Cotrimox
Generic Name
Co-trimoxazole
Manufacturer
Popular Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| cotrimox 400 mg tablet | ৳ 1.35 | N/A |
Description
Overview of the medicine
Cotrimox-400-mg-tablet is a combination antibiotic containing sulfamethoxazole and trimethoprim, used to treat various bacterial infections including urinary tract infections, respiratory tract infections, and certain types of pneumonia. It works by inhibiting two sequential steps in the bacterial synthesis of folic acid, which is essential for bacterial growth.
Uses & Indications
Dosage
Adults
For UTIs: 2 tablets (Sulfamethoxazole 800 mg, Trimethoprim 160 mg equivalent) orally every 12 hours for 10-14 days. For PCP: 15-20 mg/kg trimethoprim and 75-100 mg/kg sulfamethoxazole per day in 3-4 divided doses for 14-21 days.
Elderly
Dosage adjustments may be necessary due to potential for decreased renal function. Monitor renal function closely.
Renal_impairment
Creatinine clearance 15-30 mL/min: Reduce dose by 50%. Creatinine clearance <15 mL/min: Not recommended.
How to Take
Oral. Take with a full glass of water, with or without food. It is recommended to take with food to minimize gastrointestinal upset. Ensure adequate fluid intake during treatment to prevent crystalluria.
Mechanism of Action
Sulfamethoxazole inhibits bacterial dihydrofolate synthase, preventing para-aminobenzoic acid (PABA) incorporation into folic acid. Trimethoprim inhibits bacterial dihydrofolate reductase, blocking the conversion of dihydrofolic acid to tetrahydrofolic acid. This synergistic blockade of two consecutive steps in the bacterial folate metabolism pathway leads to bactericidal action.
Pharmacokinetics
Onset
Clinical effects typically begin within 1-2 hours.
Excretion
Primarily excreted by the kidneys through glomerular filtration and tubular secretion. A small amount is excreted in feces.
Half life
Trimethoprim: 8-10 hours; Sulfamethoxazole: 10-12 hours.
Absorption
Both sulfamethoxazole and trimethoprim are rapidly and almost completely absorbed from the gastrointestinal tract following oral administration. Peak plasma concentrations are reached within 1-4 hours for trimethoprim and 2-4 hours for sulfamethoxazole.
Metabolism
Both are metabolized in the liver, primarily by N-acetylation and glucuronidation for sulfamethoxazole, and oxidation for trimethoprim.
Side Effects
Contraindications
- •Hypersensitivity to sulfamethoxazole, trimethoprim, or any component
- •Severe renal impairment (CrCl <15 mL/min)
- •Severe hepatic impairment
- •Blood dyscrasias (e.g., megaloblastic anemia due to folate deficiency)
- •Infants less than 2 months of age
- •Pregnancy (especially near term) and lactation (due to risk of kernicterus in infants)
Drug Interactions
Warfarin
Increased anticoagulant effect.
Phenytoin
Increased phenytoin levels.
Methotrexate
Increased methotrexate levels and toxicity.
Diuretics (especially thiazides)
Increased risk of thrombocytopenia with purpura, especially in elderly.
Oral Hypoglycemics (sulfonylureas)
Enhanced hypoglycemic effect.
Potassium-sparing diuretics/ACE inhibitors/ARBs
Increased risk of hyperkalemia.
Storage
Store in a cool, dry place below 30°C, away from direct light and moisture. Keep out of reach of children.
Overdose
Symptoms of acute overdose may include nausea, vomiting, diarrhea, anorexia, mental depression, confusion, and bone marrow depression. Chronic overdose can lead to megaloblastic anemia. Treatment involves gastric lavage, emesis, and supportive measures. Folinic acid may be given to counteract trimethoprim's effects on folate metabolism.
Pregnancy & Lactation
Pregnancy Category D. Contraindicated during pregnancy, especially near term, due to potential for hyperbilirubinemia and kernicterus in the newborn. Avoid during lactation as both components are excreted in breast milk and may cause kernicterus in infants.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 to 36 months from manufacturing date
Availability
Pharmacies, Hospitals
Approval Status
Approved by major regulatory bodies globally (e.g., FDA, MHRA, DGDA)
Patent Status
Off-patent
WHO Essential Medicine
YesAlternative Medicines in Bangladesh
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Global Brand Names
International brand names for this medicine
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