INDICATIONS     CONTRA-INDICATIONS     DOSAGE     SIDE-EFFECTS     PREGNANCY     OVERDOSE     IDENTIFICATION     PATIENT INFORMATION

Logo Q-MED CO-TRIMOXAZOLE TABLETS

SCHEDULING STATUS:
S4

PROPRIETARY NAME
(and dosage form):

Q-MED CO-TRIMOXAZOLE TABLETS

COMPOSITION:
Each tablet contains:
Trimethoprim         80 mg
Sulphamethoxazole         400 mg
Preservative: 
Nipastat         0,025% m/m

PHARMACOLOGICAL CLASSIFICATION:
A 20.2 Antimicrobial agents other than antibiotics.

PHARMACOLOGICAL ACTION:
Co-trimoxazole tablets is a combination of trimethoprim and sulphamethoxazole and results in synergistic effects causing a bactericidal action (in vitro). The action of co-trimoxazole is achieved by the sequential blocking of two enzymes essential in folinic acid synthesis in the organism.

INDICATIONS:
The treatment of infections of the upper and lower respiratory tract, the urinary tract and the alimentary and genital tract in both sexes, and skin infections caused by sensitive organisms.

CONTRA-INDICATIONS:
Co-trimoxazole tablets is contra-indicated in patients with known sulphonamide or trimethoprim hypersensitivity of who are suffering from porphyria. It should not be used in patients suffering from liver parenchymal damage, or a severe renal insufficiency. Co-trimoxazole should not be used during pregnancy and lactation. Use of the substance in premature or new-born infants during the first two months of life is contra-indicated.
Should not be given to patients with megaloblastic anaemia or blood dyscrasias. Contra-indicated in the presence of vitamin B12 and folic acid deficiency state.

WARNINGS:
Erythema multiforme, toxic dermal necrolysis and allergic vasculitis may occur.

DOSAGE AND DIRECTIONS FOR USE:
Adults and children older than 12 years:
Two tablets every 12 hours for a period of 10 to 14 days.

SIDE-EFFECTS AND SPECIAL PRECAUTIONS:
Haematological changes such as anaemia (including aplastic, haemolytic and macrocytic), coagulation disorders, granulocytopenia, agranulocytosis, purpura, Henoch-Schönlein purpura; and sulphaemoglobinaemia may occur. Skin disorders e.g. reddening exanthema and itch may occur. Exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis (Lyells Syndrome) may occur.
When a rash appears, this medicine must be discontinued.
Megaloblastosis, leucopenia or thrombocytopenia may occur. Nausea and vomiting constitutes the bulk of gastro-intestinal reactions; diarrhoea may occur. Glossitis and stomatitis are relatively common. Transient Jaundice has been noted and appears to have the histological features of allergic cholestatic hepatitis. Central nervous system reactions consists of headache, depression and hallucinatory manifestations, dizziness, drug fever and psychosis.
Other adverse effects include: acidosis, anorexia, goitre, hypothyroidism, arthralgia, drowsiness, fatigue, insomnia, nightmares, confusion, vertigo, ataxia, tinnitus, peripheral neuritis and polyarteritis nodosa. Toxic nephrosis has been reported. Direct exposure to sunlight should be avoided as it facilitates development of sensitisation dermatitis. Co-trimoxazole tablets should be used with caution in patients with allergic conditions or bronchial asthma.
Pseudomembranous colitis and anaphylaxis have been reported.
Previous or simultaneous administration of diuretics with co-trimoxazole may cause an increased risk of thrombocytopenia, especially in elderly patients with heart failure; death may occur.
In patients with renal impairment, reduced or widely spaced dosage is indicated to avoid accumulation in the blood. For such patients measurements of plasma concentration is advisable. Regular blood counts are advisable if co-trimoxazole is to be given for a long period.
Paraldehyde has been reported to increase the acetylation of sulphamethoxazole with subsequent increased risk of crystalluria.
Co-trimoxazole tablets may be antagonized by p-aminobenzoic acid and compounds derived from it.
High doses of co-trimoxazole may have a hypoglycaemic effect. Thyroid tests must be carried out in patients with thyroid disorders.
Sulphamethoxazole is strongly bound to proteins. Patients receiving anticoagulants of the coumarin groups or methotrexate concomitantly should therefore be carefully monitored. Sulphamethoxazole increases the hypoglycaemic action of sulphonylureas in diabetic patients.
Co-trimoxazole should be used with caution in patients receiving pyrimethamine or immuno-suppressive therapy. Trimethoprim prolongs the half-life of phenytoin.
Co-trimoxazole may interact with the following medicines by interfering with their clearance: digoxin, procainamide and tolbutamide.
Sulphamethoxazole has been reported to interfere with some diagnostic tests including those for urea, creatinine, urinary glucose and urobilinogen.
Trimethoprim may interfere with some diagnostic tests including serum methotrexate assay and the Jaffé reaction for creatinine.
Adverse effects on the blood may be more severe and higher blood levels are reached in malnourished or elderly patients. Because of the risk of crystalluria, an adequate fluid intake should be maintained.

KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT:
Nausea, vomiting, cyanosis, heamaturia, oliguria or anuria and allergic skin reactions (skin rashes, anaphylaxis, etc.). Treatment is supportive and symptomatic.

IDENTIFICATION:
White, round flat tablet bisected on one side.

PRESENTATION:
In bottles of 20, 100, 500 and 1000 tablets.

STORAGE INSTRUCTIONS:
Store in a cool dry place, below 25°C. Protect from light and heat.
KEEP OUT OF REACH OF CHILDREN.

REGISTRATION NUMBER:
27/20.2/0302

NAME AND BUSINESS ADDRESS OF APPLICANT:
QUATROMED LIMITED
10 Lindley Street
BETHLEHEM
9701

DATE OF PUBLICATION:
December 1992
        PC00141/7-99

Updated on this site: June 2000

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