Each 5 mL contains:
Trimethoprim — 40 mg
Sulfamethoxazole — 200 mg
Trimoshin, Co-trimoxazole, is a broad-spectrum antibacterial combination of Trimethoprim and Sulfamethoxazole.
Trimethoprim is 5-(3,4,5-Trimethoxybenzyl) pyrimidine-2,4-diamine with chemical formula of C₁₄H₁₈N₄O₃ and molecular weight of 290.3.
Sulfamethoxazole is 4-Amino-N-(5-methylisoxazol-3-yl) benzenesulfonamide with chemical formula of C₁₀H₁₁N₃O₃S and molecular weight of 253.3.
A mixture of trimethoprim and sulfamethoxazole are used in combination as (Co-trimoxazole) because of their synergistic activity.
Trimethoprim prevents the reduction of dihydrofolic acid to tetrahydrofolic acid by competitive inhibition of dihydrofolate reductase, thereby interfering with cell replication.
Sulfamethoxazole inhibits dihydropteroate synthase, which catalyzes the reduction of folic acid to dihydrofolic acid.
This combination blocks two consecutive steps in bacterial biosynthesis of essential nucleic acids and proteins. Thus the components act synergistically to produce a bactericidal action against a wide range of gram-positive, gram-negative and some protozoa.
It is active against: Aerobic Gram-Positive Organisms: Streptococcus pneumoniae, Aerobic Gram-Negative: Escherichia coli, Klebsiella species, Enterobacter species, Haemophilus influenzae, Morganella morganii, Proteus mirabilis, Proteus vulgaris, Shigella flexneri, Shigella sonnei;
Other organisms: Pneumocystis jirovecii.
Co-trimoxazole is rapidly and almost completely absorbed from the bowel, reaching peak plasma concentration 1–4 hours after ingestion.Sulfamethoxazole is 65% and trimethoprim is 45% protein bound.Trimethoprim/sulfamethoxazole is distributed to sputum, vaginal fluid and middle ear fluid; trimethoprim...
It is indicated in uncomplicated urinary tract infections, prostatitis, acute exacerbations of chronic bronchitis, acute otitis media, susceptible strains of shigella and salmonella infections, nocardiosis, treatment and prophylaxis of *Pneumocystis jirovecii* infections and treatment of moderate or...
Treatment of susceptible infections:
Children 6 weeks–5 months:** 120 mg twice daily, alternatively 24 mg/kg twice daily.
Children 6 months–5 years:** 240 mg twice daily, alternatively 24 mg/kg twice daily.
Children 6–11 years:** 480 mg twice daily, alternatively 24 mg/kg twice daily.
Children 12–17 years:** 960 mg twice daily.
Adults: 960 mg twice daily.
Moderate / Severe diabetic foot infection:
Adults: 960 mg twice daily.
Urinary Tract Infections:
480–960 mg every 12 hours daily for 10–14 days.
Acute exacerbations of chronic bronchitis: 480–960 mg every 12 hours daily for 14 days.
Treatment of Pneumocystis jirovecii infections: 120 mg/kg daily in 2–4 divided doses for 14–21 days.
It should be taken on an empty stomach but taken with food if nausea or diarrhea occurs. Shake well before use. Follow with water.
Co-trimoxazole is contraindicated in patients with known hypersensitivity to trimethoprim or sulfonamides; in patients with severe liver or kidney problems, thrombocytopenia, megaloblastic anaemia due to folate deficiency and in pediatric patients less than 2 months of age.
Use with caution in patients with folic acid deficiency, impaired renal or hepatic function, G6PD deficiency, hypoglycaemia, a rare blood problem called porphyria, hypothyroidism; underweight or malnourished patients and elderly.
Common adverse effects are muscle cramps or pain, irregular heartbeats, unusual tiredness or weakness, headache, nausea, diarrhea, skin rash and urticaria.
Diuretics (primarily thiazides): Increased incidence of thrombocytopenia.
Warfarin : Co-trimoxazole may prolong prothrombin time.
Phenytoin :Co-trimoxazole may inhibit the hepatic metabolism of Phenytoin.
Methotrexate : Sulfonamides can displace methotrexate from plasma protein binding sites and compete with renal transport of methotrexate, thus increasing free methotrexate concentrations.
Cyclosporine : Marked but reversible nephrotoxicity.
Digoxin : Increased digoxin level especially in elderly patients.
Indomethacin : Increased sulfamethoxazole blood levels.
Tricyclic antidepressants : Efficacy of tricyclic antidepressants decreased.
Oral hypoglycaemics : Co-trimoxazole potentiates the effect of oral hypoglycaemics.
Store below 30°C in a cool, dry place. Protect from light and moisture. Tightly recap after use. Keep out of reach and sight of children.
60 mL amber-coloured plastic bottle in a carton box.