Sulfonamide contraindications

Discuss the uses, general drug actions, and general adverse reactions, contraindications, precautions, and interactions of the sulfonamides. 

Celecoxib is contraindicated in patients who are allergic to die drug itself, die sulfonamides, odier NSAIDs, or aspirin it also is contraindicated during pregnancy (Category C) and lactation. 

Loop diuretics are contraindicated in patients with known hypersensitivity to the loop diuretics or to the sulfonamides, severe electrolyte imbalances, hepatic coma, or anuria, and in infants (ethacrynic acid). 

The antibiotic and sulfonamide ophthalmics are contraindicated in patients with a hypersensitivity to the drug or any component of the drug. These dru are also contraindicated in patients with epithelial herpes simplex keratitis, varicella, mycobacterial infection of the eye, and fungal diseases of the eye There are no significant precautions or interactions when the dru are administered as directed by the primary health care provider. 

Local side effects include burning, stinging, itching, foreign body sensation, dry eyes, and conjunctivitis. Brinzolamide may have a lower incidence of these side effects since the drug is in a neutral pH solution. Dorzolamide has been reported to cause irreversible corneal decompensation. Taste abnormalities have been reported with each agent. Both topical carbonic anhydrase inhibitors are sulfonamides and are contraindicated in patients with history of sulfonamide hypersensitivity.10,13... 

Do not administer to infants younger than 2 months of age systemic sulfonamides are contraindicated in this age group. 

Celecoxib is indicated for the treatment of osteoarthritis and rheumatoid arthritis. Its use is contraindicated in individuals with hypersensitivity to sulfonamides or other NSAIDs. It should be used with caution in persons with hepatic disease. Interactions occur with other drugs that induce CYP2C9 (e.g. ri-... 

Sulfasalazine is contraindicated in individuals with hypersensitivity to salicylates, sulfonamides, sulfonylureas, and certain diuretics (furosemide, thiazides, and carbonic anhydrase inhibitors). Because it can cause kernicterus, sulfasalazine is contraindicated in infants and children under 2 years of age. Sulfasalazine passes into breast milk and is therefore contraindicated for nursing mothers. Similarly, pregnant women near term should not use this drug, although it appears to be the safest of the DMARDs during early pregnancy. 

Contraindications Severe renal disease, adrenal insufficiency, hypochloremic acidosis, hypersensitivityto acetazolamide, to any component of the formulation, orto sulfonamides. 

Contraindications Anuria, history of hypersensitivity to sulfonamides or thiazide diuretics, renal decompensation... 

Contraindications Hypersensitivity to trimethoprim or any sulfonamides, megaloblastic anemia due to folate deficiency. 

Contraindications Anuria, hypersensitivity to sulfonamides Side Effects... 

I Contraindications ttypersensitivity to sulfonamides or any component of preparation (some products contain sulfite), use in combination with silver-containing products... 

Contraindications Hypersensitivitytocarbonicanhydraseinhibitors, local anesthetics, salicylates, sulfonamides, sulfonylureas, sunscreens containing PABA, or thiazide or loop diuretics intestinal or urinary tract obstruction porphyria severe hepatic or renal dysfunction... 

Contraindications Hypersensitivity to esther local anesthetics, sulfites, PABA, infection or inflammation at the injection site, bacteremia, platelet abnormalities, thrombocytopenia, increased bleeding time, uncontrolled coagulopathy, anticoagulant therapy, sulfonamide therapy. 

Used in all types of infection caused by Salmonella typhi, Klebsiella, Enterobacter, Pneumocystis carinii etc. and many other sulfonamide resistant stains of S. aureus, Strep, pyogenes, Shigella, E. coli, H. influenzae, meningococci and gonococci etc. It is particularly effective as a second line agent in penicillin allergic patients and also in patients where newer antibiotics are contraindicated or can t be used. 

Tipranavir is a newer PI for treating patients with resistance to other PI agents. Bioavailability is poor but is increased when taken with a high-fat meal. The drug is metabolized by the liver microsomal system. Tipranavir must be taken in combination with ritonavir to achieve effective serum levels. It is contraindicated in patients with hepatic insufficiency. Tipranavir contains a sulfonamide moiety and should not be administered to patients with known sulfa allergy. 

Topical sulfacetamide is available alone as a 10% lotion (Klaron) and as a 10% wash (Ovace), and in several preparations in combination with sulfur for the treatment of acnevulgaris and acne rosacea. The mechanism of action is thought to be inhibition of P acnes by competitive inhibition of p-aminobenzoic acid utilization. Approximately 4% of topically applied sulfacetamide is absorbed percutaneously, and its use is therefore contraindicated in patients having a known hypersensitivity to sulfonamides. 

Contraindications Sulfas should be avoided in newborns and infants less than 2 months old as well as pregnant women at term, due to the danger of kernicterus. Because sulfonamides condense with formaldehyde, they should not be given to patients receiving methenamine (see p. 327) for urinary tract infections. 

Adverse effects The side effects include gastrointestinal distress. At higher doses, albuminuria, hematuria and rashes may develop. Methenamine mandelate is contraindicated in treating patients with renal insufficiency, because mandelic acid may precipitate. Sulfonamides react with formaldehyde and must not be used concomitantly with methenamine. 

Other Medical Conditions. Other systemic disorders can be affected by or contraindicate the use of topically applied medications. Examples include myasthenia gravis, which can be worsened with topical timolol, and erythema multiforme (Stevens-Johnson syndrome), which can be caused or exacerbated by topical ocular sulfonamides and related antiglaucoma drugs such as carbonic anhydrase inhibitors. 

Sulfonamides are contraindicated in patients with known hypersensitivity or intolerance to any member of this drug femily. Sulfonamides are also contraindicated in pregnancy at term, for nursing mothers, and for infants less than 2 months old becanse they can promote kernicterus in the newborn by displacing bilirubin from plasma proteins. The sulfonamides, pyrimethamine, and trimethoprim are contraindicated in patients with documented blood dyscrasias. 

Fatal anaphylactic shock with massive pulmonary edema has been reported in a 66-year-old woman who was taking acetazolamide for glaucoma (21). She had a history of sulfonamide allergy, and acetazolamide is a sulfonamide derivative. Sulfonamide allergy should be regarded as a contraindication to acetazolamide. 

Whether allergic reactions to celecoxib occur more often in patients who report a previous reaction to sulfonamides, and should therefore be contraindicated in such patients, is still unknown (132). 

A sulfur component is necessary for the receptor binding of both celecoxib and rofecoxib, but their structures differ and they have different potentials for causing allergic reactions. Consequently, celecoxib is thought to be contraindicated in patients with a history of allergy to sulfonamides. The available data on the immunological tolerability profile of celecoxib and rofecoxib are scanty but merit attention. 

Wihohn BE, Shear NH, Knowles S, Shapiro L. Should celecoxib be contraindicated in patients who are allergic to sulfonamides Drug Saf 2002 25(4) 297-9. 

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