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Co-trioxazole Forte

JohnEGreen

JohnEGreen

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I have just started taking this medication and was wondering if any one else here is taking it and if they have had any problems with it.
As I just found this on the net.

Co-trimoxazole-induced hypoglycaemia in an immunosuppressed intensive care patient

"
Abstract
An 18-year-old female inpatient on a neurosciences intensive care unitwith new onset super-refractory epilepsy became hypoglycaemic 48 h after commencing co-trimoxazole. She had been placed on this for prophylaxis against Pneumocystis jiroveci infection in the context of significant immunosuppression with high-dose corticosteroid therapy. In order to maintain glucose control, she required a continuous infusion of 10% dextrose at rates of 15–25 ml/h. Recurrent attempts to wean this were limited by further hypoglycaemia, until she spontaneously regained normoglycaemia after 73 days. This case report will discuss this unusual case of refractory hypoglycaemia, and the proposed pathophysiology of hypoglycaemia related to co-trimoxazole therapy."

"Background
Pneumocystis jiroveci pneumonia is a life-threatening condition associated with significant immunosuppression. As this can be life-threatening, it is advised that patients receiving over 20 mg prednisolone for over one month should be commenced on prophylactic antibiotics.1 Co-trimoxazole (combination of trimethoprim and sulfamethoxazole in a 1:5 ratio) is first line for prophylaxis due to its efficacy.1 However, it carries a high incidence of adverse effects, including hypoglycaemia."

http://journals.sagepub.com/doi/full/10.1177/1751143716660330

I know this is an intensive care journal but though not in an ICU the reasons I think apply to me.
 
JohnEGreen said:
I have just started taking this medication and was wondering if any one else here is taking it and if they have had any problems with it.
As I just found this on the net.

Co-trimoxazole-induced hypoglycaemia in an immunosuppressed intensive care patient

"
Abstract
An 18-year-old female inpatient on a neurosciences intensive care unitwith new onset super-refractory epilepsy became hypoglycaemic 48 h after commencing co-trimoxazole. She had been placed on this for prophylaxis against Pneumocystis jiroveci infection in the context of significant immunosuppression with high-dose corticosteroid therapy. In order to maintain glucose control, she required a continuous infusion of 10% dextrose at rates of 15–25 ml/h. Recurrent attempts to wean this were limited by further hypoglycaemia, until she spontaneously regained normoglycaemia after 73 days. This case report will discuss this unusual case of refractory hypoglycaemia, and the proposed pathophysiology of hypoglycaemia related to co-trimoxazole therapy."

"Background
Pneumocystis jiroveci pneumonia is a life-threatening condition associated with significant immunosuppression. As this can be life-threatening, it is advised that patients receiving over 20 mg prednisolone for over one month should be commenced on prophylactic antibiotics.1 Co-trimoxazole (combination of trimethoprim and sulfamethoxazole in a 1:5 ratio) is first line for prophylaxis due to its efficacy.1 However, it carries a high incidence of adverse effects, including hypoglycaemia."

http://journals.sagepub.com/doi/full/10.1177/1751143716660330

I know this is an intensive care journal but though not in an ICU the reasons I think apply to me.
Click to expand...
@JohnEGreen im on immuno suppression drugs and co-trimoxazole but haven’t had any problems so far
 
Ziggy2017 said:
@JohnEGreen im on immuno suppression drugs and co-trimoxazole but haven’t had any problems so far
Click to expand...
That's good very reassuring was a bit worried there.

I have been put on them because I have Lymphcytopenia and that puts me at risk of pneumocystis carinii the old name for Pneumocystis jiroveci it seems.

edit to add if I recall correctly have you not been having the odd unexplained hypo of late and though I don't take Gliclazide or such it does interact with co-trimoxazole to a degree.
 
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I haven’t needed any antibiotics since my diabetes diagnosis. However I’m very allergic to Cotrimoxazole, causes a florid rash and drowsiness so I wouldn’t be given it. But very worth while mentioning for anyone else prescribed it.
 
JohnEGreen said:
That's good very reassuring was a bit worried there.

I have been put on them because I have Lymphcytopenia and that puts me at risk of pneumocystis carinii the old name for Pneumocystis jiroveci it seems.

edit to add if I recall correctly have you not been having the odd unexplained hypo of late and though I don't take Gliclazide or such it does interact with co-trimoxazole to a degree.
Click to expand...
@JohnEGreen yes I have had a few unexplained hypos though I thought maybe it was the heat and no I’m not gliclazide thanks for your help john
 
@Ziggy2017 Just been going through the drug interaction list for Co-trimoxazole and insulin is listed as a drug with moderate interaction.
Co-trimoxazole seems to have interaction with several hundred different medications ranging from serious to so what.
 
JohnEGreen said:
@Ziggy2017 Just been going through the drug interaction list for Co-trimoxazole and insulin is listed as a drug with moderate interaction.
Co-trimoxazole seems to have interaction with several hundred different medications ranging from serious to so what.
Click to expand...
@JohnEGreen maybe that’s why I’ve been having the odd hypo
 
It is a possibility you could discuss it with your doctor as it may need to be taken into account when setting your insulin dose but is only a moderate interaction so doctor may feel it can safely be ignored.

Found it also has moderate interaction with metformin

I take at least two meds that are on the serious list and it seems I am now Tea Total no more alcohol now for me that is really serious. :)

Here is a link https://www.drugs.com/drug-interact...imethoprim,co-trimoxazole-index.html?filter=2
 
One thing that is worth noting with this medication is the no alcohol rule means no alcohol at all. As it blocks a metabolic pathway whereby alcohol is dealt with by the liver and causes a build up of Acetaldehyde
 
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