sulfamethoxazole and trimethoprim, Bactrim, Septra (cont.)
ulfamethoxazole/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 divalproex, valproic acid (Depakote, Depakote ER, Depakene, Depacon, Stavzor), methotrexate (Rheumatrex, Trexall), pyrimethamine, triamterene, or trimetrexate. Increased blood levels of potassium may occur when sulfamethoxazole/trimethoprim is combined with ACE inhibitors.
PREGNANCY: Use of sulfonamides may cause bilirubin to be displaced from proteins in the infant's blood. Displacement of bilirubin can lead to jaundice and a dangerous condition called kernicterus in the infant. For this reason, sulfamethoxazole/trimethoprim should not be used near term (late in pregnancy) among women.
NURSING MOTHERS: Sulfamethoxazole/trimethoprim should not be used by nursing mothers because sulfamethoxazole is excreted in milk and can cause kernicterus.
SIDE EFFECTS: Sulfamethoxazole/trimethoprim may cause dizziness, headache, lethargy, diarrhea, anorexia, nausea, vomiting, and rash. Sulfamethoxazole/trimethoprim should be stopped at the first appearance of a skin rash before the rash becomes severe. Serious rashes include Stevens-Johnson syndrome (aching joints and muscles; redness, blistering, and peeling of the skin); toxic epidermal necrolysis (difficulty in swallowing; peeling, redness, loosening, and blistering of the skin).
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