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Trimethoprim
Trimethoprim is an antibiotic used primarily to treat urinary tract infections (UTIs) and certain other bacterial infections. It works by inhibiting the production of folic acid in bacteria, which is essential for their growth and replication. Trimethoprim is often used alone or in combination with sulfamethoxazole (as in Bactrim) for broader-spectrum treatment.
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Frequently Asked Questions
How quickly does trimethoprim work for UTIs?
Improvement in symptoms is typically seen within 1 to 3 days, but it is important to complete the entire course of antibiotics to ensure the infection is fully treated.
Can I take trimethoprim if I’m pregnant?
Trimethoprim may interfere with folic acid metabolism, which is essential during pregnancy. It should only be used if the potential benefits outweigh the risks. Discuss with your healthcare provider.
What should I do if I miss a dose?
If you miss a dose, take it as soon as you remember. If it’s close to the time of your next dose, skip the missed dose and resume your regular dosing schedule. Do not take extra doses to make up for the missed one.
Can trimethoprim cause high potassium levels?
Yes, trimethoprim can cause hyperkalemia (high potassium levels), especially in people with kidney problems or those taking other medications that affect potassium levels.
Is trimethoprim safe for long-term use?
Long-term use of trimethoprim may increase the risk of folic acid deficiency or anemia. Regular monitoring by your healthcare provider is recommended if you are on long-term therapy.
Comprehensive Drug Guide
How Does Trimethoprim Work?
Trimethoprim inhibits the dihydrofolate reductase enzyme in bacteria, which is necessary for converting dihydrofolic acid to tetrahydrofolic acid, a form of folic acid needed for bacterial growth. By blocking this enzyme, trimethoprim disrupts the bacterial ability to produce essential proteins and DNA, leading to their death.
Common Dosages
- 100 mg and 200 mg tablets
- Oral suspension (various concentrations)
Typical Dosing
- For adults with UTIs, the usual dose is 100 mg twice daily for 10 days, or 200 mg once daily for 10 days.
- For pediatric patients, the dose is typically based on weight, and the duration is generally 7 to 10 days.
- For prophylaxis of recurrent UTIs, the typical dose is 100 mg once daily.
Typical Dosing
FDA Approved Indications
- Treatment of acute urinary tract infections (UTIs) caused by susceptible bacteria.
- Prophylaxis of recurrent UTIs.
- Acute otitis media (middle ear infection) in pediatric patients, in combination therapy.
Who Shouldn't Take Trimethoprim?
- Known hypersensitivity to trimethoprim or any of its components.
- Megaloblastic anemia caused by folate deficiency.
- Severe liver or kidney disease, without dosage adjustment.
Advice From The Pharmacist
- Take trimethoprim exactly as prescribed and complete the full course, even if symptoms improve, to prevent bacterial resistance.
- Drink plenty of fluids to help prevent kidney stones while taking trimethoprim.
- Avoid alcohol, as it may increase the risk of side effects, including nausea and dizziness.
- If you experience symptoms like rash, itching, or difficulty breathing, discontinue use and contact your healthcare provider, as these may be signs of an allergic reaction.
- Inform your doctor if you are pregnant or planning to become pregnant, as trimethoprim may interfere with folic acid metabolism.
Side Effects of Trimethoprim
Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Rash
- Headache
Uncommon/Severe Side Effects
- Severe allergic reactions, including rash or difficulty breathing.
- Megaloblastic anemia (due to folic acid deficiency).
- Hyperkalemia (high potassium levels), particularly in patients with kidney problems.
- Kidney damage (rare).
Risks and Warnings of Trimethoprim
- Folic Acid Deficiency: Trimethoprim can interfere with folic acid metabolism, increasing the risk of megaloblastic anemia. This is more common in individuals with pre-existing folic acid deficiency, pregnant women, or patients on long-term therapy. Supplementation with folic acid may be necessary in some cases.
- Hyperkalemia: Trimethoprim can cause elevated potassium levels in the blood, especially in patients with kidney disease or those taking medications like ACE inhibitors or potassium-sparing diuretics.
- Renal Impairment: Patients with kidney disease may require dose adjustments or monitoring for side effects, including high potassium levels.
Interactions with Trimethoprim
Common Drug Interactions
- Folic acid antagonists: Taking trimethoprim with drugs like methotrexate (which also inhibits folate metabolism) can increase the risk of folate deficiency and side effects.
- ACE inhibitors/ARBs: Combining trimethoprim with these medications can increase the risk of hyperkalemia.
- Diuretics (e.g., spironolactone): Increased risk of high potassium levels.
- Phenytoin: Trimethoprim may increase the effects of phenytoin, leading to potential toxicity.
Alternatives to Trimethoprim
- Sulfamethoxazole-trimethoprim (Bactrim): A combination antibiotic used to treat a broader range of infections.
- Nitrofurantoin (Macrobid): Another antibiotic commonly used for UTIs.
- Ciprofloxacin: A fluoroquinolone antibiotic used for various infections, including UTIs.
