Sulfamethoxazole and Trimethoprim (Co-trimoxazole) is a Medicine belongs to Sulfonamide group whose information about Brand can be referenced from   Book : Martindale    Page : 282   Edition : 37,

  ►   Brandname : Bactrim,Ciplin,Colizole,Cotrimol,Oriprim,Sepmax,Fectrim,Septrin,Bactrim,Cotrim,Septra,SMZ-TMP,Sulfatrim

  ►  Strength : Tablet with 80+400  mg, Tablet with 160+800  mg, Tablet with 40+200  mg, Suspension with 40+200/5  mg/ml, Injection with 80+400/5  mg/ml,

Reference of this Medicine for its Strength can be taken from   Book : Basic & Clinical pharmacology    Page : 837   Edition : 12,
A Route of administration in pharmacology and toxicology is the path by which a drug, fluid, poison, or other substance is taken into the body. Routes of administration are generally classified by the location at which the substance is applied. Common examples include oral and intravenous administration.

  ►  Route of administration : Oral, IV,
Reference :-   Book : Martindale    Page : 281   Edition : 37,

Dosing of Medicine differ in Adult & Pediatrics ↓


Adult Dose

S.No Ailment   Route   Dose Min   Dose Max   Unit   Dosage Form   Frequency   Additional Info
1 Bacterial infections Oral 960 mg Tablet b.d.
2 Severe infections Oral 2.88 gm Daily in 2 divided doses .
3 Pneumocystis pneumonia Oral 120 mg/kg Daily given in 2 to 4 divided doses for 14 to 21 days.
4 Prophylaxis of pneumocystis pneumonia Oral 960 mg Tablet o.d.

Ref :-  Book : Martindale    Page : 281   Edition : 37,




Pediatric Dose

S.No Ailment   Age Min   Age Max   Weight ( Kg ) Route   Dose Min   Dose Max   Unit   Dosage Form   Frequency  Additional Info  
1 Prophylaxis of pneumocystis pneumonia 6 Week 6 Month Oral 120 mg Tablet b.d.
2 Prophylaxis of pneumocystis pneumonia 6 Month 6 Year Oral 240 mg Tablet b.d.
3 Prophylaxis of pneumocystis pneumonia 6 Year 12 Year Oral 480 mg Tablet b.d.
4 Prophylaxis of pneumocystis pneumonia IV 18 mg/kg Injection b.d.
5 Severe infections IV 27 mg/kg Injection b.d.

Ref :- Book : Martindale    Page : 282   Edition : 37,
►  Side Effect : Skin reactions, toxic epidermal necrolysis, Stevens-Johnson syndrome, hepatic necrosis, hepatomegaly, jaundice, myocarditis, pulmonary eosinophilia, fibrosing alveolitis, hypoglycemia, hypothyroidism, neurological reactions, Aseptic memingitis, ataxia, benign intracranial hypertension, convulsion, Dizziness, drowsiness, fatigue, headache, insomnia, mental depression, Peripheral and autonomic neuropathies, psychoses, tinnitus, vertigo, Pancreatitis, pruritus, Skin rashes, gastrointestinal disturbance, nausea, vomiting, glossitis, photosensitivity, agranulocytosis, aplastic anaemia, thrombocytopenia, leucopenia, hypoprothrombinaemia, eosinophilia, cyanosis, anaphylaxis, severe skin reactions,
Ref :-   Book : Martindale    Page : 369, 386, 280   Edition : 37,

►  Drug Interaction : Drug interaction of Sulfamethoxazole and Trimethoprim (Co-trimoxazole) is with Ropinirole , Methotrexate, Phenytoin , Ropivacaine , Amlodipine , , Phenytoin , Digoxin , Procainamide , Rosiglitazone , Repaglinide , Zidovudine, Zalcitabine, Lamivudine, Dapsone , Rifampicin , Cyclosporine , Tenecteplase , Sertraline,
Ref :-   Book : Martindale    Page : 387   Edition : 37,


  ►    Mechanism of Drug Drug Interaction :  Sulfamethoxazole and other sulfonamides may potentiate the effects of some drugs, such as oral anticoagulants, methotrexate, and phenytoin; this may be due to displacement of the drug from plasma protein binding sites or to inhibition of metabolism. High doses of sulfonamides have been reported to have a hypoglycaemic effect; the antidiabetic effect of the sulfonylurea compounds may be enhanced by sulfonamides. Trimethoprim and co-trimoxazole can cause rises in serum creatinine, and therefore may contribute to ciclosporin-induced nephrotoxicity. Trimethoprim may increase serum concentrations and potentiate the effect of a number of drugs, including phenytoin, digoxin, procainamide, rosiglitazone, and repaglinide. Trimethoprim has been reported to reduce the renal excretion and increase blood concentrations of zidovudine, zalcitabine, and lamivudine. Trimethoprim and dapsone increase each other’s serum concentrations, whereas rifampicin may decrease trimethoprim concentrations. An increased risk of nephrotoxicity has been reported with the use of trimethoprim or co-trimoxazole and ciclosporin. Intravenous use of trimethoprim and sulfonamides may reduce ciclosporin concentrations in blood. Hyponatraemia has been reported in patients given trimethoprim with diuretics. An increased risk of thrombocytopenia has been seen in elderly patients given co-trimoxazole with diuretics, although it is unclear which component of the antibacterial is responsible. Severe hyperkalaemia has been noted in patients given trimethoprim (or co-trimoxazole) together with an ACE inhibitor.,
Ref :-   Book :    Page : 370,386   Edition : 37,


►  Contraindication : Hypersensitivity, hepatic impairment, renal impairment, Breast feeding,
Ref :-   Book : Martindale    Page : 280   Edition : 37,
  ►  Mechanism of Action :   Co-trimoxazole is a mixture of the sulfonamide, sulfamethoxazole, and the diaminopyrimidine, trimethoprim, in the proportion of 5 parts of sulfamethoxazole to 1 part of trimethoprim.The enzyme dihydrofolic acid (DHF) synthase converts p-aminobenzoic aid (PABA) to folic acid (THF), purines and DNA. The sulphonamides are structurally similar to PABA, successfully complete with it for DHF synthase and thus ultimately impair DNA formation. Trimethoprim acts at the subsequent step by inhibiting DHF reductase, which converts DHF to THF. Both sulphonamide and trimethoprim are bacteriostatic. ,
Ref :-   Book : Martindale    Page : 281   Edition : 37,

Pathway of Dietry Product


​   ► Act.Comp / Nutrient / Food / Herb as follows :- Tulsi with Another pathway, amarnath with Another pathway, amarnath with Another pathway, Liquorice with Another pathway,

  ►  Pathway with its reference as follows :-
  • Estragole have antibiotic property --- (Duke, J. & Duke, J. (2002). Handbook of medicinal herbs. Boca Raton, FL: CRC Press. )
  • Nimbin have Anti-malerial property --- (Kokate, C. (2013). Pharmacognosy (4th ed.). Pune: Nirali Prakashan. )
  • Nimbidin have Anti-malerial property --- ( Prophylatic Potential of Lemon Grass and Neem as Antimalarial Agents. (2010). Journal Of American Science, 6(8). )
  • Triterpene Saponins has the ability to release endogenous secretion, which is potetial mediator of the antulcer actions. --- (: Abbas, A. (2015). Antimicrobial potential of glycchariza glaba. Journal Of Drug Design And Medicinal Chemistr, 1(2). http://dx.doi.org/10.11648/j.jddmc.20150102.12 )

  •   ►  URL -- https://books.google.co.in/books?id=UcLYLpwdcm8C&pg=PA513&dq=Duke, +J.+%26+Duke, +J.+(2002).+Handbook+of+medicinal+herbs.+Boca+Raton, +FL:+CRC+Press.&hl=en&sa=X&redir_esc=y#v=onepage&q=Duke%2C%20J.%20%26%20Duke%2C%20J.%20(2002).%20Handbook%20, Kokate, C. (2013). Pharmacognosy (4th ed.). Pune: Nirali Prakashan., http://www.jofamericanscience.org/journals/am-sci/am0608/62_3089am0608_503_507.pdf, http://article.sciencepublishinggroup.com/pdf/10.11648.j.jddmc.20150102.12.pdf,


    Dietry Substance Interactions


    ​   ► This Medicine interact with :- VITAMIN K with Decrease in Nutrient Level, FOLIC ACID with Decrease in Nutrient Level,

      ►  Reference :-
  • Gaby, A. (2006). A–Z Guide to Drug-Herb-Vitamin Interactions. 2nd ed. New York: Three Rivers Press
  • Gaby, A. (2006). A–Z Guide to Drug-Herb-Vitamin Interactions. 2nd ed. New York: Three Rivers Press

  •   ►  URL -- http://www.otto-wipfel.co.uk/otto/supplements-medication/DRUG-HERB-VITAMINS-INTERACTIONS-A-Z_Guide.pdf,


    ContraIndication Dietry Substance


    ​   ► This Medicine contraindicate with :- NA

    ►   Route of Elimination :   Biliary, Hepatic (Metabolism), Renal,
    Ref :-   Book : Martindale    Page : 370,387   Edition : 37,


    ►    Plasma Half-life :
      Min value :-   NA    Max value :-   NA


    ►    Peak Plasma Concentration :   Min value :-   NA    Max value :-   NA