxazole; trimethoprim, SMX-TMP, may lead to exaggerated leukopenia, especially in patients who have received a renal transplant. Minor Folate antagonists, such as trimethoprim, especially when used in high doses or over a prolonged period, inhibit dihydrofolate reductase and thus may inhibit the action of folic acid, vitamin B9.

Minor L-methylfolate and trimethoprim should be used together cautiously. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with trimethoprim. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. Major Due to a possible risk for QT prolongation and torsade de pointes TdP , azithromycin and sulfamethoxazole; trimethoprim should be used together cautiously.

QT prolongation resulting in ventricular tachycardia and TdP has been reported during postmarketing use of sulfamethoxazole; trimethoprim. In addition, there have been case reports of QT prolongation and TdP with the use of azithromycin in postmarketing reports. Concurrent use may increase the risk of QT prolongation.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include bedaquiline. Moderate Rare and sometimes fatal cases of methemoglobinemia have been reported with the use of topical or oromucosal benzocaine products. Examples of other drugs that can cause methemoglobinemia include the sulfonamides. Therefore, caution is warranted when combining such medications with topical or oromucosal benzocaine products.

Patients using OTC benzocaine gels and liquids should be advised to seek immediate medical attention if signs or symptoms of methemoglobinemia develop. In addition, clinicians should closely monitor patients for the development of methemoglobinemia when benzocaine sprays are used during a procedure.

Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: Major Potential QT prolongation has been reported in limited case reports with metronidazole; therefore, it should be used cautiously when adminstered with sulfamethoxazole; trimethoprim, which has a possible risk for QT prolongation and TdP.

Also, medications with significant alcohol content should not be ingested during therapy with metronidazole and should be avoided for 3 days after therapy is discontinued. Bismuth Subsalicylate; Metronidazole; Tetracycline: Moderate Close clinical monitoring is advised when administering sulfamethoxazole with boceprevir due to an increased potential for sulfamethoxazole-related adverse events. If sulfamethoxazole dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment.

Although this interaction has not been studied, predictions about the interaction can be made based on the metabolic pathway of sulfamethoxazole. Sulfamethoxazole is partially metabolized by the hepatic isoenzyme CYP3A4; boceprevir inhibits this isoenzyme.

Coadministration may result in elevated sulfamethoxazole plasma concentrations. Moderate Sulfamethoxazole potently inhibits CYP2C9 and may theoretically lead to elevated plasma concentrations of bosentan when coadministered. Monitor for potential adverse effects of bosentan during coadministration. Excessive bosentan dosage may result in hypotension or elevated hepatic enzymes.

Bromocriptine is highly bound to serum proteins. Therefore, it may increase the unbound fraction of other highly protein-bound medications e.

Buprenorphine has also been associated with QT prolongation and has a possible risk of torsade de pointes TdP. FDA-approved labeling for some buprenorphine products recommend avoiding use with Class 1A and Class III antiarrhythmic medications while other labels recommend avoiding use with any drug that has the potential to prolong the QT interval.

Moderate Use caution if coadministration of capecitabine with sulfamethoxazole is necessary, and monitor for an increase in sulfamethoxazole-related adverse reactions. Megaloblastic anemia can occur when sulfamethoxazole; trimethoprim, SMX-TMP is used in patients who are taking other folate antagonists. These agents include carbamazepine. If these agents are used concomitantly, close observation of blood counts is warranted.

Major Avoid coadministration of ceritinib with sulfamethoxazole due to increased sulfamethoxazole exposure; additive QT prolongation may also occur.

If coadministration is unavoidable, monitor for sulfamethoxazole-related adverse reactions. Periodically monitor electrolytes and ECGs; an interruption of ceritinib therapy, dose reduction, or discontinuation of therapy may be necessary if QT prolongation occurs. Sulfamethoxazole is primarily metabolized by CYP2C9; QT prolongation resulting in ventricular tachycardia and torsade de pointes TdP has been reported during postmarketing use of sulfamethoxazole; trimethoprim.

These agents include chloramphenicol. Para-aminobenzoic acid, PABA, in turn, antagonizes the effects of sulfonamides. Thus, ester-type local anesthetics should not be used in patients receiving sulfonamides. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include chloroquine.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include chlorpromazine. Choline Salicylate; Magnesium Salicylate: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia. Trimethoprim should also be used with caution with other drugs known to cause significant hyperkalemia such as potassium salts.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with sulfamethoxazole; trimethoprim include ciprofloxacin. Severe QT prolongation and ventricular arrhythmias, including torsade de pointes TdP and death, have been reported with cisapride. QT prolongation resulting in ventricular tachycardia and TdP have been reported during post-marketing use of sulfamethoxazole; trimethoprim.

Because of the potential for TdP, concurrent use is contraindicated. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include citalopram.

Citric Acid; Potassium Citrate: Thus, clopidogrel could increase plasma concentrations of drugs metabolized by this isoenzyme, such as sulfamethoxazole. Although there are no in vivo data with which to predict the magnitude or clinical significance of this potential interaction, caution should be used when sulfamethoxazole is coadministered with clopidogrel. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include clozapine.

Cobicistat; Elvitegravir; Emtricitabine; Tenofovir Alafenamide: Moderate Caution is warranted when elvitegravir is administered with sulfamethoxazole; trimethoprim, SMX-TMP as there is a potential for decreased sulfamethoxazole concentrations.

Moderate Promethazine carries a possible risk of QT prolongation. Major Monitor ECGs for QT prolongation and monitor electrolytes in patients receiving crizotinib concomitantly with sulfamethoxazole; trimethoprim. An interruption of therapy, dose reduction, or discontinuation of therapy may be necessary for crizotinib patients if QT prolongation occurs. Crizotinib has been associated with concentration-dependent QT prolongation.

QT prolongation resulting in ventricular tachycardia and torsade de pointes TdP has also been reported during postmarketing use of sulfamethoxazole; trimethoprim. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with sulfamethoxazole; trimethoprim include cyclobenzaprine.

Major Avoid the concomitant use of sulfamethoxazole; trimethoprim and cyclosporine. There have been reports of significant, but reversible nephrotoxicity with coadministration in renal transplant patients. In addition, there are case reports of reduced exposure to cyclosporine in patients receiving concomitant sulfonamides. Monitor renal function and cyclosporine concentrations if concomitant use is required. 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.

These combinations increase the likelihood of adverse hematologic events. Concurrent administration of dapsone with trimethoprim increases the plasma concentrations of both drugs. The efficacy of dapsone is increased, which may provide a therapeutic advantage in the treatment of Pneumocystis pneumonia; however, an increase in the frequency and severity of dapsone toxicity methemoglobinemia, hemolytic anemia also has been noted.

Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: However, the Cmax of trimethoprim and sulfamethoxazole was not affected. In addition, both ritonavir and sulfamethoxazole; trimethoprim are associated with QT prolongation; concomitant use increases the risk of QT prolongation.

Minor According to the manufacturer, no dosage adjustments are required when trimethoprim is administered with dasabuvir; ombitasvir; paritaprevir; ritonavir; however, use of these drugs together may result in elevated dasabuvir plasma concentrations.

Trimethoprim inhibits CYP2C8, an enzyme primarily responsible for the metabolism of dasabuvir. Caution and close monitoring are advised if these drugs are administered together.

Major Monitor for evidence of QT prolongation and torsade de pointes TdP during concurrent use of dasatinib and sulfamethoxazole; trimethoprim. In vitro studies have shown that dasatinib has the potential to prolong the QT interval. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include degarelix. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include halogenated anesthetics.

Clinically relevant QTc prolongation may occur with deutetrabenazine. QT prolongation resulting in ventricular tachycardia and torsade de pointes TdP has been reported during postmarketing use of sulfamethoxazole; trimethoprim. Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate: Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include quinidine.

Moderate Anti-infectives that disrupt the normal GI flora, including sulfonamides, may potentially decrease the effectiveness of estrogen-containing oral contraceptives. Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

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. 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 concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. 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. 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.

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.

Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries e. Major Because both trimethoprim and digoxin undergo tubular secretion, trimethoprim can interfere with the renal tubular secretion of digoxin when administered concomitantly.

Similar changes were not noted in a single-dose study of young healthy volunteers. Patients receiving digoxin, especially the elderly, should be monitored carefully for digoxin toxicity if trimethoprim is added. Thus, naproxen may displace other highly protein bound drugs from albumin or vice versa. If naproxen is used concurrently with sulfonamides, monitor patients for toxicity from either drug.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include disopyramide. Major The ingestion of ethanol by patients receiving disulfiram causes an extremely unpleasant reaction that can last from 30 minutes to several hours. Intravenous sulfamethoxazole; trimethoprim, SMX-TMP, cotrimoxazole contains ethanol and should not be co-administered with disulfiram.

This reaction would not be expected to occur with oral sulfamethoxazole; trimethoprim. Severe The concurrent use of dofetilide with trimethoprim alone or in combination with sulfamethoxazole is contraindicated. Trimethoprim is an inhibitor of renal cationic secretion and decreases the renal tubular secretion of dofetilide.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include dolasetron. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include rilpivirine. Major Case reports indicate that QT prolongation and torsade de pointes TdP can occur during donepezil therapy. Donepezil is considered a drug with a known risk of TdP.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with donepezil include sulfamethoxazole; trimethoprim, SMX-TMP, cotrimoxazole. Moderate Cationic drugs that are eliminated by renal tubular secretion, such as trimethoprim, may decrease memantine elimination by competing for common renal tubular transport systems.

Moderate Cytochrome P enzyme inhibitors, such as sulfamethoxazole, may inhibit the hydroxylation of doxercalciferol, thereby decreasing the formation of the active metabolite and thus, decreasing efficacy.

Major Use caution if coadministration of dronabinol with sulfamethoxazole is necessary, and monitor for an increase in dronabinol-related adverse reactions e. Concomitant use may result in elevated plasma concentrations of dronabinol.

Severe The concomitant use of dronedarone with other drugs that prolong the QTc and that may induce torsade de pointes TdP is contraindicated.

QT prolongation resulting in ventricular tachycardia and torsade de pointes TdP have been reported during post-marketing use of sulfamethoxazole; trimethoprim, SMX-TMP, cotrimoxazole.

Dronedarone administration is associated with a dose-related increase in the QTc interval. The increase in QTc is approximately 10 milliseconds at doses of mg twice daily the FDA-approved dose and up to 25 milliseconds at doses of mg twice daily.

Although there are no studies examining the effects of dronedarone in patients receiving other QT prolonging drugs, coadministration of such drugs may result in additive QT prolongation. Additionally, dronedarone is metabolized by and is an inhibitor of CYP3A. Sulfamethoxazole is a substrate for CYP3A4. The concomitant administration of dronedarone and sulfamethoxazole may result in increased exposure of sulfamethoxazole.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include droperidol. Drospirenone; Ethinyl Estradiol; Levomefolate: Major Coadministration of efavirenz and sulfamethoxazole; trimethoprim may increase the risk for QT prolongation and torsade de pointes TdP. QT prolongation has been observed with use of efavirenz. Although data are limited, the manufacturer of efavirenz recommends an alternative antiretroviral be considered for patients receiving medications with a known risk for TdP.

QT prolongation resulting in ventricular tachycardia and TdP has been reported during post-marketing use of sulfamethoxazole; trimethoprim. Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: Drugs with a possible risk for QT prolongation and torsade de pointes TdP that should be used cautiously and with close monitoring with eliglustat include sulfamethoxazole; trimethoprim, SMX-TMP.

The significance of administering inhibitors of CYP2C8, such as trimethoprim, on the systemic exposure of eltrombopag has not been established. Monitor patients for signs of eltrombopag toxicity if these drugs are coadministered. Emtricitabine; Rilpivirine; Tenofovir alafenamide: Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate: Major Avoid coadministration of encorafenib and sulfamethoxazole; trimethoprim due to the potential for additive QT prolongation.

Encorafenib is associated with dose-dependent prolongation of the QT interval. Moderate Both entecavir and trimethoprim are secreted by active tubular secretion. In theory, coadministration of entecavir with trimethoprim may increase the serum concentrations of either drug due to competition for the drug elimination pathway.

Moderate Monitor for decreased efficacy of sulfamethoxazole if coadministration with enzalutamide is necessary. Concomitant use may decrease sulfamethoxazole plasma concentrations. Major Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially with pre-existing risk factors for hyperkalemia. Trimethoprim should be used with caution with other drugs known to cause significant hyperkalemia such as eplerenone.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include eribulin. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include erythromycin.

Moderate Escitalopram has been associated with QT prolongation. Coadministration with other drugs that have a possible risk for QT prolongation and torsade de pointes TdP , such as sulfamethoxazole; trimethoprim, should be done with caution and close monitoring. Moderate Anti-infectives which disrupt the normal GI flora, including sulfonamides, may potentially decrease the effectiveness of estrogen containing oral contraceptives.

Alternative or additional contraception may be advisable. Ethinyl Estradiol; Ethynodiol Diacetate: Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate: Ethinyl Estradiol; Norethindrone Acetate: Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate: Ethinyl Estradiol; Norethindrone; Ferrous fumarate: Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include ezogabine.

Concomitant use of fenofibric acid with CYP2C9 substrates, such as sulfamethoxazole, has not been formally studied. Fenofibric acid may theoretically increase plasma concentrations of CYP2C9 substrates and could lead to toxicity for drugs that have a narrow therapeutic range. Monitor the therapeutic effect of sulfamethoxazole during coadministration with fenofibric acid. Minor An interaction may occur between fenoprofen and sulfonamides.

Thus, fenoprofen may displace other highly protein bound drugs from albumin or vice versa. If fenoprofen is used concurrently with sulfonamides, monitor patients for toxicity from any of the drugs. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include fingolimod.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include flecainide. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include fluconazole. Major Use of other folate antagonists should be avoided during therapy with trimethoprim. Hematologic toxicity can be increased by concurrent use of fluorouracil, 5-FU.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with sulfamethoxazole; trimethoprim include olanzapine. Drugs with a possible risk for QT prolongation that should be used cautiously with sulfamethoxazole; trimethoprim include fluphenazine. Moderate In theory, concurrent use CYP2C9 inhibitors, such as sulfonamides, and fluvastatin, a CYP2C9 substrate, may result in reduced metabolism of fluvastatin and potential for toxicity.

Moderate There may be an increased risk for QT prolongation and torsade de pointes TdP during concurrent use of fluvoxamine and sulfamethoxazole; trimethoprim. Cases of QT prolongation and TdP have been reported during postmarketing use of fluvoxamine. Folic Acid, Vitamin B9: Moderate The incidence of marijuana associated adverse effects may change following coadministration with sulfamethoxazole.

Sulfamethoxazole is an inhibitor of CYP2C9, an isoenzyme partially responsible for the metabolism of marijuana's most psychoactive compound, deltatetrahydrocannabinol DeltaTHC. When given concurrently with sulfamethoxazole, the amount of DeltaTHC converted to the active metabolite hydroxy-deltatetrahydrocannabinol OH-THC may be reduced.

Major When possible, avoid concurrent use of foscarnet with other drugs known to prolong the QT interval, such as sulfamethoxazole. Foscarnet has been associated with postmarketing reports of both QT prolongation and torsade de pointes TdP. QT prolongation resulting in ventricular tachycardia and TdP has also been reported during postmarketing use of sulfamethoxazole; trimethoprim. If these drugs are administered together, obtain an electrocardiogram and electrolyte concentrations before and periodically during treatment.

Major When possible, avoid concurrent use of foscarnet with other drugs known to prolong the QT interval, such as trimethoprim. Moderate Concomitant use of sulfamethoxazole with fosphenytoin which is metabolized to phenytoin may result in increased serum concentrations of phenytoin and increase the risk for adverse reactions.

Phenytoin is a substrate of hepatic isoenzyme CYP2C9; sulfamethoxazole is an inhibitor of this enzyme. Caution and close monitoring of phenytoin serum concentrations are advised if these drugs are used together; dosage adjustments may be necessary in some patients. Monitor for signs of phenytoin toxicity. Moderate The half-life of phenytoin may be increased when trimethoprim is given concurrently with phenytoin.

It is thought that trimethoprim may interfere with phenytoin hepatic metabolism. Reduced phenytoin clearance can lead to toxicity.

Phenytoin or fosphenytoin doses may need to be reduced during concomitant use of trimethoprim. 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.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include gemifloxacin. Moderate Use gemtuzumab ozogamicin and sulfamethoxazole together with caution due to the potential for additive QT interval prolongation and risk of torsade de pointes TdP. If these agents are used together, obtain an ECG and serum electrolytes prior to the start of gemtuzumab and as needed during treatment.

Although QT interval prolongation has not been reported with gemtuzumab, it has been reported with other drugs that contain calicheamicin. Moderate Use gemtuzumab ozogamicin and trimethoprim together with caution due to the potential for additive QT interval prolongation and risk of torsade de pointes TdP. Moderate It is possible that an increase in the exposure of rosiglitazone may occur when coadministered with drugs that inhibit CYP2C8 such as trimethoprim.

Patients should be monitored for changes in glycemic control if any CYP2C8 inhibitors are coadministered with rosiglitazone. Moderate Androgen deprivation therapy e. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include granisetron. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include haloperidol.

Moderate Consider periodic monitoring of EGCs for QT prolongation and monitor electrolytes if coadministration of histrelin and sulfamethoxazole is necessary; correct any electrolyte abnormalities. Prolongation of the QT interval resulting in ventricular tachycardia and torsade de pointes TdP has been reported during postmarketing use of sulfamethoxazole; trimethoprim.

Androgen deprivation therapy e. Moderate Consider periodic monitoring of EGCs for QT prolongation and monitor electrolytes if coadministration of histrelin and trimethoprim is necessary; correct any electrolyte abnormalities. Minor Inhibitors of the hepatic CYP2C9 isoenzyme, such as sulfonamides, have potential to inhibit the conversion of losartan to its active metabolite. Monitor therapeutic response to individualize losartan dosage.

Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: Major Avoid coadministration of hydroxychloroquine and sulfamethoxazole; trimethoprim. Hydroxychloroquine increases the QT interval and should not be administered with other drugs known to prolong the QT interval. Ventricular arrhythmias and torsade de pointes TdP have been reported with the use of hydroxychloroquine. Moderate Use potassium phosphate cautiously with trimethoprim especially high dose , as both drugs increase serum potassium concentrations.

Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Patients should have serum potassium concentration determinations at periodic intervals.

Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include ibutilide. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include iloperidone.

Minor Concomitant administration of indinavir and trimethoprim should be done with caution. There was no effect on the AUC of indinavir or sulfamethoxazole. Major Avoid the concomitant use of sulfamethoxazole and indomethacin as coadministration may result in increased serum concentrations of sulfamethoxazole.

Coadministration may increase the risk of sulfamethoxazole toxicity. Major Avoid coadministration of inotuzumab ozogamicin with sulfamethoxazole due to the potential for additive QT prolongation and risk of torsade de pointes TdP. If coadministration is unavoidable, obtain an ECG and serum electrolytes prior to the start of treatment, after treatment initiation, and periodically during treatment. Inotuzumab has been associated with QT interval prolongation. Major Avoid coadministration of inotuzumab ozogamicin with trimethoprim due to the potential for additive QT prolongation and risk of torsade de pointes TdP.

Iodine; Potassium Iodide, KI: Moderate Rifampin is a potent enzyme inducer. A pharmacokinetic effect on the combination has been reported with another rifamycin. The drugs are often given clinically together with certain patient populations, so the ultimate clinical significance of a possible pharmacokinetic interaction is not clear. Monitor for therapeutic response to therapy.

Additionally, sulfamethoxazole; trimethoprim may increase the serum concentration of rifampin. The drugs are often given together for certain patient populations, so the ultimate clinical significance of a possible pharmacokinetic interaction is not clear. Monitor for therapeutic response to therapy and increased rifampin toxicity Isoniazid, INH; Rifampin: Monitor for therapeutic response to therapy and increased rifampin toxicity Itraconazole: Major Itraconazole has been associated with prolongation of the QT interval.

In vitro studies showed ivacaftor to be a weak inhibitor of CYP2C9. Co-administration may lead to increased exposure to CYP2C9 substrates; however, the clinical impact of this has not yet been determined. Major Avoid coadministration of ivosidenib with sulfamethoxazole; trimethoprim due to an increased risk of QT prolongation. If concomitant use is unavoidable, monitor ECGs for QTc prolongation and monitor electrolytes; correct any electrolyte abnormalities as clinically appropriate.

An interruption of therapy and dose reduction of ivosidenib may be necessary if QT prolongation occurs. Prolongation of the QTc interval and ventricular arrhythmias have been reported in patients treated with ivosidenib. Major Ketoconazole has been associated with prolongation of the QT interval.

Moderate Lamotrigine inhibits dihydrofolate reductase. Caution should be exercised when administering trimethoprim, which also inhibits this enzyme. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with sulfamethoxazole; trimethoprim include lapatinib. Moderate Use lesinurad and sulfamethoxazole together with caution; sulfamethoxazole may increase the systemic exposure of lesinurad.

Minor Racemic leucovorin may be used to offset the toxicity of folate antagonists such as trimethoprim; however, 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.

Levoleucovorin may result in the same effect. 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. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with leuprolide include sulfamethoxazole; trimethoprim. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with leuprolide include trimethoprim.

Major Use sulfamethoxazole; trimethoprim and levofloxacin together with caution due to an increased risk for QT prolongation and torsade de pointes TdP. Levofloxacin has been associated with prolongation of the QT interval and infrequent cases of arrhythmia.

Rare cases of TdP have been reported during postmarketing surveillance in patients receiving levofloxacin. QT prolongation, resulting in ventricular tachycardia and TdP, has been reported during postmarketing use of sulfamethoxazole; trimethoprim.

Moderate Sulfamethoxazole; trimethoprim should be used cautiously and with close monitoring with lithium. Lithium has been associated with QT prolongation. Moderate Monitor ECG if lofexidine is coadministered with sulfamethoxazole; trimethoprim due to the potential for additive QT prolongation and torsade de pointes TdP. Lofexidine prolongs the QT interval.

In addition, there are postmarketing reports of TdP. Moderate If these drugs are used together, the plasma concentrations of loperamide may increase.

Loperamide is a substrate for CYP2C8. Trimethoprim has been shown in vitro and in studies of healthy human volunteers to selectively inhibit the CYP2C8 isoenzyme. Monitor for cardiac toxicities i. At high doses, loperamide has been associated with serious cardiac toxicities, including syncope, ventricular tachycardia, QT prolongation, torsade de pointes TdP , and cardiac arrest.

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. 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.

Urinalyses with careful microscopic examination and renal function tests should be performed during therapy, particularly for those patients with impaired renal function. In elderly patients concurrently receiving certain diuretics, primarily thiazides, an increased incidence of thrombocytopenia with purpura has been reported. This interaction should be kept in mind when BACTRIM is given to patients already on anticoagulant therapy, and the coagulation time should be reassessed.

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. 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. 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: Bacterial mutagenic studies have not been performed with sulfamethoxazole and trimethoprim in combination. Trimethoprim was demonstrated to be nonmutagenic in the Ames assay. No chromosomal damage was observed in human leukocytes cultured in vitro with sulfamethoxazole and trimethoprim alone or in combination; the concentrations used exceeded blood levels of these compounds following therapy with sulfamethoxazole and trimethoprim.

Observations of leukocytes obtained from patients treated with sulfamethoxazole and trimethoprim revealed no chromosomal abnormalities. In some rabbit studies, an overall increase in fetal loss dead and resorbed and malformed conceptuses was associated with doses of trimethoprim 6 times the human therapeutic dose. While there are no large, well-controlled studies on the use of sulfamethoxazole and trimethoprim in pregnant women, Brumfitt and Pursell,12 in a retrospective study, reported the outcome of 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. Because sulfamethoxazole and trimethoprim may interfere with folic acid metabolism, BACTRIM should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

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.

Bactrim Tablets contain 1. Bactrim DS Tablets contain 3. Pharmacokinetics parameters for sulfamethoxazole were similar for geriatric subjects and younger adult subjects. Agranulocytosis, aplastic anemia, thrombocytopenia, leukopenia, neutropenia, hemolytic anemia, megaloblastic anemia, hypoprothrombinemia, methemoglobinemia, eosinophilia. 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. 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. 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.

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Monitor for cardiac toxicities i. Although data are limited, the manufacturer of efavirenz recommends an alternative antiretroviral be considered for patients receiving medications with a known risk for TdP. Major Monitor patients for QT prolongation if coadministration of trimethoprim with sunitinib is daily. Additionally, dosage glycol toxicity may result in acute kidney injury, CNS toxicity, and multi-organ failure. If concomitant use is unavoidable, periodically monitor ECGs for QT prolongation and monitor electrolytes; an interruption of osimertinib therapy with dose reduction or discontinuation of therapy may be necessary if QT prolongation occurs. Patients should limit sunlight and UV exposure, and follow proper bactrim for sunscreens and protective clothing. Sulfamethoxazole; trimethoprim has also been associated with severe cases of hyponatremia, particularly in patients daily treatment for pneumocystis pneumonia PCP. Thus, naproxen may displace other highly protein bound drugs from albumin or vice versa. Hepatitis including cholestatic jaundice and hepatic necrosiselevation bactrim serum transaminase and bilirubin, bactrim ds daily dosage, pseudomembranous enterocolitis, bactrim ds daily dosage, pancreatitis, stomatitis, bactrim, nausea, emesis, abdominal pain, bactrim ds daily dosage, diarrhea, anorexia. Drugs with a possible risk for QT prolongation and TdP that should be daily cautiously and with close dosage with sulfamethoxazole; trimethoprim include aripiprazole.

Bactrim DS

Drugs with a possible risk for QT prolongation and TdP that should be bactrim cautiously and with close monitoring with donepezil include sulfamethoxazole; trimethoprim, SMX-TMP, bactrim ds daily dosage, cotrimoxazole. However, bactrim ds daily dosage, previous American Academy of Pediatrics AAP dosages considered sulfamethoxazole; trimethoprim as usually compatible with breast-feeding. For the treatment of acute otitis media in pediatric patients due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae when in the judgment of the physician sulfamethoxazole and trimethoprim offers some advantage over the use of other antimicrobial agents. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired daily function. Use sulfamethoxazole; trimethoprim during pregnancy only if the potential benefit justifies the potential risk to the fetus. Dronedarone administration is associated with a dose-related increase in the QTc interval. Moderate Anti-infectives which disrupt the normal GI flora, including sulfonamides, may potentially decrease the effectiveness of estrogen containing oral contraceptives. Occasional bactrim suggest that patients receiving pyrimethamine as malaria prophylaxis in doses exceeding 25 mg weekly may develop megaloblastic anemia if BACTRIM is prescribed. Because sulfamethoxazole and trimethoprim may interfere with folic acid metabolism, BACTRIM should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme Medications similar to lipitor dosages and trimethoprim is necessary.

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Minor Use caution if sulfamethoxazole and aprepitant are used bactrim and dosage for a possible decrease in the efficacy of sulfamethoxazole. Drugs with a daily risk for QT prolongation and TdP that should be used cautiously and dosage close monitoring with sulfamethoxazole; trimethoprim include fluconazole. Bactrim Caffeine; Phenyltoloxamine; Salicylamide: Antibiotics prevent this bacterial infection from occurring, thereby, bactrim ds daily dosage, dosage the vaccines protective immune response. The drugs are often given together for certain patient populations, so the ultimate clinical significance of a possible pharmacokinetic interaction is not clear. Taking these drugs together may also increase risk for phototoxicity, bactrim ds daily dosage. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with sulfamethoxazole; trimethoprim include mifepristone. If bactrim use is unavoidable, oxycodone and treximet monitor ECGs for QT prolongation and monitor electrolytes; correct hypokalemia or hypomagnesemia daily to administration of toremifene. Use not recommended by the manufacturer.

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