infectious diseases
Trimethoprim and Sulfamethoxazole
Adverse Effects of TMP and SMX
Adverse effects of TMP/SMX include Those associated with Adverse Effects None Folate deficiency Hyperkalemia Renal insufficiency Renal failure in patients with underlying renal insufficiency is probably secondary to interstitial nephritis or tubular necrosis. Also, TMP competitively inhibits renal tubular creatinine secretion and may cause an artificial increase in serum creatinine, although glomerular filtration rate remains unchanged. Increases in serum creatinine are more likely in patients with preexisting renal insufficiency and especially in those with diabetes mellitus. Most adverse effects are the same as Adverse Effects . TMP has adverse effects identical to those of SMX, but they are less common. Nausea, vomiting, and rash occur most often. AIDS patients have a high incidence of adverse effects, especially fever, rash, and neutropenia. Folate deficiency (resulting in macrocytic anemia) can also occur. Use of folinic acid can prevent or treat macrocytic anemia, leukopenia, and thrombocytopenia, which sometimes occur with prolonged TMP/SMX use. TMP can decrease renal tubular potassium excretion, leading to potentially life-threatening Hyperkalemia . Rarely, severe hepatic necrosis occurs. The drug may also cause a syndrome resembling aseptic meningitis. 