PREPARATIONS: Tablets: 160 mg trimethoprim and 800 mg sulfamethoxazole (Bactrim DS, Septra DS); 80 mg trimethoprim and 400 mg sulfamethoxazole (Bactrim; Septra).
DRUG INTERACTIONS: Sulfamethoxazole/trimethoprim can enhance the blood-thinning effects of warfarin (Coumadin), possibly leading to bleeding. Sulfonamides such as sulfamethoxazole can increase the metabolism (break-down and elimination) of cyclosporine (causing loss of effectiveness of cyclosporine), and can add to the kidney damage caused by cyclosporine.
Blood levels of phenytoin (Dilantin) may be increased by treatment with sulfamethoxazole/trimethoprim. This may lead to side effects associated with phenytoin (Dilantin, Dilantin-125) such as dizziness, and reduced attention.
Sulfamethoxazole/trimethoprim also may increase blood levels of digoxin (Lanoxin) and possibly lead to serious toxic effects. Anemia, due to a reduction in folic acid, can occur in persons receiving sulfamethoxazole/trimethoprim in combination with:
- valproic acid (Depakote, Depakote ER, Depakene, Depacon, Stavzor),
- methotrexate (Rheumatrex, Trexall),
- triamterene, or
Increased blood levels of potassium may occur when sulfamethoxazole/trimethoprim is combined with ACE inhibitors.
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