Bactrim ds how many mg

Eplerenone: 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. Eprosartan: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Erdafitinib: Major Avoid coadministration of erdafitinib and sulfamethoxazole due to the risk of increased plasma concentrations of erdafitinib.

If concomitant use is unavoidable, closely monitor for erdafitinib-related adverse reactions and consider dose modifications as clinically appropriate. If sulfamethoxazole is discontinued, the dose of erdafitinib may be increased in the absence of drug-related toxicity.

Ertugliflozin: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

Ertugliflozin; Metformin: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

Ertugliflozin; Sitagliptin: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

Estradiol Cypionate; Medroxyprogesterone: 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. Estradiol: Moderate Anti-infectives that disrupt the normal GI flora, including sulfonamides, may potentially decrease the effectiveness of estrogen-containing oral contraceptives. Moderate Anti-infectives which disrupt the normal GI flora, including sulfonamides, may potentially decrease the effectiveness of estrogen containing oral contraceptives.

Estradiol; Levonorgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Estradiol; Norethindrone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Estradiol; Norgestimate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. 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.

Ethinyl Estradiol; Norelgestromin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Norethindrone Acetate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Ethinyl Estradiol; Norgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethynodiol Diacetate; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Etonogestrel; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Exenatide: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. 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. Fenoprofen: 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. Finerenone: Moderate Monitor serum potassium concentrations closely if finerenone and trimethoprim are used together. Concomitant use may increase the risk of hyperkalemia. High doses of trimethoprim may increase the risk for hyperkalemia especially in patients with additional risk factors such as renal insufficiency.

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. Fluvastatin: 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.

Folic Acid, Vitamin B9: 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. Food: 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. Fosinopril: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary. Fosphenytoin: 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.

Ganciclovir: 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. Glimepiride: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

Glimepiride; Rosiglitazone: 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 Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Glipizide: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Glipizide; Metformin: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

Glyburide: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Glyburide; Metformin: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

Guaifenesin; Potassium Guaiacolsulfonate: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia. Hetastarch; Dextrose; Electrolytes: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia.

Hydrocodone; Potassium Guaiacolsulfonate: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia. Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia.

Ibritumomab Tiuxetan: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia. 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.

Imipramine: Moderate Monitor therapeutic response and adjust the tricyclic antidepressant dose, if needed, when use sulfamethoxazole; trimethoprim concomitantly. Incretin Mimetics: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Indinavir: Minor Concomitant administration of indinavir and trimethoprim should be done with caution. There was no effect on the AUC of indinavir or sulfamethoxazole.

Indomethacin: 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.

Insulin Degludec; Liraglutide: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Insulin Glargine; Lixisenatide: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

Insulins: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Iodine; Potassium Iodide, KI: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia. Irbesartan: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary.

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. Moderate Rifampin is a potent enzyme inducer.

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: Moderate Rifampin is a potent enzyme inducer. Monitor for therapeutic response to therapy and increased rifampin toxicity Ivacaftor: Minor Increased monitoring is recommended if ivacaftor is administered concurrently with CYP2C9 substrates, such as sulfamethoxazole; trimethoprim, SMX-TMP. Lamotrigine: Moderate Lamotrigine inhibits dihydrofolate reductase.

Caution should be exercised when administering trimethoprim, which also inhibits this enzyme. Lesinurad: Moderate Use lesinurad and sulfamethoxazole together with caution; sulfamethoxazole may increase the systemic exposure of lesinurad. Lesinurad; Allopurinol: Moderate Use lesinurad and sulfamethoxazole together with caution; sulfamethoxazole may increase the systemic exposure of lesinurad.

Leucovorin: 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.

Leuprolide; Norethindrone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Levoleucovorin: 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.

Levomefolate: Minor L-methylfolate and trimethoprim should be used together cautiously. Levonorgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Levonorgestrel; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Lidocaine: Moderate Coadministration of lidocaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia.

Lidocaine; Prilocaine: Moderate Coadministration of lidocaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. Moderate Coadministration of prilocaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue prilocaine and any other oxidizing agents.

Linagliptin; Metformin: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Liraglutide: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Lisinopril: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary.

Lixisenatide: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Lonafarnib: Major Avoid coadministration of lonafarnib and sulfamethoxazole; concurrent use may increase the exposure of lonafarnib and the risk of adverse effects. If coadministration is unavoidable, closely monitor patients for lonafarnib-related adverse reactions.

Loperamide: 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.

Loperamide; Simethicone: Moderate If these drugs are used together, the plasma concentrations of loperamide may increase. Losartan: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary.

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. Sulfamethoxazole is a substrate of CYP2C9; in vitro data suggest it is also a substrate for the P-glycoprotein P-gp drug transporter.

The net effect of lumacaftor; ivacaftor on CYP2C9-mediated metabolism and P-gp transport is not clear, but substrate exposure may be affected leading to decreased efficacy or increased or prolonged therapeutic effects and adverse events. Magnesium Salicylate: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.

Inhibitors of the 2C9 isoenzyme, such as trimethoprim, may lead to increased serum concentrations of mefenamic acid. Meglitinides: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

Meloxicam: Moderate Consider a meloxicam dose reduction and monitor for adverse reactions if coadministration with sulfamethoxazole is necessary. Memantine: 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.

Mepivacaine: Moderate Coadministration of mepivacaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue mepivacaine and any other oxidizing agents.

Mepivacaine; Levonordefrin: Moderate Coadministration of mepivacaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. Mercaptopurine, 6-MP: Moderate Increased bone marrow suppression may occur if mercaptopurine is coadministered with trimethoprim sulfamethoxazole.

If concomitant use is necessary, monitor complete blood counts and adjust the dose of mercaptopurine if severe neutropenia or thrombocytopenia occur. Mestranol; Norethindrone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Metformin: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

The possibility of an increased risk of hypoglycemia should be considered during concomitant use of trimethoprim and repaglinide. Metformin; Rosiglitazone: Moderate It is possible that an increase in the exposure of rosiglitazone may occur when coadministered with drugs that inhibit CYP2C8 such as trimethoprim.

Metformin; Saxagliptin: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

Metformin; Sitagliptin: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Methenamine: Major Sulfonamides can crystallize in an acidic urine.

Methotrexate: Major Avoid concurrent use of sulfamethoxazole and methotrexate. Sulfonamides can displace methotrexate from plasma protein binding sites and compete with renal transport of methotrexate, thus increasing free methotrexate concentrations.

Major Avoid concurrent use of trimethoprim and methotrexate. If concurrent use is necessary, closely monitor patients for signs or symptoms of skin toxicity. Methyclothiazide: Major Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. Metolazone: Major Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. Metronidazole: Major Medications with significant alcohol content should not be ingested during therapy with metronidazole and should be avoided for 3 days after therapy is discontinued.

Miglitol: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Moexipril: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary. Nanoparticle Albumin-Bound Paclitaxel: Moderate Monitor for an increase in paclitaxel-related adverse reactions if coadministration of nab-paclitaxel with trimethoprim is necessary due to the risk of increased plasma concentrations of paclitaxel.

In vitro, the metabolism of paclitaxel to 6-alpha-hydroxypaclitaxel was inhibited by another inhibitor of CYP2C8. Nebivolol; Valsartan: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Norethindrone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Norethindrone; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Norethindrone; Ethinyl Estradiol; Ferrous fumarate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Norgestimate; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Norgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Nortriptyline: Moderate Monitor therapeutic response and adjust the tricyclic antidepressant dose, if needed, when use sulfamethoxazole; trimethoprim concomitantly.

Olmesartan: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Minor Sulfonamides may compete with amoxicillin for renal tubular secretion, increasing amoxicillin serum concentrations. Oral Contraceptives: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. If these drugs are administered concurrently, monitor for sulfamethoxazole toxicity such as diarrhea, anorexia, or nausea.

Oxacillin: Minor Sulfonamides may compete with oxacillin for renal tubular secretion, increasing oxacillin serum concentrations. If coadministration is necessary, use caution and monitor for increased paclitaxel side effects, including myelosuppression and peripheral neuropathy. This interaction may also be applicable to combination products containing trimethoprim, including sulfamethoxazole; trimethoprim also known as SMX-TMP or cotrimoxazole. Penicillin G Benzathine: Minor Sulfonamides may compete with penicillin for renal tubular secretion, increasing penicillin serum concentrations.

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. If methemoglobinemia occurs or is suspected, discontinue penicillin G procaine and any other oxidizing agents.

Sulfonamides may also compete with penicillin for renal tubular secretion, increasing penicillin serum concentrations. Minor Sulfonamides may compete with penicillin for renal tubular secretion, increasing penicillin serum concentrations.

Penicillin G Procaine: Moderate Coadministration of penicillin G procaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. Penicillin G: Minor Sulfonamides may compete with penicillin for renal tubular secretion, increasing penicillin serum concentrations. Penicillin V: Minor Sulfonamides may compete with penicillin for renal tubular secretion, increasing penicillin serum concentrations. Perindopril: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary.

Perindopril; Amlodipine: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary.

Perphenazine; Amitriptyline: Moderate Monitor therapeutic response and adjust the tricyclic antidepressant dose, if needed, when use sulfamethoxazole; trimethoprim concomitantly. Pexidartinib: Moderate Monitor for evidence of hepatotoxicity if pexidartinib is coadministered with sulfamethoxazole. Avoid concurrent use in patients with increased serum transaminases, total bilirubin, or direct bilirubin more than ULN or active liver or biliary tract disease.

Phenytoin: Moderate Concomitant use of sulfamethoxazole with phenytoin may result in increased serum concentrations of phenytoin and increase the risk for adverse reactions.

Phenytoin is a substrate of CYP2C9; sulfamethoxazole is an inhibitor of this enzyme. Moderate The half-life of phenytoin may be increased with trimethoprim. Phenytoin doses may need to be reduced during concomitant use of trimethoprim. Photosensitizing agents topical : Moderate Sulfonamides may cause photosensitization and may increase the photosensitizing effects of photosensitizing agents used during photodynamic therapy.

Pioglitazone: 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. Pioglitazone; Glimepiride: 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. Pioglitazone; Metformin: 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.

Piperacillin: Minor Sulfonamides may compete with piperacillin for renal tubular secretion, increasing piperacillin serum concentrations. Piperacillin; Tazobactam: Minor Sulfonamides may compete with piperacillin for renal tubular secretion, increasing piperacillin serum concentrations.

Porfimer: Major Avoid coadministration of porfimer with sulfonamides due to the risk of increased photosensitivity. Porfimer is a light-activated drug used in photodynamic therapy; all patients treated with porfimer will be photosensitive. Concomitant use of other photosensitizing agents like sulfonamides may increase the risk of a photosensitivity reaction.

Posaconazole: Major Posaconazole and sulfamethoxazole should be coadministered with caution due to an increased potential for sulfamethoxazole-related adverse events.

Posaconazole is a potent inhibitor of CYP3A4, an isoenzyme partially responsible for the metabolism of sulfamethoxazole. These drugs used in combination may result in elevated sulfamethoxazole plasma concentrations, causing an increased risk for sulfamethoxazole-related adverse events.

Potassium Acetate: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia. Potassium Bicarbonate: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia. Potassium Chloride: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia. Potassium Citrate: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia.

Potassium Gluconate: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia.

Potassium Iodide, KI: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia.

Potassium Phosphate: Moderate Use potassium phosphate cautiously with trimethoprim especially high dose , as both drugs increase serum potassium concentrations.

Potassium Phosphate; Sodium Phosphate: Moderate Use potassium phosphate cautiously with trimethoprim especially high dose , as both drugs increase serum potassium concentrations. Potassium: Moderate Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia.

Potassium-sparing diuretics: Major Trimethoprim has a potassium-sparing effect and may induce hyperkalemia, especially in patients with pre-existing risk factors for hyperkalemia e. Concomitant administration of drugs that undergo substantial renal clearance, such as sulfamethoxazole; trimethoprim, SMX-TMP, may result in delayed clearance of pralatrexate.

Pramlintide: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

Prilocaine: Moderate Coadministration of prilocaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. Prilocaine; Epinephrine: Moderate Coadministration of prilocaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia.

Probenecid: Minor Probenecid may inhibit the renal transport of sulfonamides. Procainamide: Moderate Monitor procainamide plasma concentrations, if available, and for clinical and ECG signs of procainamide toxicity with concomitant trimethoprim use.

Trimethoprim increases the plasma concentrations of procainamide and its active N-acetyl metabolite NAPA. The increased procainamide and NAPA plasma concentrations are associated with further prolongation of the QTc interval. Protriptyline: Moderate Monitor therapeutic response and adjust the tricyclic antidepressant dose, if needed, when use sulfamethoxazole; trimethoprim concomitantly. Pyrimethamine: Major Avoid concurrent use of sulfamethoxazole and pyrimethamine.

Additionally, the concomitant use of other antifolic drugs associated with myelosuppression, including sulfamethoxazole; trimethoprim, may increase the risk of bone marrow suppression. Major Avoid concurrent use of trimethoprim and pyrimethamine. Pyrimethamine; Sulfadoxine: Major Avoid concurrent use of sulfamethoxazole and pyrimethamine. Quinapril: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary.

Ramelteon: Moderate Ramelteon should be administered with caution to patients taking CYP2C9 inhibitors, such as sulfamethoxazole. The patient should be monitored closely for toxicity even though ramelteon has a wide therapeutic index. Ramipril: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary. Relugolix; Estradiol; Norethindrone acetate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Rifampin: Moderate Rifampin is a potent enzyme inducer. Monitor for therapeutic response to therapy and increased rifampin toxicity Riluzole: Moderate Monitor for signs and symptoms of hepatic injury during coadministration of riluzole and sulfamethoxazole.

Concomitant use may increase the risk for hepatotoxicity. Discontinue riluzole if clinical signs of liver dysfunction are present. Ropivacaine: Moderate Coadministration of ropivacaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue ropivacaine and any other oxidizing agents.

Rosiglitazone: Moderate It is possible that an increase in the exposure of rosiglitazone may occur when coadministered with drugs that inhibit CYP2C8 such as trimethoprim. Sacubitril; Valsartan: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary.

Salicylates: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Salsalate: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Sapropterin: Moderate Drugs that inhibit folate metabolism, such as trimethoprim, should be used with caution in patients taking sapropterin.

More frequent monitoring of blood phenylalanine concentrations is warranted in patients receiving these agents concurrently. An increased dosage of sapropterin may be necessary to achieve a biochemical response. Trimethoprim may decrease the bioavailability of endogenous tetrahydrobiopterin BH4 by inhibiting the enzyme dihydrofolate reductase. Reduction of BH4 could make management of hyperphenylalaninemia with sapropterin more difficult.

Segesterone Acetate; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Selexipag: Major Consider a less frequent dosing regimen e. Reduce the selexipag dose when trimethoprim is initiated in patients already taking selexipag.

Coadministration can be expected to increase exposure to selexipag and its active metabolite. Semaglutide: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.

SGLT2 Inhibitors: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Siponimod: Moderate Concomitant use of siponimod and sulfamethoxazole may increase siponimod exposure.

If the patient is also receiving a drug regimen containing a moderate or strong CYP3A4 inhibitor, use of siponimod is not recommended due to a significant increase in siponimod exposure. Check with your doctor if you have a skin rash, blistering, peeling, loosening of the skin, chills, cough, diarrhea, itching, joint or muscle pain, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, white spots in the mouth or on the lips, black, tarry stools, chest pain, or painful or difficult urination.

Check with your doctor right away if you have dark urine, clay-colored stools, stomach pain, or yellow eyes or skin. These may be symptoms of a serious liver problem. This medicine, especially if you are receiving high doses or for a long period of time, may lower the number of platelets in your body, which are necessary for proper blood clotting. Because of this, you may bleed or get infections more easily. Talk with your doctor if you have black, tarry stools, bleeding gums, blood in urine or stools, pinpoint red spots on the skin, unusual bleeding or bruising.

This medicine may cause diarrhea, and in some cases it can be severe. It may occur 2 months or more after you stop taking this medicine.

Do not take any medicine to treat diarrhea without first checking with your doctor. If you have any questions or if mild diarrhea continues or gets worse, check with your doctor.

Check with your doctor right away if you or your child have stomach cramps, bloating, watery and severe diarrhea, which may also be bloody, nausea or vomiting, or unusual tiredness or weakness. These may be symptoms of a serious intestinal infection. This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention.

Check with your doctor right away if you or your child have a rash, itching, swelling of the face, tongue, and throat, trouble breathing, or chest pain after you use the medicine. This medicine may cause electrolyte problems, including high potassium in the blood hyperkalemia and low sodium in the blood hyponatremia. Tell your doctor right away if you have confusion, weakness, muscle twitching, an irregular heartbeat, numbness or tingling in the hands, feet, or lips, or trouble breathing.

This medicine may cause hypoglycemia low blood sugar in some patients. Check with your doctor if you have anxiety, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty with concentrating, drowsiness, excessive hunger, headache, nausea, nervousness, rapid heartbeat, shakiness, or unusual tiredness or weakness.

Before you have any medical tests, tell the medical doctor in charge that you or your child are taking this medicine. The results of some tests may be affected by this medicine.

Patients receiving anticonvulsant treatment medicines to prevent seizures may be at risk for a folate vitamin B9 deficiency, which may increase the risk for side effects. Talk with your doctor if you have concerns about this. Do not use this medicine for Pneumocystis jiroveci pneumonia PCP if you are also using leucovorin. Using these medicines together may cause these medicines to not work as well for you. Do not take other medicines unless they have been discussed with your doctor.

This includes leucovorin, other prescription or nonprescription over-the-counter [OTC] medicines and herbal or vitamin supplements. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine.

Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects. Maintain adequate hydration. Discontinue at 1 st sign of skin rash or any other serious reaction. Embryo-fetal toxicity. Nursing mothers. See Contraindications. May potentiate oral anticoagulants eg, warfarin , hypoglycemics, phenytoin, methotrexate, digoxin; monitor.

May be potentiated by indomethacin. May increase risk of thrombocytopenia with diuretics esp. Nephrotoxicity with cyclosporine in renal transplant. May antagonize tricyclic antidepressants. May interfere with assays for serum methotrexate, creatinine.