Pyrimethamine nephrotoxicity

With increasing frequency, clindamycin in combination with pyrimethamine is been used as the replacement drug for sulfadiazine in the treatment of cerebral toxoplasmosis. Perhaps this new combination again may send sulfadiazine nephrotoxicity into "oblivion". Nevertheless, until this possibility occurs, primary care physicians should be aware that sulfadiazine can cause renal toxicity and that effective preventive measures are available. 

Pyrimethamine does not belong to the group of known nephrotoxic agents [39]. Because pyrimethamine and trimethoprim have a similar 2, 4-diaminopyrimidine molecular structure, Opravil et d [197] reported a similar handling of tubular secretion of creatinine. In six healthy volunteers and nine patients with AIDS, pyrimethamine caused a reversible, small to moderate, similar between the two groups, but statistically significant increase (26%) in serum creatinine concentration with a concomitant... 

Siegers, C.R Moller-Hartmann, W. Cholestyramine as an antidote against paracetamol-inducedhepato-and nephrotoxicity in the rat. Toxicol.Lett., 1989, 47, 179-184 [rat urine extracted metabolites] Lam, S. Malikin, G. An improved micro-scale protein precipitation procedure for HPLC assay of therapeutic drugs in serum. J.Liq.Chromatogr., 1989, 12, 1851-1872 [serum also amiodarone, aspirin, caffeine, chloramphenicol, flecainide, pentobarbital, procainamide, pyrimethamine, quinidine, theophylline, tocainide, trazodone fluorescence detection UV detection]... 

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