sulfadiazine (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 500mg

Load

2-4 g PO

Maintenance

2-4 g/day divided 3-6x/day PO

Prophylaxis of Recurrent Rheumatic Fever

>30 kg: 1 g/day

<30 kg: 500 mg/day

Toxoplasmosis

Given with Pyrimethamine & Folinic Acid

1-1.5 g QID us. for 3-4 weeks

Prophylaxis (in patients with HIV): 0.5-1 g q6hr with pyrimethamine (25-75 mg/day PO) & folinic acid (10-25 mg/day PO)

Other Information

Asymptomatic meningococcal carriers: 1 g BID x2 days

Monitor: renal function, CBC

Other Indications & Uses

Burkholderia pseudomallei, Chlamydia trachomatis,Nocardia asteroides & brasiliensis, Mycobacterium smegmatis, Mycobacterium chelonae, Mycobacterium fortuitum

First Line:Mycobacterium smegmatis, Nocardia asteroides & brasiliensis

Dosage Forms & Strengths

tablet

  • 500mg

Load (>2 Months Old)

75 mg/kg PO OR  

2 g/sq.meter PO

Maintenance (>2 Months Old)

150 mg/kg/day divided q4- 6hr PO, OR  

4 g/sq. meter/day divided q4 -6hr PO

No more than 6 g/day

Toxoplasmosis

Given with pyrimethamine and folinic acid

100-200 mg/kg/day divided q6hr PO x3-4 weeks  

Infants <2 months old: 25 mg/kg/day divided QID PO

Prophylaxis (in patients with HIV): 85-120 mg/kg/day divided BID, TID or QID with pyrimethamine (1 mg/kg or 15 mg/sq.meter daily-maximum dose 25 mg) & folinic acid (5 mg every third day)

Congenital Toxoplasmosis

Given with pyrimethamine and folinic acid

100 mg/kg/day divided q6hr PO x 12 months  

Other Information

Prophylaxis of recurrent rheumatic fever: see Adult Dosing

Monitor: renal function, CBC

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Interactions

Interaction Checker

and sulfadiazine

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              Serious - Use Alternative (28)

              • aminobenzoate potassium

                aminobenzoate potassium decreases effects of sulfadiazine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • aminolevulinic acid oral

                aminolevulinic acid oral, sulfadiazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.

              • aminolevulinic acid topical

                sulfadiazine increases toxicity of aminolevulinic acid topical by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of photosensitizing drugs may enhance the phototoxic reaction to photodynamic therapy with aminolevulinic acid.

              • antithrombin alfa

                sulfadiazine increases effects of antithrombin alfa by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of antithrombin alfa by plasma protein binding competition. Avoid or Use Alternate Drug.

              • antithrombin III

                sulfadiazine increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of antithrombin III by plasma protein binding competition. Avoid or Use Alternate Drug.

              • argatroban

                sulfadiazine increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of argatroban by plasma protein binding competition. Avoid or Use Alternate Drug.

              • BCG vaccine live

                sulfadiazine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • bemiparin

                sulfadiazine increases effects of bemiparin by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of bemiparin by plasma protein binding competition. Avoid or Use Alternate Drug.

              • bivalirudin

                sulfadiazine increases effects of bivalirudin by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of bivalirudin by plasma protein binding competition. Avoid or Use Alternate Drug.

              • cholera vaccine

                sulfadiazine, 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.

              • dalteparin

                sulfadiazine increases effects of dalteparin by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of dalteparin by plasma protein binding competition. Avoid or Use Alternate Drug.

              • enoxaparin

                sulfadiazine increases effects of enoxaparin by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of enoxaparin by plasma protein binding competition. Avoid or Use Alternate Drug.

              • erdafitinib

                sulfadiazine will increase the level or effect of erdafitinib by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with strong CYP2C9 inhibitors, monitor closely for adverse reactions and consider decreasing dose accordingly. If strong CYP2C9 inhibitor is discontinued, consider increasing erdafitinib dose in the absence of any drug-related toxicities.

              • fondaparinux

                sulfadiazine increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of fondaparinux by plasma protein binding competition. Avoid or Use Alternate Drug.

              • heparin

                sulfadiazine increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of heparin by plasma protein binding competition. Avoid or Use Alternate Drug.

              • ivosidenib

                ivosidenib will decrease the level or effect of sulfadiazine 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.

              • methenamine

                methenamine, sulfadiazine. Other (see comment). Contraindicated. Comment: This combination may form an insoluble precipitate in the urine, decreasing the effects of both agents.

              • methotrexate

                sulfadiazine increases toxicity of methotrexate by plasma protein binding competition. Avoid or Use Alternate Drug.

              • methyl aminolevulinate

                sulfadiazine, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.

              • pexidartinib

                sulfadiazine and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.

              • phenindione

                sulfadiazine increases effects of phenindione by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of phenindione by plasma protein binding competition. Avoid or Use Alternate Drug.

              • pretomanid

                sulfadiazine, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

              • protamine

                sulfadiazine increases effects of protamine by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of protamine by plasma protein binding competition. Avoid or Use Alternate Drug.

              • siponimod

                sulfadiazine 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.

              • tretinoin

                sulfadiazine, tretinoin. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased phototoxicity.

              • tretinoin topical

                sulfadiazine, tretinoin topical. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased phototoxicity.

              • typhoid vaccine live

                sulfadiazine decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • warfarin

                sulfadiazine increases effects of warfarin by decreasing metabolism. Avoid or Use Alternate Drug.

                sulfadiazine increases effects of warfarin by plasma protein binding competition. Avoid or Use Alternate Drug.

              Monitor Closely (53)

              • alpelisib

                alpelisib will decrease the level or effect of sulfadiazine by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.

              • apalutamide

                apalutamide will decrease the level or effect of sulfadiazine 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.

              • bazedoxifene/conjugated estrogens

                sulfadiazine 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.

              • bupivacaine implant

                sulfadiazine, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

              • cannabidiol

                cannabidiol will increase the level or effect of sulfadiazine by decreasing metabolism. Modify Therapy/Monitor Closely. Cannabidiol may potentially inhibit CYP2C9 activity. Consider reducing the dose when concomitantly using CYP2C9 substrates.

              • chlorpropamide

                sulfadiazine increases levels of chlorpropamide by plasma protein binding competition. Use Caution/Monitor.

              • conjugated estrogens

                sulfadiazine 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.

              • cyclosporine

                sulfadiazine decreases effects of cyclosporine by unknown mechanism. Use Caution/Monitor. Increased nephrotoxicity with this combination.

                sulfadiazine, cyclosporine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • dapsone topical

                sulfadiazine increases toxicity of dapsone topical by decreasing metabolism. Modify Therapy/Monitor Closely. May induce methemoglobinemia .

              • diclofenac

                sulfadiazine will increase the level or effect of diclofenac by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Do not exceed diclofenac dose of 50 mg BID

              • digoxin

                sulfadiazine will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • dronabinol

                sulfadiazine will increase the level or effect of dronabinol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Dronabinol is a CYP2C9 substrate.

              • eluxadoline

                sulfadiazine increases levels of eluxadoline by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. As a precautionary measure due to incomplete information on the metabolism of eluxadoline, use caution when coadministered with strong CYP2C9/10 inhibitors.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF decreases levels of sulfadiazine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Elvitegravir is a moderate CYP2C9 inducer.

              • estradiol

                sulfadiazine 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

                sulfadiazine 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

                sulfadiazine 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

                sulfadiazine 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.

              • glimepiride

                sulfadiazine increases levels of glimepiride by plasma protein binding competition. Use Caution/Monitor.

              • glipizide

                sulfadiazine increases levels of glipizide by plasma protein binding competition. Use Caution/Monitor.

              • glyburide

                sulfadiazine increases levels of glyburide by plasma protein binding competition. Use Caution/Monitor.

                sulfadiazine increases levels of glyburide by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Strong CYP2C9 inhibitors may decrease glyburide metabolism.

              • insulin aspart

                sulfadiazine increases effects of insulin aspart by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • insulin aspart protamine/insulin aspart

                sulfadiazine increases effects of insulin aspart protamine/insulin aspart by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • insulin degludec

                sulfadiazine, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

                sulfadiazine increases effects of insulin degludec by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • insulin degludec/insulin aspart

                sulfadiazine, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

              • insulin detemir

                sulfadiazine increases effects of insulin detemir by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • insulin glargine

                sulfadiazine increases effects of insulin glargine by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • insulin glulisine

                sulfadiazine increases effects of insulin glulisine by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • insulin inhaled

                sulfadiazine, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

                sulfadiazine increases effects of insulin inhaled by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • insulin isophane human/insulin regular human

                sulfadiazine increases effects of insulin isophane human/insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • insulin lispro

                sulfadiazine increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • insulin lispro protamine/insulin lispro

                sulfadiazine increases effects of insulin lispro protamine/insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • insulin NPH

                sulfadiazine increases effects of insulin NPH by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • insulin regular human

                sulfadiazine increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and sulfonamide antibiotics may require insulin dosage adjustment and increased glucose monitoring.

              • lacosamide

                sulfadiazine increases levels of lacosamide by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely. Consider decreasing lacosamide dose when coadministered with strong CYP2C9 inhibitors.

              • lesinurad

                sulfadiazine will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                sulfadiazine 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.

              • lumacaftor/ivacaftor

                lumacaftor/ivacaftor, sulfadiazine. affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C9 substrates. .

              • mestranol

                sulfadiazine 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.

              • methoxsalen

                methoxsalen, sulfadiazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive photosensitizing effects.

              • nateglinide

                sulfadiazine increases levels of nateglinide by plasma protein binding competition. Use Caution/Monitor.

              • nitisinone

                nitisinone will increase the level or effect of sulfadiazine 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.

              • ospemifene

                sulfadiazine increases levels of ospemifene by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • porfimer

                sulfadiazine, porfimer. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Enhanced photosensitivity.

              • promazine

                promazine increases toxicity of sulfadiazine by unspecified interaction mechanism. Use Caution/Monitor. Enhanced myelosuppression.

              • repaglinide

                sulfadiazine increases levels of repaglinide by plasma protein binding competition. Use Caution/Monitor.

              • rucaparib

                rucaparib will increase the level or effect of sulfadiazine by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C9 substrates, if clinically indicated.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                sulfadiazine 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.

              • terbinafine

                sulfadiazine will increase the level or effect of terbinafine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • tetracaine

                tetracaine, sulfadiazine. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.

              • tolazamide

                sulfadiazine increases levels of tolazamide by plasma protein binding competition. Use Caution/Monitor.

              • tolbutamide

                sulfadiazine increases levels of tolbutamide by plasma protein binding competition. Use Caution/Monitor.

              • voclosporin

                voclosporin, sulfadiazine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

              Minor (47)

              • amiloride

                amiloride increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • aminohippurate sodium

                sulfadiazine, aminohippurate sodium. Other (see comment). Minor/Significance Unknown. Comment: This substance interferes with chemical color development of aminohippurate (PAH) essential to accurate renal clearance analysis.

              • aspirin

                aspirin increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • aspirin rectal

                aspirin rectal increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • balsalazide

                sulfadiazine will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

                balsalazide increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • bendroflumethiazide

                bendroflumethiazide increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • biotin

                sulfadiazine will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • bumetanide

                bumetanide increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • chlorothiazide

                chlorothiazide increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • chlorthalidone

                chlorthalidone increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • cyclopenthiazide

                cyclopenthiazide increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • diflunisal

                diflunisal increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • drospirenone

                drospirenone increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • ethacrynic acid

                ethacrynic acid increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • ethotoin

                sulfadiazine increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.

              • fosphenytoin

                sulfadiazine increases levels of fosphenytoin by decreasing metabolism. Minor/Significance Unknown.

              • furosemide

                furosemide increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • hydrochlorothiazide

                hydrochlorothiazide increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • indapamide

                indapamide increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • indomethacin

                indomethacin increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • isocarboxazid

                isocarboxazid increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • linezolid

                linezolid increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • mesalamine

                mesalamine increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • methyclothiazide

                methyclothiazide increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • metolazone

                metolazone increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • mineral oil

                mineral oil decreases levels of sulfadiazine by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pantothenic acid

                sulfadiazine will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • phenelzine

                phenelzine increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • phenytoin

                sulfadiazine increases levels of phenytoin by decreasing metabolism. Minor/Significance Unknown.

              • primaquine

                primaquine, sulfadiazine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hemolysis in G6PD deficient pts.

              • probenecid

                probenecid increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • pyridoxine

                sulfadiazine 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)

                sulfadiazine will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pyrimethamine

                sulfadiazine, pyrimethamine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased bone marrow toxicity.

              • salicylates (non-asa)

                salicylates (non-asa) increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • salsalate

                salsalate increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • selegiline transdermal

                selegiline transdermal increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • spironolactone

                spironolactone increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • sulfasalazine

                sulfasalazine increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • thiamine

                sulfadiazine will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • torsemide

                torsemide increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • tranylcypromine

                tranylcypromine increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • triamterene

                triamterene increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • verteporfin

                sulfadiazine, verteporfin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased phototoxicity.

              • willow bark

                willow bark increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Diarrhea (33%)

              Headache (33%)

              Reversible oligospermia (33%)

              Anorexia

              Gastric distress

              Nausea

              Photosensitivity

              Vomiting

              1-10%

              Allergic reactions-rash

              Aplastic anemia

              Dizziness

              Hypersensitivity

              Itching

              Thyroid fuction disturbance

              Franulocytopenia

              Thrombocytopenia

              Frequency Not Defined

              Lyell's syndrome

              Sstevens Johnson syndrome

              Rash

              Fever

              Granulocytopenia

              Hemolytic anemia

              Leukopenia

              Hepatitis

              Jaundice

              Hematuria

              Acute nephropathy

              Intestinal nephritis

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              Warnings

              Contraindications (additional)

              Should not be used for group A beta-hemolytic strep infections

              Documented megaloblastic or folate deficiency anemia, obstructive uropathy

              Cautions (additional)

              Drink 250 mL water w/ each dose & frequently throughout day while taking sulfadiazine

              Adverse Drug Reactions

              Lyell's syndrome, stevens Johnson syndrome, itching, rash, photosensitivity, thyroid function disturbance, anorexia, diarrhea, nausea, vomiting, dizziness, fever, headache, aplastic anemia, granulocytopenia, hemolytic anemia, leukopenia, thrombocytopenia, hepatitis, jaundice, hematuria, acute nephropathy, intestinal nephritis

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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: enters breast milk; risk of kernicterus if infant <2 mo

              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.

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              Pharmacology

              Absorption: well absorbed

              Distribution: sulfadiazine is distributed into most body tissues; appears to cross cell membranes freely; at a plasma concentration of 100 mcg/mL

              Protein Bound: approximately 32-56%

              Elimination: largely in urine; urinary concentrations usually are 10-25 times those attained in serum

              Mechanism of Action

              Exerts bacteriostatic action through competitive antagonism with para-aminobenzoic acid (PABA). Microorganisms that require exogenous folic acid and do not synthesize folic acid are not susceptible to the action of sulfonamides

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              sulfadiazine oral
              -
              500 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              sulfadiazine oral

              SULFADIAZINE - ORAL

              (sull-fuh-DYE-uh-zeen)

              USES: This medication is used to treat and prevent a wide variety of infections. Sulfadiazine belongs to the class of drugs known as sulfa antibiotics. It works by stopping the growth of bacteria and other organisms.This antibiotic treats only certain types of infections. It will not work for viral infections (e.g., common cold, flu). Unnecessary use or misuse of any antibiotic can lead to its decreased effectiveness.This medication should not be used in infants younger than 2 months because of the risk of serious side effects, unless treatment is for a very serious infection (congenital toxoplasmosis).

              HOW TO USE: Take this medication by mouth with a full glass of water (8 ounces or 240 milliliters) as directed by your doctor. Drink plenty of fluids during treatment with this medication unless your doctor advises you otherwise. This will help prevent unlikely side effects such as crystals appearing in the urine and kidney stones.The dosage is based on your medical condition, weight, and response to treatment. Children must not take more than 6 grams per day (same as 6,000 milligrams per day) of this medication.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 for the full time prescribed, 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 persists or worsens.

              SIDE EFFECTS: Nausea, vomiting, diarrhea, loss of appetite, or headache may occur. If any of these effects persist or worsen, notify 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 any of these unlikely but serious side effects occur: mental/mood changes (e.g., depression, hallucinations), signs of kidney problems (such as change in the amount of urine, crystals in the urine, painful urination), lump/growth/swelling in the front of the neck (goiter), signs of low blood sugar (e.g., shaking, dizziness, blurred vision, unusual hunger).Seek immediate medical attention if any of these rare but very serious side effects occur: confusion, persistent/severe headache, neck stiffness, seizures.This medication may rarely cause serious (possibly fatal) allergic reactions and other side effects such as a severe peeling skin rash (e.g., Stevens-Johnson syndrome), blood disorders (e.g., agranulocytosis, aplastic anemia), liver damage, or lung injury. Seek immediate medical attention if you notice any of the following: skin rash/blisters, itching/swelling (especially of the face/tongue/throat), severe dizziness, persistent cough, trouble breathing, signs of a new infection (e.g., persistent sore throat, fever), pale skin, easy bleeding/bruising, yellowing eyes/skin, persistent nausea/vomiting, unusual tiredness, dark urine, stomach/abdominal pain, joint pain.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 vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.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 sulfadiazine, tell your doctor or pharmacist if you are allergic to it; or to sulfa medications; 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: certain metabolic disorders (porphyria, G6PD deficiency), kidney disease, liver disease, severe allergies, asthma, diabetes, blood disorders (e.g., anemia due to folate vitamin deficiency), decreased bone marrow function (bone marrow suppression).Sulfadiazine may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.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. Get medical help right away if you get sunburned or have skin blisters/redness.Kidney function declines as you grow older. This medication is removed by the kidneys. The elderly may be more sensitive to the side effects of the drug, especially skin reactions and blood disorders.During pregnancy, this medication should be used only when clearly needed. This medication should not be used near the expected delivery date because of possible harm to the unborn baby. Discuss the risks and benefits with your doctor.This drug passes into breast milk. While there have been no reports of harm to healthy infants, this drug may have undesirable effects on infants who are ill or premature or have certain disorders (jaundice, high blood levels of bilirubin, G6PD deficiency). Breast-feeding is not recommended in infants with these conditions. Consult your doctor before breast-feeding any infant.

              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.Some products that may interact with this drug include: methenamine, methotrexate, PABA taken by mouth, warfarin.

              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: dizziness, drowsiness, blood in the urine, fever, loss of consciousness.

              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.If you are using this medication for an extended period, laboratory and/or medical tests (e.g., complete blood count, kidney function tests) should be performed periodically to monitor your progress or check for side effects. 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 August 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.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.