Sumetrolim
Generic Name
Sulfamethoxazole + Trimethoprim
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| sumetrolim 200 mg suspension | ৳ 21.61 | N/A |
Description
Overview of the medicine
Sumetrolim is a combination antibiotic containing sulfamethoxazole and trimethoprim, used to treat various bacterial infections.
Uses & Indications
Dosage
Adults
For most infections, 800 mg Sulfamethoxazole + 160 mg Trimethoprim (1 tablet of Sumetrolim Forte) every 12 hours for 7-14 days, depending on the infection severity and type.
Elderly
Dosage adjustment may be necessary due to age-related decrease in renal function. Renal function should be monitored.
Renal_impairment
Significant dose reduction or increased dosing interval is required. For creatinine clearance 15-30 mL/min, reduce dose by 50%. Below 15 mL/min, not recommended.
How to Take
Administer orally with plenty of water, preferably after meals, to minimize gastrointestinal upset. Complete the full prescribed course.
Mechanism of Action
Sulfamethoxazole inhibits dihydrofolate synthesis, and trimethoprim inhibits dihydrofolate reductase, blocking sequential steps in bacterial folic acid synthesis.
Pharmacokinetics
Onset
Onset of action within 1-4 hours.
Excretion
Primarily renal excretion (urine) via glomerular filtration and tubular secretion. Small amounts excreted in feces.
Half life
Sulfamethoxazole: approximately 10 hours; Trimethoprim: approximately 8-10 hours.
Absorption
Well absorbed orally (sulfamethoxazole 90%, trimethoprim 90-100%). Peak plasma concentrations reached within 1-4 hours.
Metabolism
Hepatic metabolism: Sulfamethoxazole undergoes N4-acetylation; Trimethoprim undergoes oxidation and hydroxylation.
Side Effects
Contraindications
- Hypersensitivity to sulfamethoxazole, trimethoprim, or any excipients.
- Severe renal or hepatic impairment.
- Megaloblastic anemia due to folate deficiency.
- Infants less than 2 months of age.
- Pregnancy (especially third trimester) and lactation.
- Porphyria.
Drug Interactions
Warfarin
May increase anticoagulant effect, requiring dose adjustment and close monitoring of INR.
Phenytoin
Can increase phenytoin concentrations, leading to toxicity.
Cyclosporine
Increased risk of nephrotoxicity with concomitant use.
Methotrexate
Increased risk of methotrexate toxicity due to reduced renal excretion.
Thiazide diuretics
Increased risk of thrombocytopenia with purpura in elderly.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms of acute overdose may include nausea, vomiting, dizziness, headache, mental depression, confusion, and bone marrow depression. Chronic overdose can lead to bone marrow depression (megaloblastic anemia, leukopenia, thrombocytopenia). Treatment is symptomatic and supportive, including gastric lavage, forced diuresis with alkalinization of urine, and adequate fluid intake. Leucovorin may be administered to counteract folate deficiency.
Pregnancy & Lactation
Pregnancy category C/D (depending on trimester). Generally avoided in late pregnancy (third trimester) due to risk of kernicterus in neonates. Excreted into breast milk and should be avoided in breastfeeding mothers, particularly if the infant is premature, jaundiced, or has glucose-6-phosphate dehydrogenase (G6PD) deficiency.
Side Effects
Contraindications
- Hypersensitivity to sulfamethoxazole, trimethoprim, or any excipients.
- Severe renal or hepatic impairment.
- Megaloblastic anemia due to folate deficiency.
- Infants less than 2 months of age.
- Pregnancy (especially third trimester) and lactation.
- Porphyria.
Drug Interactions
Warfarin
May increase anticoagulant effect, requiring dose adjustment and close monitoring of INR.
Phenytoin
Can increase phenytoin concentrations, leading to toxicity.
Cyclosporine
Increased risk of nephrotoxicity with concomitant use.
Methotrexate
Increased risk of methotrexate toxicity due to reduced renal excretion.
Thiazide diuretics
Increased risk of thrombocytopenia with purpura in elderly.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms of acute overdose may include nausea, vomiting, dizziness, headache, mental depression, confusion, and bone marrow depression. Chronic overdose can lead to bone marrow depression (megaloblastic anemia, leukopenia, thrombocytopenia). Treatment is symptomatic and supportive, including gastric lavage, forced diuresis with alkalinization of urine, and adequate fluid intake. Leucovorin may be administered to counteract folate deficiency.
Pregnancy & Lactation
Pregnancy category C/D (depending on trimester). Generally avoided in late pregnancy (third trimester) due to risk of kernicterus in neonates. Excreted into breast milk and should be avoided in breastfeeding mothers, particularly if the infant is premature, jaundiced, or has glucose-6-phosphate dehydrogenase (G6PD) deficiency.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the manufacturing date, consult product packaging for exact details.
Availability
Available in pharmacies and hospitals
Approval Status
Approved by major regulatory bodies (e.g., FDA, DGDA)
Patent Status
Generic available (off-patent)
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established the efficacy and safety of sulfamethoxazole/trimethoprim for various bacterial infections since its introduction in the 1970s. Ongoing surveillance and post-marketing studies continue to monitor its use.
Lab Monitoring
- Complete Blood Count (CBC) with differential (especially for prolonged therapy or in immunocompromised patients).
- Renal function tests (BUN, serum creatinine, creatinine clearance).
- Liver function tests (ALT, AST, bilirubin).
- Serum potassium levels, particularly in patients at risk of hyperkalemia.
Doctor Notes
- Emphasize the importance of completing the full course of therapy to prevent resistance and treatment failure.
- Advise patients to maintain adequate hydration to minimize the risk of crystalluria.
- Monitor CBC, renal function (BUN, creatinine), and liver function (ALT, AST) especially in elderly patients, those with pre-existing renal impairment, or during prolonged treatment.
- Counsel patients on potential severe skin reactions (SJS/TEN) and to seek immediate medical attention if symptoms occur.
Patient Guidelines
- Drink plenty of fluids (at least 6-8 glasses of water daily) to prevent crystalluria and kidney stone formation.
- Complete the full course of treatment as prescribed, even if symptoms improve, to prevent recurrence and resistance.
- Avoid prolonged exposure to direct sunlight or artificial UV light; use protective clothing and broad-spectrum sunscreen.
- Report any severe skin rash, sore throat, fever, unusual bleeding, or bruising immediately to your doctor.
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
This medicine may cause dizziness, drowsiness, or visual disturbances in some individuals. Exercise caution when driving or operating machinery until you know how the medicine affects you.
Lifestyle Advice
- Maintain good hydration throughout the treatment period.
- Avoid alcohol consumption during treatment as it may exacerbate side effects.
- Follow up with your doctor for prescribed lab tests, especially during prolonged therapy.
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