Sumetrolim
Generic Name
Co-trimoxazole (Sulfamethoxazole + Trimethoprim)
Manufacturer
Gedeon Richter Plc.
Country
Hungary
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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 200 mg Suspension is a combination antibiotic used to treat a wide range of bacterial infections. It contains two active ingredients, sulfamethoxazole and trimethoprim, which work together to inhibit bacterial growth.
Uses & Indications
Dosage
Adults
Standard dosage for moderate to severe infections: 20 mL (400 mg SMX / 80 mg TMP) twice daily for 10-14 days, depending on the infection. For PCP, higher doses are used.
Elderly
Dosage adjustments may be necessary due to potential renal impairment and increased susceptibility to adverse effects. Monitor renal function closely.
Renal_impairment
Reduced dosage or extended dosing intervals are required for patients with creatinine clearance <30 mL/min. Not recommended for severe renal impairment.
How to Take
Shake the bottle well before each use. Administer orally, preferably with food or milk to minimize gastrointestinal upset. Ensure adequate fluid intake during treatment.
Mechanism of Action
Co-trimoxazole inhibits two sequential steps in the bacterial synthesis of tetrahydrofolic acid, which is essential for bacterial nucleic acid and protein synthesis. Sulfamethoxazole inhibits dihydrofolate synthesis, and trimethoprim inhibits dihydrofolate reductase.
Pharmacokinetics
Onset
Antibacterial effects begin within 1 hour after administration.
Excretion
Primarily excreted by the kidneys, both unchanged drug and metabolites. Approximately 50-60% of trimethoprim and 10-20% of sulfamethoxazole are excreted unchanged in urine.
Half life
Sulfamethoxazole: 9-11 hours; Trimethoprim: 8-10 hours.
Absorption
Rapidly and well absorbed from the gastrointestinal tract after oral administration. Peak plasma concentrations usually occur 1-4 hours after administration.
Metabolism
Both components are metabolized in the liver: sulfamethoxazole by acetylation, and trimethoprim by oxidation.
Side Effects
Contraindications
- Known hypersensitivity to sulfamethoxazole, trimethoprim, or any excipients.
- Severe renal impairment (creatinine clearance <15 mL/min) if not monitored.
- Severe hepatic impairment.
- Megaloblastic anemia due to folate deficiency.
- Infants under 2 months of age (due to risk of kernicterus).
- Pregnancy at term and during lactation (for infants <2 months).
Drug Interactions
Warfarin
Increased anticoagulant effect, leading to increased bleeding risk.
Phenytoin
Increased phenytoin levels, leading to toxicity.
Methotrexate
Increased methotrexate toxicity (e.g., bone marrow suppression).
Diuretics (especially thiazides)
Increased risk of thrombocytopenia with purpura in elderly patients.
ACE inhibitors/Potassium-sparing diuretics
Increased risk of hyperkalemia.
Storage
Store below 30°C (86°F). Protect from light and moisture. Do not freeze. Keep out of reach of children.
Overdose
Symptoms of acute overdose include nausea, vomiting, dizziness, headache, and mental depression. Chronic overdose may lead to bone marrow suppression (leukopenia, thrombocytopenia) and megaloblastic anemia. Treatment is symptomatic and supportive; folinic acid may be administered to counteract trimethoprim's folate antagonistic effects.
Pregnancy & Lactation
Pregnancy Category D. Should be avoided in late pregnancy due to the risk of kernicterus in neonates. Excreted in breast milk; avoid use in breastfeeding mothers with infants less than 2 months old or with G6PD deficiency.
Side Effects
Contraindications
- Known hypersensitivity to sulfamethoxazole, trimethoprim, or any excipients.
- Severe renal impairment (creatinine clearance <15 mL/min) if not monitored.
- Severe hepatic impairment.
- Megaloblastic anemia due to folate deficiency.
- Infants under 2 months of age (due to risk of kernicterus).
- Pregnancy at term and during lactation (for infants <2 months).
Drug Interactions
Warfarin
Increased anticoagulant effect, leading to increased bleeding risk.
Phenytoin
Increased phenytoin levels, leading to toxicity.
Methotrexate
Increased methotrexate toxicity (e.g., bone marrow suppression).
Diuretics (especially thiazides)
Increased risk of thrombocytopenia with purpura in elderly patients.
ACE inhibitors/Potassium-sparing diuretics
Increased risk of hyperkalemia.
Storage
Store below 30°C (86°F). Protect from light and moisture. Do not freeze. Keep out of reach of children.
Overdose
Symptoms of acute overdose include nausea, vomiting, dizziness, headache, and mental depression. Chronic overdose may lead to bone marrow suppression (leukopenia, thrombocytopenia) and megaloblastic anemia. Treatment is symptomatic and supportive; folinic acid may be administered to counteract trimethoprim's folate antagonistic effects.
Pregnancy & Lactation
Pregnancy Category D. Should be avoided in late pregnancy due to the risk of kernicterus in neonates. Excreted in breast milk; avoid use in breastfeeding mothers with infants less than 2 months old or with G6PD deficiency.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Usually 2-3 years for unopened bottles. Refer to the product label for specific details after opening.
Availability
Available in pharmacies and hospitals
Approval Status
Approved
Patent Status
Expired (Generic available)
WHO Essential Medicine
YesClinical Trials
Co-trimoxazole has been extensively studied in numerous clinical trials since its introduction, demonstrating efficacy across a wide range of bacterial infections. Ongoing research explores its role in emerging antimicrobial resistance.
Lab Monitoring
- Complete Blood Count (CBC) with differential, especially during prolonged treatment.
- Renal function tests (BUN, creatinine) due to renal excretion and potential for crystalluria.
- Liver function tests (ALT, AST) periodically, especially in patients with pre-existing hepatic impairment.
Doctor Notes
- Caution in patients with G6PD deficiency due to risk of hemolytic anemia.
- Monitor for signs of hypersensitivity reactions, especially dermatologic ones (SJS/TEN).
- Ensure adequate hydration to minimize the risk of crystalluria.
- Advise patients about potential photosensitivity.
Patient Guidelines
- Complete the entire course of medication as prescribed, even if symptoms improve, to prevent recurrence and resistance.
- Maintain adequate fluid intake to prevent crystalluria.
- Report any severe skin rash, persistent sore throat, fever, or unusual bruising/bleeding immediately to your doctor.
- Avoid excessive sun exposure and use sunscreen as photosensitivity may occur.
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 resume your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
This medicine may cause dizziness or confusion in some individuals. If you experience these symptoms, avoid driving or operating machinery.
Lifestyle Advice
- Stay well-hydrated by drinking plenty of water throughout the day.
- Avoid prolonged exposure to sunlight and wear protective clothing/sunscreen due to increased sun sensitivity.
- Maintain good hygiene to prevent further infections.
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