Deotrim
Generic Name
Co-trimoxazole (Trimethoprim and Sulfamethoxazole)
Manufacturer
General Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| deotrim 200 mg suspension | ৳ 17.50 | N/A |
Description
Overview of the medicine
Deotrim 200 mg Suspension is a combination antibiotic containing Trimethoprim and Sulfamethoxazole, used to treat various bacterial infections.
Uses & Indications
Dosage
Adults
Not typically for adults in suspension form; for children, dosage is based on Trimethoprim component (6-12 mg/kg/day) divided into two doses.
Elderly
Dose adjustment required based on renal function. Caution with concomitant medications that affect potassium levels.
Renal_impairment
Significant dose reduction or increased dosing interval necessary. Not recommended for severe impairment (CrCl <15 mL/min).
How to Take
Administer orally, preferably with food or milk to minimize gastrointestinal upset. Ensure adequate fluid intake. Shake bottle well before each use.
Mechanism of Action
Co-trimoxazole acts by sequentially blocking two enzymes involved in bacterial folic acid synthesis. Sulfamethoxazole inhibits dihydropteroate synthase, and Trimethoprim inhibits dihydrofolate reductase, leading to a synergistic antibacterial effect.
Pharmacokinetics
Onset
Antibacterial effect typically observed within 1-2 hours.
Excretion
Mainly renal, through glomerular filtration and tubular secretion.
Half life
Trimethoprim: 8-10 hours; Sulfamethoxazole: 10-12 hours.
Absorption
Well absorbed orally, reaching peak plasma concentrations within 1-4 hours.
Metabolism
Primarily hepatic, via acetylation and oxidation.
Side Effects
Contraindications
- Hypersensitivity to sulfonamides, trimethoprim, or any excipients.
- Severe renal impairment (CrCl <15 mL/min) if not monitored carefully.
- Severe hepatic impairment.
- Megaloblastic anemia due to folate deficiency.
- Infants less than 2 months old (risk of kernicterus).
- Pregnancy (especially third trimester).
Drug Interactions
Warfarin
Potentiates anticoagulant effect, increasing bleeding risk.
Phenytoin
Increases phenytoin plasma concentrations.
Cyclosporine
Increased nephrotoxicity.
Methotrexate
Increases methotrexate toxicity (e.g., bone marrow suppression).
Diuretics (especially thiazides)
Increased risk of thrombocytopenia, particularly in elderly.
ACE inhibitors/Potassium-sparing diuretics
Increased risk of hyperkalemia.
Storage
Store below 30°C. Protect from light and moisture. Do not freeze. Keep out of reach of children.
Overdose
Symptoms may include nausea, vomiting, diarrhea, dizziness, headache, mental depression, crystalluria, hematuria. Management involves gastric lavage, forced diuresis, and acidification/alkalinization of urine as appropriate. Folinic acid may be given to counteract trimethoprim effects.
Pregnancy & Lactation
Pregnancy Category D. Avoid during pregnancy, especially in the first trimester (risk of neural tube defects) and third trimester (risk of kernicterus in the neonate). Excreted in breast milk; use with caution during lactation, particularly in premature infants or those with G6PD deficiency.
Side Effects
Contraindications
- Hypersensitivity to sulfonamides, trimethoprim, or any excipients.
- Severe renal impairment (CrCl <15 mL/min) if not monitored carefully.
- Severe hepatic impairment.
- Megaloblastic anemia due to folate deficiency.
- Infants less than 2 months old (risk of kernicterus).
- Pregnancy (especially third trimester).
Drug Interactions
Warfarin
Potentiates anticoagulant effect, increasing bleeding risk.
Phenytoin
Increases phenytoin plasma concentrations.
Cyclosporine
Increased nephrotoxicity.
Methotrexate
Increases methotrexate toxicity (e.g., bone marrow suppression).
Diuretics (especially thiazides)
Increased risk of thrombocytopenia, particularly in elderly.
ACE inhibitors/Potassium-sparing diuretics
Increased risk of hyperkalemia.
Storage
Store below 30°C. Protect from light and moisture. Do not freeze. Keep out of reach of children.
Overdose
Symptoms may include nausea, vomiting, diarrhea, dizziness, headache, mental depression, crystalluria, hematuria. Management involves gastric lavage, forced diuresis, and acidification/alkalinization of urine as appropriate. Folinic acid may be given to counteract trimethoprim effects.
Pregnancy & Lactation
Pregnancy Category D. Avoid during pregnancy, especially in the first trimester (risk of neural tube defects) and third trimester (risk of kernicterus in the neonate). Excreted in breast milk; use with caution during lactation, particularly in premature infants or those with G6PD deficiency.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from manufacturing date, refer to product packaging for specific expiry.
Availability
Pharmacies, hospitals
Approval Status
Approved by regulatory authorities (e.g., DGDA)
Patent Status
Generic available, off-patent
WHO Essential Medicine
YesClinical Trials
Co-trimoxazole has been extensively studied and is a well-established antibiotic. Many clinical trials have confirmed its efficacy and safety for various bacterial infections since its introduction.
Lab Monitoring
- Complete Blood Count (CBC) with differential (especially with prolonged therapy or high doses)
- Renal function tests (BUN, creatinine)
- Liver function tests (LFTs)
- Serum potassium (in patients at risk of hyperkalemia)
Doctor Notes
- Monitor complete blood count (CBC) and renal function, especially in patients on prolonged therapy, elderly, or those with pre-existing renal impairment.
- Advise patients on adequate hydration to prevent crystalluria.
- Be aware of significant drug interactions, particularly with warfarin, methotrexate, and diuretics.
- Contraindicated in infants <2 months due to kernicterus risk.
Patient Guidelines
- Complete the entire prescribed course of medication, even if symptoms improve.
- Drink plenty of fluids throughout the day to prevent kidney stone formation.
- Take with food or milk to reduce stomach upset.
- Report any severe skin rash, yellowing of skin/eyes, or unusual bleeding/bruising to your doctor immediately.
Missed Dose Advice
Take the missed dose as soon as you remember. 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
May cause dizziness in some individuals. Exercise caution when driving or operating machinery until you know how the medicine affects you.
Lifestyle Advice
- Stay well-hydrated during treatment.
- Avoid excessive exposure to direct sunlight or use sun protection due to photosensitivity.
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