Common side effects include nausea, vomiting, rash, and diarrhea. Severe allergic reactions and Clostridium difficile infection may occasionally occur. Its use in pregnancy is not recommended. It appears to be safe for use during breastfeeding as long as the baby is healthy.<unk>  generally results in bacterial death. It works by blocking the making and use of folate by the microorganisms. Contraindications Contraindications include the following: * Known hypersensitivity to<unk> , sulphonamides or any other ingredients in the formulations * Pregnancy – especially in the period prior to birth * Severe hepatic failure, marked liver parenchymal damage or jaundice. * Serious haematological disorders and porphyria (due to the sulfonamide component of the preparation). * Severe chronic kidney disease (CrCl <15 ml/min) where repeated measurements of the plasma concentration cannot be performed * Co-trimoxazole should not be given to neonates during the first 6 weeks, except for the treatment/prophylaxis of Pneumocystis jirovecii (P. carinii) in infants of four weeks of age or greater. Interactions Its use is advised against in people being concomitantly treated with: * ACE inhibitors like captopril, enalapril, lisinopril, perindopril, and ramipril due to the potential for additive hyperkalaemic effects * Prilocaine — additive risk of methaemoglobinaemia * Antiarrhythmics like amiodarone (increased risk of ventricular arrhythmias) and dofetilide (increased risk of QT interval prolongation) * Antibacterials like dapsone (increases plasma levels of both drugs), methenamine (increased risk of crystalluria) and rifampicin (as it may lead to an increased plasma level of rifampicin and lower plasma levels of<unk>  * Anticoagulants like warfarin and acenocoumarol — anticoagulant effects of either drug is potentiated by this combination * Sulfonylureas — effects enhanced * Phenytoin, half-life of phenytoin is increased * Antifolates like pyrimethamine, proguanil and methotrexate increase the risk of associated side effects like bone marrow toxicity, folic acid supplementation should be considered. A significant risk of megaloblastic anaemia exists with doses of pyrimethamine in excess of 25 mg/wk. * Antivirals, more specifically, lamivudine (increased plasma concentrations of lamivudine), zalcitabine (increased plasma concentrations of zalcitabine) and zidovudine (increased risk of haematological reactions) * Procainamide and/or amantadine may have their plasma concentrations increased bilaterally or unilaterally. * Clozapine and other antipsychotics — increased risk of haematological side effects * Nucleoside analogue antineoplastics like azathioprine and mercaptopurine — increased risk of haematological toxicity * Digoxin — increase in digoxin levels in a proportion of elderly patients * Diuretics — elderly patients receiving thiazide diuretics are at a heightened risk for developing thrombocytopaenia while on co-trimoxazole * Ciclosporin — patients who have received a kidney transplant and are receiving co-trimoxazole and ciclosporin concomitantly are at an increased risk of having a reversible deterioration in their kidney function. *Spironolactone — concurrent use can increase the likelihood of hyperkalemia, especially in the elderly. The<unk>  portion acts to prevent potassium excretion in the distal tubule of the nephron. * Potassium aminobenzoate — effects of sulfonamides (like<unk>  inhibited. * Laboratory tests —<unk>  and sulfonamides have been reported to interfere with diagnostic tests, including serum-methotrexate and elevated serum creatinine levels, also urea, urinary glucose and urobilinogen tests. Overdose Likely signs of toxicity include: * Nausea * Vomiting * Dizziness * Headache * Mental depression * Confusion * Thrombocytopenia * Uremia * Bone marrow depression * Loss of appetite * Colic * Drowsiness * Unconsciousness The recommended treatment for overdose includes: * Administration of activated charcoal * Stomach pumping * General supportive measures * Haemodialysis, which is moderately effective in clearing co-trimoxazole from the plasma. * Calcium folinate treatment in cases of blood dyscrasias * Forcing oral fluids Alkalinisation of the urine may reduce the toxicity of<unk> , but it may increase the toxic effects of<unk> .
Trimethoprim/sulfamethoxazole
Doxycycline
Dapsone
Micafungin
Merafloxacin
Teicoplanin
Phenoxymethylpenicillin
Amikacin