Cotrim-DS
Generic Name
Co-trimoxazole (Sulfamethoxazole and Trimethoprim)
Manufacturer
Beximco Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| cotrim ds 800 mg tablet | ৳ 2.66 | ৳ 26.60 |
Description
Overview of the medicine
Cotrim-DS is a combination antibiotic containing sulfamethoxazole and trimethoprim, used to treat various bacterial infections.
Uses & Indications
Dosage
Adults
Typically, one Cotrim-DS tablet (800 mg sulfamethoxazole/160 mg trimethoprim) orally every 12 hours for 7 to 14 days, depending on the infection.
Elderly
Similar to adults, but with caution, especially considering renal function. Dosage adjustments may be needed based on creatinine clearance.
Renal_impairment
Dosage adjustment is necessary based on the patient's creatinine clearance. Reduced doses are required for severe renal impairment.
How to Take
Administer orally, with or without food. Taking it with food or milk may minimize gastrointestinal upset. Drink plenty of water to help prevent crystalluria.
Mechanism of Action
Co-trimoxazole works by inhibiting bacterial folic acid synthesis at two different sequential steps. Sulfamethoxazole interferes with dihydrofolate synthetase, and trimethoprim inhibits dihydrofolate reductase, thereby preventing bacterial growth and replication.
Pharmacokinetics
Onset
Rapid
Excretion
Mainly renal excretion (glomerular filtration and tubular secretion).
Half life
Sulfamethoxazole: 9-11 hours; Trimethoprim: 8-10 hours.
Absorption
Both sulfamethoxazole and trimethoprim are well absorbed orally. Peak plasma concentrations are reached within 1 to 4 hours.
Metabolism
Primarily hepatic metabolism (sulfamethoxazole undergoes acetylation, trimethoprim undergoes oxidation).
Side Effects
Contraindications
- Hypersensitivity to sulfamethoxazole, trimethoprim, or any excipients of the product
- Severe renal impairment where plasma concentrations cannot be monitored
- Severe hepatic parenchymal damage
- Megaloblastic anemia due to folate deficiency
- Infants younger than 2 months of age
Drug Interactions
Warfarin
May enhance the anticoagulant effect of warfarin, increasing the risk of bleeding.
Phenytoin
Can inhibit the metabolism of phenytoin, leading to increased plasma concentrations.
Cyclosporine
May decrease the efficacy of cyclosporine and increase the risk of nephrotoxicity.
Methotrexate
May increase the toxicity of methotrexate by displacing it from protein binding sites and inhibiting renal excretion.
Diuretics (especially thiazides)
Increased risk of thrombocytopenia with purpura in elderly patients.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include nausea, vomiting, dizziness, confusion, and bone marrow depression. Management is supportive, including gastric lavage, forced diuresis, and administration of leucovorin for hematologic effects.
Pregnancy & Lactation
Pregnancy Category D (risk of neural tube defects, kernicterus in late pregnancy). Excreted in breast milk and generally not recommended unless benefits outweigh risks. Use during late pregnancy and in newborns is contraindicated.
Side Effects
Contraindications
- Hypersensitivity to sulfamethoxazole, trimethoprim, or any excipients of the product
- Severe renal impairment where plasma concentrations cannot be monitored
- Severe hepatic parenchymal damage
- Megaloblastic anemia due to folate deficiency
- Infants younger than 2 months of age
Drug Interactions
Warfarin
May enhance the anticoagulant effect of warfarin, increasing the risk of bleeding.
Phenytoin
Can inhibit the metabolism of phenytoin, leading to increased plasma concentrations.
Cyclosporine
May decrease the efficacy of cyclosporine and increase the risk of nephrotoxicity.
Methotrexate
May increase the toxicity of methotrexate by displacing it from protein binding sites and inhibiting renal excretion.
Diuretics (especially thiazides)
Increased risk of thrombocytopenia with purpura in elderly patients.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include nausea, vomiting, dizziness, confusion, and bone marrow depression. Management is supportive, including gastric lavage, forced diuresis, and administration of leucovorin for hematologic effects.
Pregnancy & Lactation
Pregnancy Category D (risk of neural tube defects, kernicterus in late pregnancy). Excreted in breast milk and generally not recommended unless benefits outweigh risks. Use during late pregnancy and in newborns is contraindicated.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2 to 3 years from the date of manufacture.
Availability
Pharmacies, hospitals
Approval Status
Approved
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Co-trimoxazole has been extensively studied in numerous clinical trials establishing its efficacy and safety for various bacterial infections since its introduction.
Lab Monitoring
- Complete Blood Count (CBC) with differential, especially for prolonged therapy or in elderly patients
- Renal function tests (creatinine, BUN)
- Liver function tests (LFTs)
Doctor Notes
- Monitor complete blood count (CBC), renal function, and liver function regularly, particularly during prolonged therapy.
- Advise patients on the importance of adequate hydration to prevent renal complications.
- Be vigilant for signs of severe dermatologic reactions and other hypersensitivity reactions.
Patient Guidelines
- Complete the entire course of medication, even if symptoms improve, to prevent resistance and relapse.
- Drink plenty of fluids while taking this medication to prevent crystalluria and kidney stone formation.
- Report any severe skin rash, unusual bruising, bleeding, or persistent fever to your doctor immediately.
- Avoid excessive exposure to sunlight or use sunscreen as this medication can cause photosensitivity.
Missed Dose Advice
If a dose is missed, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Driving Precautions
This medication may cause dizziness or blurred vision in some individuals. Patients should be cautious when driving or operating machinery until they know how the drug affects them.
Lifestyle Advice
- Maintain good hydration throughout the treatment period.
- Avoid alcohol if it exacerbates gastrointestinal upset.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.