Dosing & Uses
Dosage Forms & Strengths
oral solution
- 50mg/5mL
tablet
- 100mg
Susceptible Infections
100 mg PO q12hr
Dosing Modifications
Renal impairment
- CrCl 15-30 mL/min: 50 mg q12hr
- CrCl <15 mL/min: 100 mg q24hr or avoid use
Other Information
See also combo with sulfamethoxazole (Cotrim/Bactrim/Septra/Sulfatrim)
Other Indications and Uses
UTI caused by E. coli, Enterobacter spp., K. pneumoniae, P. mirabilis, coagulase-neg Staphylococcus spp.
<12 years old: safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (29)
- abametapir
abametapir will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.
- amiodarone
amiodarone and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- apalutamide
apalutamide will decrease the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
- BCG vaccine live
trimethoprim decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cholera vaccine
trimethoprim, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
- disopyramide
disopyramide and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- erdafitinib
trimethoprim will increase the level or effect of erdafitinib by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. If coadministration of a strong CYP2C9 inhibitors is unavoidable, closely monitor adverse reactions and modify dose of erdafitinib accordingly. If strong CYP2C9 inhibitor is discontinued, consider increasing erdafitinib dose in the absence of any drug-related toxicities.
- fexinidazole
fexinidazole will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
- ibutilide
ibutilide and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- idelalisib
idelalisib will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- indapamide
indapamide and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
ivosidenib will decrease the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
ivosidenib will decrease the level or effect of trimethoprim by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2C9 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs. - leucovorin
leucovorin decreases effects of trimethoprim by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Monitor for trimethoprim treatment failure or decreased efficacy when coadministered with leucovorin, especially when used with sulfamethoxazole for Pneumocystis jiroveci pneumonia in patients who are HIV positive .
- levoleucovorin
levoleucovorin decreases effects of trimethoprim by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Monitor for trimethoprim treatment failure or decreased efficacy when coadministered with levoleucovorin, especially when used with sulfamethoxazole for Pneumocystis jiroveci pneumonia in patients who are HIV positive .
- lonafarnib
lonafarnib will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
- lopinavir
lopinavir will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- mefloquine
mefloquine increases toxicity of trimethoprim by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- methotrexate
trimethoprim, methotrexate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Due to an additive antifolate effect, trimethoprim has been shown to rarely increase bone marrow suppression in patients receiving methotrexate.
- pentamidine
pentamidine and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- pimozide
pimozide and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- procainamide
procainamide and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- quinidine
quinidine and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
trimethoprim will increase the level or effect of siponimod by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with drugs that cause moderate CYP2C9 AND a moderate or strong CYP3A4 inhibition is not recommended. Caution if siponimod coadministered with moderate CYP2C9 inhibitors alone.
- sotalol
sotalol and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- tafenoquine
tafenoquine will increase the level or effect of trimethoprim by Other (see comment). Avoid or Use Alternate Drug. Tafenoquine inhibits organic cation transporter-2 (OCT2) and multidrug and toxin extrusion (MATE) transporters in vitro. Avoid coadministration with OCT2 or MATE substrates. If coadministration cannot be avoided, monitor for substrate-related toxicities and consider dosage reduction if needed based on product labeling of the coadministered drug.
- trilaciclib
trilaciclib will decrease the level or effect of trimethoprim by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of trilaciclib (OCT2, MATE1, and MATE-2K inhibitor) with substrates where minimal increased concentration in kidney or blood may lead to serious or life-threatening toxicities.
- tucatinib
trimethoprim will increase the level or effect of tucatinib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of tucatinib (a CYP2C8 substrate) with a strong or moderate CYP2C8 inhibitors increases tucatinib plasma concentrations and risk of toxicities.
tucatinib will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling. - typhoid vaccine live
trimethoprim decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- voxelotor
voxelotor will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
Monitor Closely (137)
- aliskiren
trimethoprim and aliskiren both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- alpelisib
alpelisib will decrease the level or effect of trimethoprim by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.
- amantadine
trimethoprim increases levels of amantadine by decreasing elimination. Use Caution/Monitor. Coadministration may impair renal clearance of amantadine, resulting in higher plasma concentrations.
- amiloride
trimethoprim and amiloride both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- amiodarone
amiodarone will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- amitriptyline
amitriptyline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- amoxapine
amoxapine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- apalutamide
apalutamide will decrease the level or effect of trimethoprim by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Coadministration of apalutamide, a weak CYP2C9 inducer, with drugs that are CYP2C9 substrates can result in lower exposure to these medications. Evaluate for loss of therapeutic effect if medication must be coadministered.
- artemether/lumefantrine
artemether/lumefantrine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- bazedoxifene/conjugated estrogens
trimethoprim will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- benazepril
trimethoprim and benazepril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- canagliflozin
trimethoprim and canagliflozin both increase serum potassium. Use Caution/Monitor.
- candesartan
trimethoprim and candesartan both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- cannabidiol
cannabidiol will increase the level or effect of trimethoprim by decreasing metabolism. Modify Therapy/Monitor Closely. Cannabidiol may potentially inhibit CYP2C9 activity. Consider reducing the dose when concomitantly using CYP2C9 substrates.
- captopril
trimethoprim and captopril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- chlorpromazine
chlorpromazine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- cimetidine
cimetidine will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- clarithromycin
clarithromycin and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- clomipramine
clomipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- conjugated estrogens
trimethoprim will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- crofelemer
crofelemer increases levels of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.
- cyclosporine
trimethoprim and cyclosporine both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- dabrafenib
dabrafenib will decrease the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- dapsone topical
trimethoprim increases toxicity of dapsone topical by decreasing metabolism. Modify Therapy/Monitor Closely. Coadministration increases systemic exposure of dapsone and its metabolites (N-acetyl-dapsone, dapsone hydroxylamine). May induce methemoglobinemia.
- desipramine
desipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- digoxin
trimethoprim will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
digoxin will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor. - dofetilide
dofetilide will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
dofetilide and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely. - dolasetron
dolasetron and trimethoprim both increase QTc interval. Use Caution/Monitor.
- doxepin
doxepin and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- dronedarone
dronedarone and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- droperidol
droperidol and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- elagolix
elagolix decreases levels of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
elvitegravir/cobicistat/emtricitabine/tenofovir DF decreases levels of trimethoprim by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Elvitegravir is a moderate CYP2C9 inducer. - enalapril
trimethoprim and enalapril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- encorafenib
encorafenib, trimethoprim. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- epinephrine
epinephrine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- epinephrine racemic
epinephrine racemic and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- eplerenone
trimethoprim and eplerenone both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- eprosartan
trimethoprim and eprosartan both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- erdafitinib
erdafitinib increases levels of trimethoprim by decreasing renal clearance. Modify Therapy/Monitor Closely. Consider alternatives that are not OCT2 substrates or consider reducing the dose of OCT2 substrates based on tolerability.
- erythromycin base
erythromycin base and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- erythromycin lactobionate
erythromycin lactobionate and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- erythromycin stearate
erythromycin stearate and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- estradiol
trimethoprim will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- estrogens conjugated synthetic
trimethoprim will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- estropipate
trimethoprim will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- ethinylestradiol
trimethoprim will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- fedratinib
fedratinib will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
- finerenone
trimethoprim and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.
- flecainide
flecainide and trimethoprim both increase QTc interval. Use Caution/Monitor.
- fluconazole
fluconazole and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- fluoxetine
fluoxetine and trimethoprim both increase QTc interval. Use Caution/Monitor.
- fluphenazine
fluphenazine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- fluvoxamine
fluvoxamine and trimethoprim both increase QTc interval. Use Caution/Monitor.
- formoterol
formoterol and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- foscarnet
foscarnet and trimethoprim both increase QTc interval. Use Caution/Monitor.
- fosinopril
trimethoprim and fosinopril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- fosphenytoin
fosphenytoin will decrease the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- glucarpidase
glucarpidase will decrease the level or effect of trimethoprim by increasing metabolism. Modify Therapy/Monitor Closely. Leucorvorin, reduced folates, and folate antimetabolites are substrates for glucarpidase (hydrolyzes glutamate residue from folic acid and antifolates)
- haloperidol
haloperidol and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- iloperidone
iloperidone and trimethoprim both increase QTc interval. Use Caution/Monitor.
iloperidone increases levels of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. - imipramine
imipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- indinavir
indinavir will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- irbesartan
trimethoprim and irbesartan both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- istradefylline
istradefylline will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- itraconazole
itraconazole and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- ketoconazole
ketoconazole and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- L-methylfolate
trimethoprim decreases effects of L-methylfolate by Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Folic acid antagonists may interfere with folic acid utilization.
- lamivudine
trimethoprim increases effects of lamivudine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor. Potential for increased toxicity.
- levofloxacin
levofloxacin and trimethoprim both increase QTc interval. Use Caution/Monitor.
- levonorgestrel oral/ethinylestradiol/ferrous bisglycinate
trimethoprim will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.
- lisinopril
trimethoprim and lisinopril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- lofepramine
lofepramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- losartan
trimethoprim and losartan both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- lumacaftor/ivacaftor
lumacaftor/ivacaftor, trimethoprim. affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C9 substrates. .
- lumefantrine
lumefantrine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- maprotiline
maprotiline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- mestranol
trimethoprim will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- metformin
trimethoprim increases levels of metformin by Other (see comment). Use Caution/Monitor. Comment: Trimethoprim may inhibit active renal tubular secretion of metformin (eg, via OCT2, MATE1); dose adjustments may be necessary.
- methadone
methadone and trimethoprim both increase QTc interval. Use Caution/Monitor.
- methotrexate
trimethoprim increases toxicity of methotrexate by Other (see comment). Use Caution/Monitor. Comment: Trimethoprim may increase risk of methotrexate-induced bone marrow suppression and megaloblastic anemia. If this drug combination cannot be avoided, closely monitor for signs of hematologic toxicity.
- mitotane
mitotane decreases levels of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
- moexipril
trimethoprim and moexipril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- moxifloxacin
moxifloxacin and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- nitisinone
nitisinone will increase the level or effect of trimethoprim by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Nitisinone inhibits CYP2C9. Caution if CYP2C9 substrate coadministered, particularly those with a narrow therapeutic index.
- nortriptyline
nortriptyline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- octreotide
octreotide and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- octreotide (Antidote)
octreotide (Antidote) and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- ofloxacin
ofloxacin and trimethoprim both increase QTc interval. Use Caution/Monitor.
- olmesartan
trimethoprim and olmesartan both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- paclitaxel
trimethoprim will increase the level or effect of paclitaxel by Other (see comment). Use Caution/Monitor. Paclitaxel levels/toxicity may increase when coadministered with CYP2C8 inhibitors
- paclitaxel protein bound
trimethoprim will increase the level or effect of paclitaxel protein bound by Other (see comment). Use Caution/Monitor. Paclitaxel levels/toxicity may increase when coadministered with CYP2C8 inhibitors
- paliperidone
paliperidone and trimethoprim both increase QTc interval. Use Caution/Monitor.
- paroxetine
paroxetine and trimethoprim both increase QTc interval. Use Caution/Monitor.
- pentamidine
trimethoprim and pentamidine both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- perindopril
trimethoprim and perindopril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- perphenazine
perphenazine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- posaconazole
posaconazole and trimethoprim both increase QTc interval. Use Caution/Monitor.
- potassium acid phosphate
trimethoprim and potassium acid phosphate both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- potassium chloride
trimethoprim and potassium chloride both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- potassium citrate
trimethoprim and potassium citrate both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- potassium citrate/citric acid
trimethoprim and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.
- procainamide
procainamide will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- prochlorperazine
prochlorperazine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- promazine
promazine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- promethazine
promethazine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- protriptyline
protriptyline and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- quinapril
trimethoprim and quinapril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- quinidine
quinidine will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- ramipril
trimethoprim and ramipril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- ranolazine
ranolazine and trimethoprim both increase QTc interval. Use Caution/Monitor.
- repaglinide
trimethoprim increases levels of repaglinide by decreasing metabolism. Use Caution/Monitor. Hepatic cytochrome P450 2C8.
- rifabutin
rifabutin will decrease the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- risperidone
risperidone and trimethoprim both increase QTc interval. Use Caution/Monitor.
- sacubitril/valsartan
sacubitril/valsartan and trimethoprim both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- selexipag
trimethoprim will increase the level or effect of selexipag by decreasing metabolism. Modify Therapy/Monitor Closely. Reduce selexipag dose to once daily if coadministered with moderate CYP2C8 inhibitors.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
trimethoprim decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- spironolactone
trimethoprim and spironolactone both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- sulfamethoxazole
sulfamethoxazole and trimethoprim both increase QTc interval. Use Caution/Monitor.
- tecovirimat
tecovirimat will decrease the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- telavancin
telavancin and trimethoprim both increase QTc interval. Use Caution/Monitor.
- telmisartan
trimethoprim and telmisartan both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- thioridazine
thioridazine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- trandolapril
trimethoprim and trandolapril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- trazodone
trazodone and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- triamterene
trimethoprim and triamterene both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- trifluoperazine
trifluoperazine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- trimipramine
trimipramine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.
- tropisetron
trimethoprim and tropisetron both increase QTc interval. Use Caution/Monitor.
- valsartan
valsartan and trimethoprim both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- venlafaxine
trimethoprim and venlafaxine both increase QTc interval. Use Caution/Monitor.
- voclosporin
voclosporin and trimethoprim both decrease serum potassium. Use Caution/Monitor.
- voriconazole
trimethoprim and voriconazole both increase QTc interval. Use Caution/Monitor.
- zidovudine
trimethoprim increases levels of zidovudine by decreasing renal clearance. Use Caution/Monitor. Potential for increased toxicity. .
- ziprasidone
trimethoprim and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
Minor (29)
- amiloride
amiloride, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Hyperkalemia.
- azithromycin
azithromycin and trimethoprim both increase QTc interval. Minor/Significance Unknown.
- balsalazide
trimethoprim will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- bendroflumethiazide
bendroflumethiazide, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of hyponatremia.
- biotin
trimethoprim will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- chlorothiazide
chlorothiazide, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of hyponatremia.
- chlorthalidone
chlorthalidone, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of hyponatremia.
- cyclopenthiazide
cyclopenthiazide, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of hyponatremia.
- dapsone
trimethoprim, dapsone. Either increases levels of the other by decreasing elimination. Minor/Significance Unknown.
- drospirenone
drospirenone, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Hyperkalemia.
- hydrochlorothiazide
hydrochlorothiazide will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
hydrochlorothiazide, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of hyponatremia. - indapamide
indapamide, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of hyponatremia.
- isavuconazonium sulfate
isavuconazonium sulfate will increase the level or effect of trimethoprim by Other (see comment). Minor/Significance Unknown. Isavuconazonium sulfate, an OCT2 inhibitor, may increase the effects or levels of OCT2 substrates.
- memantine
memantine will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- metformin
metformin will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- methyclothiazide
methyclothiazide will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
methyclothiazide, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of hyponatremia. - metolazone
metolazone, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of hyponatremia.
- midodrine
midodrine will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ofloxacin
ofloxacin will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- pantothenic acid
trimethoprim will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- pyridoxine
trimethoprim will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- pyridoxine (Antidote)
trimethoprim will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- quinine
quinine will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ribociclib
ribociclib will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- spironolactone
spironolactone, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Hyperkalemia.
- sulfamethoxazole
sulfamethoxazole will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- thiamine
trimethoprim will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- triamterene
triamterene will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
triamterene, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Hyperkalemia. - verapamil
trimethoprim will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Minor/Significance Unknown.
Adverse Effects
Frequency Not Defined
Aseptic meningitis
Fever
Maculopapular rash (3-7% at 200 mg/day; incidence higher with larger daily doses)
Erythema multiforme
Exfoliative dermatitis
Pruritus (common)
Phototoxic skin eruptions
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Hyperkalemia
Hyponatremia
Epigastric distress
Glossitis
Nausea
Vomiting
Leukopenia
Megaloblastic anemia
Methemoglobinemia
Neutropenia
Thrombocytopenia
Liver enzyme elevation
Cholestatic jaundice
BUN and creatinine increased
Anaphylaxis
Hypersensitivity reactions
Warnings
Contraindications
Hypersensitivity
Megaloblastic anemia due to folate deficiency
Cautions
Decreases urinary potassium excretion; may cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia
Large doses or long term therapy may interfere with hematopoiesis; the presence of clinical signs, such as sore throat, fever, pallor, or purpura may be early indications of serious blood disorders; monitor for signs/symptoms of hematologic disorders
If clinical signs of blood disorder noted, obtain a complete blood count and discontinue drug if significant reduction in count of any blood element found
Prolonged use may cause fungal or bacterial superinfection, including clostridium difficile-associated diarrhea and pseudomembranous colitis; may occur >2 months postantibiotic treatment
Hypersensitivity reactions reported
Use caution in patients with renal or hepatic impairment
Use caution in patients with potential for folate deficiency, including malnourished, chronic anticonvulsant therapy, or elderly; folates may be administered concomitantly without interfering with antibacterial action of trimethoprim
Some dosage forms may contain benzyl alcohol and derivatives; avoid in neonates
Not indicated for prophylactic or prolonged administration in otitis media at any age
Pregnancy & Lactation
Pregnancy Category: C
Lactation: enters breast milk
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Inhibits dihydrofolate reductase, which in turn inhibits folic acid reduction to tetrahydrofolate, causing inhibition of microorganism growth
Absorption
Readily and extensive
Time to peak, serum: 1-4 hr
Distribution
Widely into body tissues and fluids (middle ear, prostate, bile, aqueous humor, CSF); crosses placenta; enters breast milk
Protein binding: 42-46%
Metabolism
Partially hepatic
Elimination
Half-life: 8-14 hr; prolonged in renal impairment
Excretion: urine (60-80%) as unchanged drug
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| trimethoprim oral - | 100 mg tablet |  | |
| trimethoprim oral - | 100 mg tablet |  | |
| trimethoprim oral - | 100 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
trimethoprim oral
TRIMETHOPRIM - ORAL
(try-METH-oh-prim)
COMMON BRAND NAME(S): Primsol, Proloprim, Trimpex
USES: Trimethoprim is an antibiotic used to treat bacterial infections. It works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.
HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually once or twice daily. The dosage is based on your medical condition and response to treatment. In children, the dosage is also based on their weight.If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same time(s) every day.Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition lasts or gets worse after several days.
SIDE EFFECTS: Diarrhea, nausea, vomiting, stomach upset, loss of appetite, changes in taste, and headache may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: new signs of infection (such as sore throat that doesn't go away, fever), easy bruising/bleeding, pale skin, unusual tiredness, fast/irregular heartbeat, mental/mood changes, signs of liver disease (such as nausea/vomiting that doesn't stop, dark urine, stomach/abdominal pain, yellowing eyes/skin), stiff neck, headache that doesn't go away, muscle weakness, extreme drowsiness, signs of low blood sugar (such as sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.Get medical help right away if you have any very serious side effects, including: seizures.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking trimethoprim, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain type of anemia (due to folate deficiency), kidney disease, liver disease, vitamin deficiency (folate or folic acid), blood disorders (such as bone marrow suppression, G6PD deficiency), mineral imbalances (such as high level of potassium or low level of sodium in the blood).This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.If you have diabetes, this product may affect your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of low blood sugar (see Side Effects section). Your doctor may need to adjust your diabetes medication, exercise program, or diet.Trimethoprim may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using trimethoprim before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially mineral imbalance (high potassium blood level) and allergic reactions.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using trimethoprim. Trimethoprim may harm an unborn baby. It may lower your folic acid levels, increasing the risk of spinal cord defects. Check with your doctor to make sure you are taking enough folic acid. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.Trimethoprim passes into breast milk. While there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: dofetilide.This medication may interfere with certain lab tests (including kidney function and methotrexate blood levels), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: mental/mood changes (such as confusion), easy bruising/bleeding.
NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.Lab and/or medical tests (such as complete blood counts, kidney function, potassium blood level, cultures) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised October 2021. Copyright(c) 2021 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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