Trimethoprim nephrotoxicity

Anti-Pneumocystis Prophylaxis Sulfamethoxazole-trimethoprim (SMZ-TMP, cotrimoxazole) One SS tablet by mouth once a day3 One DS tablet by mouth once a day3 One DS tablet by mouth every MA/V/F3 Hyperkalemia Myelosuppression Nephrotoxicity Neutropenia Photosensitivity Rash... 

Drugs that may affect valganciclovir include didanosine, imipenem-cilastin, nephrotoxic drugs, probenecid, trimethoprim, zalcitabine, and zidovudine. Drugs that may be affected by valganciclovir include cytotoxic drugs, didanosine, and zidovudine. 

Trimethoprim has been reported to decrease the therapeutic effect of cyclosporine with a concomitant increased risk of nephrotoxicity. Increased levels of dapsone, warfarin, methotrexate, zidovudine, and sul-fonylureas may occur when given together with trimethoprim dosages of these drugs should be modified and the patient monitored accordingly. 

Thompson JF, Chalmers DH, Hunnisett AG, Wood RF, Morris PJ. Nephrotoxicity of trimethoprim and cotrimox-azole in renal allograft recipients treated with cyclosporine. Transplantation 1983 36(2) 204-6. 

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... 

Richmond JM, Whitworth JA, Eairley KE, Kincaid-Smith P. Co-trimoxazole nephrotoxicity. Lancet. 1979 Mar 3 1 (8114) 493. Kraemer MJ, Kendall R, Hickman RO, Haas JE, Bierman CW. A generalized allergic reaction with acute interstitial nephritis following trimethoprim-sulfamethoxazole use. Annals of allergy. 1982 Dec 49(6) 323-5. 

Zuniga CA Chua A, Alpert H,Vaamonde CA.Trimethoprim-sulfamethoxazole nephrotoxicity in patients with AIDS. Nat Kidney Found 1990 20 A29(abstract). 

Chua A ZC, Alpert H, Vaamonde CA.Trimethoprim-sulfametoxazole nephrotoxicity in the sodium-depleted rat. J Am Soc Nephrol. 1990 1 608(abstract). 

It is incumbent on health professionals to avoid toxic drugs whenever possible. Antibiotics associated with CNS toxicities, usually when not dose-adjusted for renal function, include penicillins, cephalosporins, quinolones, and imipenem. Hematologic toxicities generally are manifested with prolonged use of nafcillin (neutropenia), piperacillin (platelet dysfunction), cefotetan (hypoprothrombinemia), chloramphenicol (bone marrow suppression, both idiosyncratic and dose-related toxicity), and trimethoprim (megaloblastic anemia). Reversible nephrotoxicity classically is associated with aminoglycosides... 

Other reports describe a few patients given ciclosporin with co-trimoxazole who developed rises in creatinine levels (interpreted as evidence of nephrotoxicity), " interstitial nephritis, granulocytopenia and thrombocytopenia. Apparent nephrotoxicity has also been seen with trimethoprim and ciclosporin. ... 

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