Biotrim
Generic Name
Sulfamethoxazole + Trimethoprim (Co-trimoxazole)
Manufacturer
Beximco Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| biotrim 400 mg tablet | ৳ 1.49 | ৳ 14.90 |
Description
Overview of the medicine
Biotrim is a combination antibiotic containing sulfamethoxazole and trimethoprim, used to treat a variety of bacterial infections.
Uses & Indications
Dosage
Adults
For standard infections, 1-2 Biotrim 400 mg tablets (400 mg SMX/80 mg TMP) every 12 hours for 10-14 days. For PCP, higher doses are used.
Elderly
Dosage should be adjusted based on renal function and clinical response. Lower doses may be appropriate.
Renal_impairment
Creatinine clearance 15-30 mL/min: Reduce dose by half. Creatinine clearance <15 mL/min: Not recommended unless carefully monitored.
How to Take
Take orally with a full glass of water, with or without food. Taking with food or milk may reduce gastrointestinal upset. Drink plenty of fluids to prevent kidney stones.
Mechanism of Action
Sulfamethoxazole inhibits bacterial dihydrofolate synthesis by competing with para-aminobenzoic acid (PABA). Trimethoprim inhibits bacterial dihydrofolate reductase. This dual blockade in the folate pathway provides a synergistic bactericidal effect.
Pharmacokinetics
Onset
Antibacterial effects begin within 1-2 hours after oral administration.
Excretion
Mainly excreted via the kidneys, both by glomerular filtration and tubular secretion.
Half life
Sulfamethoxazole has a half-life of approximately 10 hours, and trimethoprim has a half-life of approximately 8-10 hours.
Absorption
Both sulfamethoxazole and trimethoprim are well absorbed orally, reaching peak plasma concentrations within 1-4 hours.
Metabolism
Primarily hepatic; sulfamethoxazole is acetylated and glucuronidated, while trimethoprim is oxidized.
Side Effects
Contraindications
- Hypersensitivity to sulfamethoxazole, trimethoprim, or any sulfonamide derivative
- Severe renal impairment (CrCl <15 mL/min) if not monitored
- Severe hepatic parenchymal damage
- Megaloblastic anemia due to folate deficiency
- Infants less than 2 months of age
- Pregnancy (especially near term) and lactation
Drug Interactions
Warfarin
May increase anticoagulant effect, requiring close INR monitoring.
Phenytoin
May increase phenytoin levels by inhibiting its metabolism.
Methotrexate
May increase methotrexate toxicity by inhibiting renal tubular secretion.
Diuretics (especially thiazides)
Increased risk of thrombocytopenia with purpura in elderly patients.
Storage
Store below 30°C in a cool, dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms may include nausea, vomiting, diarrhea, headache, dizziness, and bone marrow depression. Management involves gastric lavage, forced diuresis, and administration of leucovorin for folate deficiency.
Pregnancy & Lactation
Pregnancy Category C (some sources D). Not recommended in the first trimester and near term due to potential risks of neural tube defects and kernicterus in the neonate. Avoid during lactation due to excretion into breast milk and potential for kernicterus in infants.
Side Effects
Contraindications
- Hypersensitivity to sulfamethoxazole, trimethoprim, or any sulfonamide derivative
- Severe renal impairment (CrCl <15 mL/min) if not monitored
- Severe hepatic parenchymal damage
- Megaloblastic anemia due to folate deficiency
- Infants less than 2 months of age
- Pregnancy (especially near term) and lactation
Drug Interactions
Warfarin
May increase anticoagulant effect, requiring close INR monitoring.
Phenytoin
May increase phenytoin levels by inhibiting its metabolism.
Methotrexate
May increase methotrexate toxicity by inhibiting renal tubular secretion.
Diuretics (especially thiazides)
Increased risk of thrombocytopenia with purpura in elderly patients.
Storage
Store below 30°C in a cool, dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms may include nausea, vomiting, diarrhea, headache, dizziness, and bone marrow depression. Management involves gastric lavage, forced diuresis, and administration of leucovorin for folate deficiency.
Pregnancy & Lactation
Pregnancy Category C (some sources D). Not recommended in the first trimester and near term due to potential risks of neural tube defects and kernicterus in the neonate. Avoid during lactation due to excretion into breast milk and potential for kernicterus in infants.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture, check packaging for exact expiry date.
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Co-trimoxazole has been extensively studied since its introduction and is a well-established broad-spectrum antibiotic with numerous clinical trials demonstrating its efficacy in various bacterial infections.
Lab Monitoring
- Complete Blood Count (CBC) with differential, especially during long-term therapy
- Renal function tests (BUN, creatinine)
- Liver function tests (ALT, AST)
Doctor Notes
- Counsel patients on the importance of hydration to prevent crystalluria and maintain efficacy.
- Monitor renal function, especially in elderly patients or those with pre-existing kidney impairment.
- Be alert for signs of hypersensitivity reactions (e.g., rash, fever) and hematologic abnormalities (e.g., unexplained bruising, fatigue).
Patient Guidelines
- Complete the full course of medication, even if symptoms improve.
- Drink plenty of water to prevent crystalluria.
- Avoid prolonged exposure to sunlight and use sunscreen.
- Report any severe skin rash, yellowing of skin/eyes, or unusual bruising/bleeding to your doctor immediately.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double dose.
Driving Precautions
This medicine may cause dizziness or blurred vision in some individuals. If you experience these effects, avoid driving or operating machinery.
Lifestyle Advice
- Maintain good hydration throughout the treatment.
- Avoid direct sun exposure and wear protective clothing.
- Do not self-medicate or share this antibiotic with others.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.
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