Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
Available formulation in Zambia: 500 mg tablet
- First-line treatment of CNS toxoplasmosis: pyrimethamine + sulfadiazine (plus folinic acid).
- Maintain adequate hydration to prevent crystalluria
Zambia Information Author: Paul A. Pham, Pharm.D.
- CNS and ocular toxoplasmosis (in combination with pyrimethamine); nocardiosis.
- Malaria due to chloroquine-resistant P. falciparum malaria (in combination with quinine and pyrimethamine).
- UTI (also FDA indicated for pyelonephritis, but generally reserved for uncomplicated UTI). Sulfamethoxazole preferred.
- FDA indicated, but not generally recommended: Chancroid; trachoma; inclusion conjunctivitis.
- FDA indicated, but not generally recommended: Prophylaxis of meningococcal meningitis when sulfonamide-sensitive group A strains known to prevail; meningococcal meningitis; acute otitis media due to H. influenzae (in combination with PCN); prophylaxis against recurrences of rheumatic fever (alternative to penicillin); H. influenzae meningitis (in combination with streptomycin)
|$2.50per 500 mg tab
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- CNS and ocular toxoplasmosis (induction phase): sulfadiazine 1-1.5gm PO q6h (+ leucovorin 10-20 mg PO once-daily and pyrimethamine 100-200 mg PO loading dose, then 50-100 mg PO once-daily x 6 wks)
- CNS and ocular toxoplasmosis (maintenance phase): sulfadiazine 50 0mg PO q6h (+ leucovorin 10-20 mg PO once-daily and pyrimethamine 25-50 mg PO once-daily) until immune reconstitution (CD4 >200 x 6 mos and on stable ART)
- Treatment of norcardiosis: 1.5 gm PO q6h x >6 mos; SMX/TMP preferred (CID 1996;22:891-903). Target serum level: 100-150 g/mL (2 hrs after dose)
- Ocular toxoplasmosis: sulfadiazine 1 gm q6h (+ leucovorin 15 mg PO once-daily and pyrimethamine 100 mg PO x1, then 50 mg PO once-daily x 4 wks). Additional treatment if pt has dense vitreous floaters, active retinal inflammation, or both (Am J Ophthalmol 2002;134:34-40).
0.5-1.5 gm q6h
0.5-1.5gm q8-12h (approx. half dose)
0.5-1.5 gm q12h-24h (approx. 1/3 dose); HD: no data, dose post-HD
No data, consider 0.5-1.5 gm q12-24h
No data, consider 0.5-1.5 gm q12-24h
No data, consider 0.5-1.5 gm q8h-12h
- GI intolerance with nausea and vomiting
- Rash and pruritus
- Bone marrow suppression (anemia, thrombocytopenia, leukopenia)
- Serum sickness and drug fever
- Crystalluria with azotemia, urolithiasis,oliguria. May be prevented by adequate hydration (daily urinary output >1500 ml) and alkalinizing urine to pH >7.15.
- TEN and Stevens-Johnson syndrome
Toxoplasma gondii; P. falciparum
- Warfarin: may increase INR. Monitor closely.
- Sulfonylurea: may increase hypoglycemia. Monitor closely with coadministration.
- Cyclosporine: may decrease cyclosporine serum levels. Monitor levels closely; may require dose increase.
- Phenytoin: may increase phenytoin serum levels. Monitor free phenytoin levels with co-administration.
- Porfimer: may increase the risk of photosensitivity reaction. Avoid co-administration.
- Para-aminobenzoic acid (PABA) and derivatives (such as benzocaine, procaine, tetracaine): theoretical antagonism. Avoid co-administration.
Agent of choice for toxoplasmosis (with pyrimethamine) due to superior CNS penetration and extensive clinical data. Higher incidence of crystaluria compared to other sulfonamides. This regimen also provides PCP prophylaxis.