Cotrimox-DS
Generic Name
Co-trimoxazole (Sulfamethoxazole + Trimethoprim)
Manufacturer
Popular Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| cotrimox ds 800 mg tablet | ৳ 2.00 | N/A |
Description
Overview of the medicine
Cotrimox-DS is a combination antibiotic containing sulfamethoxazole and trimethoprim, used to treat a wide range of bacterial infections by inhibiting bacterial folic acid synthesis. The DS (Double Strength) tablet contains 800 mg of sulfamethoxazole and 160 mg of trimethoprim.
Uses & Indications
Dosage
Adults
For most infections, 1 Cotrimox-DS tablet (800 mg sulfamethoxazole/160 mg trimethoprim) twice daily (every 12 hours) for 10-14 days. For PCP, higher doses and longer duration may be required.
Elderly
No specific dose adjustment is required solely based on age; however, dose should be adjusted based on renal function, which commonly declines in the elderly.
Renal_impairment
For creatinine clearance (CrCl) 15-30 mL/min, 1/2 of the usual dose every 12 hours. For CrCl < 15 mL/min, not recommended or used with extreme caution and monitoring.
How to Take
Take Cotrimox-DS orally with a full glass of water, with or without food. Taking it with food or milk may help to minimize gastrointestinal upset. Drink plenty of fluids to prevent crystallization in the urine.
Mechanism of Action
Sulfamethoxazole inhibits bacterial dihydrofolate synthesis by competing with para-aminobenzoic acid (PABA). Trimethoprim inhibits bacterial dihydrofolate reductase, which is an enzyme that converts dihydrofolic acid to tetrahydrofolic acid. This dual blockade of the bacterial folic acid pathway results in a synergistic bactericidal effect.
Pharmacokinetics
Onset
Antibacterial effects typically begin within 1 hour after administration.
Excretion
Both drugs and their metabolites are primarily excreted by the kidneys through glomerular filtration and tubular secretion. A small amount is excreted in feces.
Half life
The elimination half-life for sulfamethoxazole is approximately 9-11 hours, and for trimethoprim, it is about 8-10 hours.
Absorption
Both sulfamethoxazole and trimethoprim are well absorbed from the gastrointestinal tract after oral administration, with peak plasma concentrations reached within 1-4 hours.
Metabolism
Both components are metabolized primarily in the liver. Sulfamethoxazole undergoes N4-acetylation and glucuronidation, while trimethoprim undergoes oxidative metabolism.
Side Effects
Contraindications
- Hypersensitivity to sulfamethoxazole, trimethoprim, or any sulfonamide derivative
- Megaloblastic anemia due to folate deficiency
- Severe renal impairment (CrCl < 15 mL/min) without hemodialysis
- Significant hepatic damage
- Infants less than 2 months of age
- Pregnancy at term and during lactation (for some indications)
Drug Interactions
Warfarin
Increased anticoagulant effect, leading to increased bleeding risk.
Phenytoin
Increased phenytoin serum concentrations, leading to toxicity.
Cyclosporine
Increased risk of nephrotoxicity and reduced cyclosporine levels.
Methotrexate
Increased methotrexate toxicity (e.g., bone marrow suppression) due to reduced renal excretion and displacement from plasma protein binding.
ACE Inhibitors / ARBs / Potassium-sparing diuretics
Increased risk of hyperkalemia, especially in the elderly or those with renal impairment.
Storage
Store below 30°C in a dry place, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose may include nausea, vomiting, dizziness, headache, confusion, and bone marrow depression. Treatment is symptomatic and supportive, including gastric lavage or emesis, forced diuresis, and acidification of the urine to increase trimethoprim excretion.
Pregnancy & Lactation
Pregnancy Category C (D at term). Not recommended in the first trimester, near term, or during lactation due to potential risks of kernicterus in newborns and folate antagonism. Consult a doctor.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
2-3 years from manufacturing date, depending on the manufacturer.
Availability
Pharmacies, Hospitals
Approval Status
Widely approved globally
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Co-trimoxazole has been extensively studied since its introduction and is supported by numerous clinical trials demonstrating its efficacy in treating various bacterial infections. Ongoing research continues to evaluate its role in emerging antimicrobial resistance.
Lab Monitoring
- Complete blood count (CBC) regularly, especially with prolonged therapy or high doses
- Renal function tests (serum creatinine, BUN)
- Liver function tests (ALT, AST)
- Serum potassium levels, especially in patients at risk of hyperkalemia
Doctor Notes
- Emphasize importance of fluid intake to prevent crystalluria.
- Caution in patients with G6PD deficiency or folate deficiency.
- Monitor for hypersensitivity reactions, especially skin rashes, and advise immediate discontinuation if observed.
- Adjust dose in renal impairment; monitor renal function and potassium levels carefully.
Patient Guidelines
- Complete the entire course of medication as prescribed, even if symptoms improve.
- Drink plenty of fluids throughout the day to prevent kidney stones.
- Avoid prolonged exposure to sunlight or use protective clothing and sunscreen, as the drug can cause photosensitivity.
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 take a double dose to make up for a missed one.
Driving Precautions
Cotrimox-DS may cause dizziness, fatigue, or confusion in some individuals. If you experience these side effects, avoid driving or operating heavy machinery.
Lifestyle Advice
- Maintain good personal hygiene to prevent recurrent infections.
- Eat a balanced diet and stay hydrated.
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Global Brand Names
International brand names for this medicine
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