Cotrimstada STADA medicine for infections (10 blisters x 10 tablets)

Dosage form Box of 10 blisters x 10 tablets
Specifications Sulfamethoxazole, trimethoprim
Ingredient Otitis media, sinusitis, prostatitis, urinary tract infections, dysentery, typhoid, pneumonia, dysentery due to shigella dysenteriae

Ingredient

Composition information	Content
Sulfamethoxazole	400mg
Trimethoprim	80mg

Uses

indications

Cotrim 480mg Stada is indicated in the following cases:

Acute otitis media;

Chronic or recurrent urinary tract infections or prostatitis;

Respiratory infections;

Gastrointestinal infections;

Brucella disease;

Cholera disease;

Plague;

pneumocystis jiroveci pneumonia (pneumocystis carinii);

Toxoplasma disease.

Pharmacy

cotrimoxazol is a mixture of sulfamethoxazol (5 parts) and trimethoprim (1 part).

sulfamethoxazol is a sulfonamide, inhibit the competition of bacterial folic acid synthesis.

trimethoprim is a derivative of pyrimidine, inhibiting the specific enzyme dihydrofolate reductase of bacteria.

Combining Trimethoprim and Sulfamethoxazol so that inhibits two consecutive stages of folic acid metabolism, thus effectively inhibits the synthesis of purin, thymidin and the last DNA of bacteria. This serial inhibition has bactericidal effects. This co -mechanism also resists the growth of anti -drug bacteria and makes the drug work even when bacteria resist each ingredient of the drug.

The following microorganisms are often sensitive to drugs: E.coli, Klebsiella spp. Shigella Sonnei, Pneumocystis Carinii.

cotrimoxazol has a few effects on Plasmodium falciparum and toxoplasma gondii.

The anti -drug microorganisms are: Enterococcus, Pseudomonas, Campylobacter, Anaerobes (anaerobes), Meningococcus, Gonococcus (Gonococcus), Mycoplasma.

resistance to cotrimoxazol slow development in vitro compared to each single ingredient of the drug. This resistance increases in both gram -positive and gram -negative bacteria. Significant resistance in Entobacter.

In Vietnam, according to the report of the National Monitoring Program on drug resistance of pathogenic bacteria (ASTS), the resistance of cotrimoxazol grows very quickly, many bacteria in the 70s and 80s of the 20th century are often sensitive to cotrimoxazol, now strong resistance (Haemophilus influenzae, e.coli, klebsiella, protous SPPP, EnPPBICTER, ENTERBICTER, AILEBICTRE Salmonella Typhi ...).

bacteria

% resistance (1992)

% resistance (1997)

9.52

31.58

75.7

Pneumoniae

44.3

83.9

pharmacokinetic pharmacokinetics

cotrimoxazole absorbs well and quickly through the digestive tract. After taking a single dose of cotrimoxazol including 160mg trimethoprim and 800mg of sulfamethoxazol, the peak concentration reached after 1-4 hours in the serum of Trimethoprim is 1 - 2mcg/ml and sulfamethoxazol without cohesion of 40 - 60mcg/ml.

cotrimoxazol is widely distributed in tissue and body fluid including saliva, aquatic fluid, middle ear fluid, prostate fluid, vaginal fluid, bile and cerebrospinal fluid; Trimethoprim is also distributed in embryo secretions.

The distribution integral of trimethoprim is higher than sulfamethoxazol. Trimethoprim binds with plasma proteins about 44% and sulfamethoxazol binds about 70%. Cotrimoxazol is easy through the placenta and distributed into breast milk.

cotrimoxazol is metabolized through the liver. Trimethoprim's waste time is about 8 - 11 hours and sulfamethoxazol 10 - 13 hours in adults with normal kidney function. About 50 - 60% trimethoprim and 45 - 70% sulfamethoxazole oral dose are excreted through urine within 24 hours. About 80% trimethoprim and 20% sulfamethoxazole are found in urine in constant form. Only a small amount of trimethoprim is discharged through feces due to excretion in bile.

Before taking Cotrimstada STADA medicine for infections (10 blisters x 10 tablets)

How to use

cotrim 480mg stada is taken with food or drink to minimize the possibility of digestive disorders.

Dosage

Cotrimoxazol dose is calculated in trimethoprim in fixed combination containing sulfamethoxazol 5mg and trimethoprim 1mg.

acute otitis media

Children from 2 months of age:

The usual dose of cotrimoxazol is 8mg trimethoprim (in cotrimoxazol tablets)/kg/day divided into 2 small doses 12 hours apart.

Time of normal treatment 10 days.

Chronic or recurrent urinary tract infections or prostatitis

Adults: Use 160mg trimethoprim (in cotrimoxazol tablets) every 12 hours for 10-14 days for chronic or recurrent urinary tract infections or for 3-6 months for prostatitis.

Prevention of chronic infection or urinary tract relapse

Adults: dose 40 - 80mg trimethoprim (in cotrimoxazol)/day or 3 times/week for 3 - 6 months.

Children 2 months and older: Normal dose 8mg trimethoprim (in cotrimoxazol tablets)/kg/day divided into 2 small doses 12 hours/time.

Respiratory infections

Adults: The usual dose 160mg trimethoprim (in cotrimoxazol tablets)/1 time 12 hours apart, 14 days.

Gastrointestinal tract infections: bacilli dysentery (S.Flexneri or S.Sonnei)

Adults: The usual dose of 160mg trimethoprim (in cotrimoxazol)/1 time 12 hours apart.

Children: 8mg Trimethoprim (in cotrimoxazol)/kg/day, divided into 2 small doses 12 hours apart in 5 days.

Brucella disease

Children: Trimethoprim oral dose (in 1 tablet of cotrimoxazol) is 10mg/kg/day (maximum 480mg/day) divided into 2 small doses for 4-6 weeks.

Cholera

Adults: The dose of 160mg trimethoprim (in cotrimoxazol tablets) taken 2 times a day, taken for 3 days.

Children: Trimethoprim dose 4 - 5mg/kg (in cotrimoxazol tablets) taken twice a day, taken for 3 days in combination with infusion and electrolytes.

Plague

Preventive for people who come into contact with people with pulmonary plague.

Adults: Trimethoprim 320 - 640mg/day (in cotrimoxazol) is divided into 2 small doses to drink 12 hours apart, drink for 7 days.

Children at least 2 months of age and older: oral dose of trimethoprim 8mg (in cotrimoxazol tablets)/kg/day divided into 2 small doses, drink for 7 days.

pneumocystis jiroveci pneumonia (pneumocystis carinii) (PCP)

Children over 2 months of age and adults: Trimethoprim's usual oral dose (in cotrimoxazol tablets) is 15 - 20mg/kg/day divided into 3 or 4 small doses equal. The usual treatment time is 14 - 21 days.

Priority or secondary backup

In adults and teenagers infected with HIV: trimethoprim oral dose (in conmoxazol tablets) is 160mg/1 time/day.

Another way is also recommended: trimethoprim oral dose (in cotrimoxazol tablets) is 80mg/1 time/day.

Primary or secondary backup in children, including HIV -infected children: Trimethoprim dosage disruptive regimen (in cotrimoxazol tablets) is 150mg/m2 divided into 2 small doses, drink for 3 days per week.

Toxoplasma disease

Primary prophylaxis in adults and teenagers, trimethoprim dose (in cotrimoxazol tablets) is 160mg/1 time/day or 80mg/1/day.

Primary prophylaxis in children with HIV -infected trimethoprim (in cotrimoxazol tablets) is 150mg/m2/day divided into 2 small doses.

Patients with renal failure

When the kidney function decreases, the dose is reduced according to the following table:

Creatinine clearance (ml/minute)

Dosage recommended

Common dose

15 - 30

½ of the common dose

Unused

Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when overdose ?

Management:

In the case of cotrimoxazol poisoning, the stomach should be empty by causing vomiting or gastric lavage. Conduct supportive treatment and symptomatic treatment. Patients should be monitored with blood formula and other appropriate clinical tests (such as serum concentrations of electrolytes). Hemolysis can only eliminate a moderate amount of drugs; The abdominal division does not increase the effectiveness of elimination of cotrimoxazol.

What to do when forgetting 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.

Side Effects

When using Cotrim 480mg Stada, you may experience unwanted effects (ADR).

Common: Nausea, vomiting, anorexia and diarrhea.

Hypersensitivity reactions:

Common: Fever, skin reactions include rash, itching, light sensitivity, flaking dermatitis and roses.

Serious: The ability to die, skin reactions including epidermal necrosis, Stevens - Johnson syndrome.

Other: Dermatitis, all -body lupus, especially worsening the available diseases.

Kidney toxicity: interstitial nephritis and kidney necrosis, Lumbar pain, bleeding, urination and difficulty urinating.

Blood disorders: granulocytes, property anemia, thrombocytopenia, leukopenia, prothrombin and eosinophilic hypercasses like eOSIN.

Disorders of liver enzymes and jaundice:

Rare: Methemoglobin, acute hemolytic anemia.

Instructions on how to handle ADR

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

contraindicated

Cotrim 480mg stada drugs contraindicated in the following cases:

Patients with hypersensitivity to sulfamethoxazol or trimethoprim or any ingredient of the drug.

Patients with severe liver damage.

Patients with severe renal impairment when the kidney function cannot be controlled or when the clearance is less than 15ml/min.

Patients with large red blood cells due to folate deficiency.

Pregnant and lactating women.

Children under 2 months of age.

Be cautious when using

S.Pyogenes sore throat: Do not use cotrimoxazol.

cotrimoxazol should be used with patients with renal impairment, patients who are likely to lack folate (such as the elderly, alcoholic, people who are taking anti -convulsions, malnutrition people, people with malabsorption syndrome), patients with severe allergens or bronchial asthma, or with patients with glucose deficiency - 6 - Phosphate dehydrogenase (G -6 -P>.

Patients who are taking cotrimoxazol should pay attention to maintain adequate drinking water to avoid crystallizing urine and uroline formation.

Should regularly conduct test formula tests, urine analysis, renal function for patients being treated for a long time with cotrimoxazol.

Elderly people may be highly sensitive to unwanted effects of the drug.

The ability to drive and operate machinery

cotrimoxazol can cause dizziness, drowsiness, tinnitus, insomnia and hallucinations, patients should certainly not be affected before driving or operating machinery.

Pregnancy and lactation

Pregnancy

cotrimoxazol passes through the placenta and can affect the metabolism of folic acid, so the drug is only used during pregnancy when the benefits of treatment are higher than the risk of harm to the fetus. Because sulfonamid can cause jaundice in infants, cotrimoxazol is contraindicated for pregnant women.

Breastfeeding period

cotrimoxazol is distributed into breast milk. Because sulfonamid can cause jaundice in children under 2 months of age, it is recommended to stop breastfeeding or stop taking cotrimoxazol or use other medications instead, consider the importance of cotrimoxazol for the mother.

Medicinal interaction

Warfarin: Cotrimoxazol can extend the blood clotting time of patients using warfarin due to the drug inhibitor the metabolic waste of warfarin.

phenytoin: cotrimoxazole inhibits the metabolism of phenytoin.

methotrexate: Because sulfonamid can occupy methotrexate in cohesion with plasma proteins thus increases the concentration of free methotrexate.

cyclosporin: signs of kidney poison but can recover in patients with kidney implants using cotrimoxazol along with cyclosporin.

Digoxin: Increasing serum Digoxin concentration may occur in patients using cotrimoxazol; This interaction often happens in the elderly. Indomethacin: Increasing sulfamethoxazol levels in plasma can occur when the patient is using indomethacin. pyrimethamine: Large red blood cell anemia has been reported in patients using cotrimoxazol and pyrimethamine more than 25mg/week (to prevent malaria).

Antidepressant: Cotrimoxazol can reduce the effectiveness of 3 -round antidepressants.

Amantadin: Poisoning has been reported when used in combination with cotrimoxazol with amantadin.

Storage

In closed packaging, dry place. The temperature does not exceed 30 ° C.

To be out of reach of children.

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