Avoid concomitant use and consider alternative antibiotic therapy in patients with additional risk factors for hyperkalemia, including patients older than 65 years, those with underlying disorders of potassium metabolism, renal insufficiency, or those requiring high doses of trimethoprim. For the safe dosage, dividing the tablet according to your pets body weight is suggested. Bismuth Subsalicylate; Metronidazole; Tetracycline: (Minor) Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. 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. Note: Weight-based dosing recommendations are based on the trimethoprim (TMP) component. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. Methoxsalen: (Moderate) Use methoxsalen and sulfonamides together with caution; the risk of severe burns/photosensitivity may be additive. In patients with normal renal function, sulfamethoxazole's half-life ranges from 6 to 12 hours, and trimethoprim's half-life ranges from 8 to 10 hours. High potassium like abnormal heartbeat, confusion, dizziness, passing out, weakness, shortness of breath, or numbness or tingling feeling. Dipeptidyl Peptidase-4 Inhibitors: (Moderate) Monitor blood glucose during concomitant dipeptidyl peptidase-4 inhibitor and sulfonamide use. Monitor therapy, Phenytoin: Trimethoprim may increase the serum concentration of Phenytoin. An enhanced effect of the displaced drug may occur. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. 150 mg/m2 trimethoprim/750 mg/m2 sulfamethoxazole PO once daily (Max: 160 mg trimethoprim/800 mg sulfamethoxazole/day) in patients with an IgG antibody to Toxoplasma and severe immunosuppression (i.e., infants and children younger than 6 years of age with a CD4 percentage less than 15% or children 6 years and older with a CD4 count less than 100 cells/mm3). If methemoglobinemia occurs or is suspected, discontinue articaine and any other oxidizing agents. 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. Excessive bosentan dosage may result in hypotension or elevated hepatic enzymes. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Note: Oral therapy should follow appropriate parenteral therapy. Severe life-threatening anaphylactic reactions or less severe asthmatic episodes can develop in susceptible patients. Avoid concomitant use and consider alternative antibiotic therapy in patients with additional risk factors for hyperkalemia, including patients older than 65 years, those with underlying disorders of potassium metabolism, renal insufficiency, or those requiring high doses of trimethoprim. If naproxen is used concurrently with sulfonamides, monitor patients for toxicity from either drug. Estradiol; Norgestimate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. Sulfonamides may also compete with penicillin for renal tubular secretion, increasing penicillin serum concentrations. 15 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 8 hours (Max: 960 mg trimethoprim/day) for 14 to 21 days. Drospirenone; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. If methemoglobinemia occurs or is suspected, discontinue chloroprocaine and any other oxidizing agents. 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. 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. Chloroprocaine: (Major) Coadministration of chloroprocaine with sulfonamides may antagonize the effect of sulfonamides. 2.5 to 5 mg/kg/dose (trimethoprim component) PO twice daily or 2 or 3 times weekly or 5 to 10 mg/kg/dose (trimethoprim component) PO once daily. Restart prophylaxis if CD4 count is less than 500 cells/mm3 or CD4 is less than 15%. For prophylaxis, 5 mg/kg/dose of trimethoprim component IV/PO every 24 to 48 hours for 3 to 7 doses/week. Sulfamethoxazole is a substrate of CYP2C9, while elvitegravir is a CYP2C9 inducer. Discontinuation may be considered in patients without evidence of active infection who have sustained improvement in immunologic status (CDC immunologic category 1 or 2) for longer than 6 months in response to ART. 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. 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. Sofosbuvir; Velpatasvir: (Moderate) Use caution when administering velpatasvir with trimethoprim. 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. Management: Seek alternatives to the CYP2C9 substrate when possible. Sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic persons. An enhanced effect of the displaced drug may occur. Mestranol; Norethindrone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. Hematologic toxicity, such as leukopenia and/or thrombocytopenia, can be increased by concurrent use of fluorouracil, 5-FU or other bone marrow depressants. 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. Monitor serum potassium concentrations at periodic intervals. 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. (Moderate) Coadministration of dapsone with sulfonamides may increase the risk of developing methemoglobinemia. Avoid concomitant use and consider alternative antibiotic therapy in patients with additional risk factors for hyperkalemia, including patients older than 65 years, those with underlying disorders of potassium metabolism, renal insufficiency, or those requiring high doses of trimethoprim. Consider pseudomembranous colitis in patients presenting with diarrhea after antibacterial use. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. 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. (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. Photosensitizing agents (topical): (Moderate) Sulfonamides may cause photosensitization and may increase the photosensitizing effects of photosensitizing agents used during photodynamic therapy. Lidocaine: (Moderate) Coadministration of lidocaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia. 10 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours (Max: 960 mg trimethoprim/day) as an alternative therapy for bacterial meningitis caused by E. coli, L. monocytogenes, or methicillin-resistant Staphylococcus aureus (MRSA). Hypoglycemia: May cause hypoglycemia, particularly in malnourished, or patients with renal or hepatic impairment. This medicine will not work for colds, flu, or other virus infections. Patients at risk for hypoglycemia due to sulfonamides include those with compromised renal function, those fasting for prolonged periods, those that are malnourished, and those receiving high or excessive doses of sulfonamides. 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 10 days; may increase dose to 20 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 640 mg trimethoprim/3,200 mg sulfamethoxazole/day) and/or duration to 3 to 4 weeks if symptoms worsen or persist. A longer course (several months) may be needed for severe or complicated infections. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. Hepatic necrosis: Fatalities associated with hepatic necrosis have occurred; discontinue use at first sign of rash or signs of serious adverse reactions. A retrospective review of 19 patients at Duke University who received co-trimoxazole for treatment of documented Nocardia infection revealed that patients received an average of 8.2 regular strength tablets/day for an average of 7.2 months. Quinapril: (Moderate) Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and trimethoprim is necessary. Overdosing is toxic for pets and can be fatal. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. May consider the addition of caspofungin for salvage therapy. Concomitant use may alter the exposure of some cannabinoids and increase the risk for adverse reactions. Or other virus infections Phenytoin: trimethoprim may increase the risk of developing methemoglobinemia heartbeat, confusion, dizziness passing. 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