Take Triprim-DS orally with a full glass of water, with or without food. Taking it with food or milk may help to minimize gastrointestinal upset. Ensure adequate fluid intake throughout the treatment to prevent crystalluria.

Co-trimoxazole works by synergistically inhibiting two sequential steps in the bacterial folic acid synthesis pathway. Sulfamethoxazole inhibits the incorporation of para-aminobenzoic acid (PABA) into dihydrofolic acid, preventing dihydropteroate synthase activity. Trimethoprim inhibits dihydrofolate reductase, blocking the conversion of dihydrofolic acid to tetrahydrofolic acid, which is essential for nucleic acid and protein synthesis.

• •Hypersensitivity to sulfamethoxazole, trimethoprim, or any excipients.
• •Severe renal impairment where plasma concentration cannot be monitored.
• •Severe hepatic impairment.
• •History of drug-induced immune thrombocytopenia with prior exposure to trimethoprim or sulfonamides.
• •Megaloblastic anemia due to folate deficiency.
• •Infants less than 2 months of age (due to kernicterus risk).

Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.

Symptoms of acute overdose include nausea, vomiting, dizziness, headache, mental depression, confusion, and bone marrow depression. Management involves gastric lavage, forced diuresis, and acidification of urine to enhance renal excretion. Leucovorin may be administered to counteract trimethoprim-induced folate deficiency and bone marrow depression.

Pregnancy Category C/D. Co-trimoxazole should be avoided during the first trimester due to potential teratogenic effects (folate antagonism) and in late pregnancy (third trimester) due to the risk of kernicterus in the newborn. It is excreted in breast milk; therefore, caution is advised, and it is generally not recommended for nursing mothers, especially if the infant is less than 2 months old, premature, jaundiced, or G6PD deficient.