Cotrimoxazole

Warning and Precautions

• Some epidemiologic assessments suggest that exposure to Cotrimoxazole during pregnancy may be associated with an increased risk of congenital malformations, mainly cardiovascular malformations, urinary tract defects, neural tube defects, oral clefts, and club foot.
• Cotrimoxazole-induced thrombocytopenia may be an immune-mediated disorder. Serious cases of thrombocytopenia that are life threatening or fatal have occurred. Patients need to be monitored for hematologic toxicity. Thrombocytopenia typically resolves within a week upon interruption of Cotrimoxazole.
• Avoid use of trimethoprim sulfamethoxazole in patients with impaired renal or hepatic function, in those with probable folate deficiency (e.g., the elderly, chronic alcoholics, patients with malabsorption syndrome, patients receiving anticonvulsant therapy, and patients in malnutrition states) and in those with severe allergies or bronchial asthma.
• Cases of hypoglycemia in non-diabetic patients treated with Cotrimoxazole have been noted, typically occurring after some days of therapy. Patients with liver disease, renal dysfunction, malnutrition or those receiving high doses of Cotrimoxazole are mainly at risk.
• Like other medicines containing sulfonamides, Cotrimoxazole can precipitate porphyria crisis and hypothyroidism. Avoid the use of Cotrimoxazole in patients with porphyria or thyroid dysfunction.
• Local irritation and inflammation because of the extravascular infiltration of the infusion have emerged with trimethoprim sulfamethoxazole injection. If these emerge the infusion should be interrupted and restarted at another site.
• Complete blood counts (CBC) and clinical chemistry testing should be performed frequently in patients receiving Cotrimoxazole. Perform urinalysis with precise microscopic assessment and renal function tests during therapy, mainly for those with impaired renal function.