Pyrimethamine and Sulfadoxine Brand Name– Fansidar
What is Pyrimethamine and Sulfadoxine
Pyrimethamine and sulfadoxine are used together in an oral preparation to treat or prevent malaria, however, the combination is no longer routinely recommended for malaria prophylaxis due to the possibility of fatal toxic epidermal necrolysis (TEN).
Prophylactic therapy should only be considered for travelers to areas where chloroquine-resistant P. falciparum malaria is endemic and sensitive to the combination, and when alternative drugs are not available or are contraindicated.
Pyrimethamine and sulfadoxine are used together because of their synergistic activity on folic acid production. In cases of chloroquine-resistant malaria, the combination of pyrimethamine and sulfadoxine is given with quinine. The combination was approved by the FDA in 1981.
Indications
- malaria
- malaria prophylaxis
- Plasmodium falciparum
Side Effects
- abdominal pain
- agranulocytosis
- alopecia
- anaphylactoid reactions
- anuria
- aplastic anemia
- arthralgia
- ataxia
- azotemia
- bone marrow suppression
- chills
- crystalluria
- depression
- diarrhea
- diuresis
- elevated hepatic enzymes
- eosinophilia
- erythema multiforme
- exfoliative dermatitis
- fatigue
- glossitis
- goiter
- hallucinations
- headache
- hemolytic anemia
- hepatic necrosis
- hepatitis
- hypoglycemia
- hypoprothrombinemia
- insomnia
- interstitial nephritis
- leukopenia
- lupus-like symptoms
- megaloblastic anemia
- methemoglobinemia
- myocarditis
- nausea
- neuritis
- oliguria
- pancreatitis
- pancytopenia
- pericarditis
- photosensitivity
- pruritus
- purpura
- rash
- renal failure (unspecified)
- seizures
- serum sickness
- Stevens-Johnson syndrome
- stomatitis
- thrombocytopenia
- tinnitus
- toxic epidermal necrolysis
- urticaria
- vertigo
- vomiting
- weakness
Pyrimethamine; Sulfadoxine therapy may be associated with pulmonary infiltrates resembling eosinophilic or allergic alveolitis.
Monitoring Parameters
- CBC
- LFTs
- urinalysis
Contraindications
- anemia
- asthma
- bone marrow suppression
- breast-feeding
- dehydration
- dental disease
- folate deficiency megaloblastic anemia
- fungal infection
- G6PD deficiency
- geriatric
- hepatic disease
- infants
- infection
- neonates
- porphyria
- pregnancy
- renal disease
- renal impairment
- serious rash
- sulfonamide hypersensitivity
- sunlight (UV) exposure
Interactions
- Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
- Acarbose
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetohexamide
- Albiglutide
- Alogliptin; Metformin
- Alpha-glucosidase Inhibitors
- Aminosalicylate sodium, Aminosalicylic acid
- Amoxicillin
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amoxicillin; Clavulanic Acid
- Ampicillin
- Ampicillin; Sulbactam
- Artemether; Lumefantrine
- Articaine; Epinephrine
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzocaine
- Benzocaine; Butamben; Tetracaine
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bromocriptine
- Bupivacaine
- Bupivacaine Liposomal
- Bupivacaine; Lidocaine
- Canagliflozin
- Canagliflozin; Metformin
- Carbamazepine
- Chloroprocaine
- Chlorpromazine
- Chlorpropamide
- Choline Salicylate; Magnesium Salicylate
- Colchicine; Probenecid
- Dapagliflozin
- Dapagliflozin; Metformin
- Dapagliflozin; Saxagliptin
- Dapsone
- Dicloxacillin
- Dienogest; Estradiol valerate
- Dipeptidyl Peptidase-4 Inhibitors
- Diphenhydramine; Naproxen
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Dulaglutide
- Empagliflozin
- Empagliflozin; Linagliptin
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Ertugliflozin
- Ertugliflozin; Metformin
- Ertugliflozin; Sitagliptin
- Esomeprazole; Naproxen
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Exenatide
- Fenoprofen
- Fluorouracil, 5-FU
- Fluvastatin
- Folic Acid, Vitamin B9
- Glimepiride
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide
- Glipizide; Metformin
- Glyburide
- Glyburide; Metformin
- Hydrochlorothiazide, HCTZ; Losartan
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Incretin Mimetics
- Insulin Degludec; Liraglutide
- Insulin Glargine; Lixisenatide
- Insulins
- Lamivudine, 3TC; Zidovudine, ZDV
- Lamotrigine
- Lansoprazole; Naproxen
- Levomefolate
- Lidocaine
- Lidocaine; Prilocaine
- Linagliptin; Metformin
- Liraglutide
- Lixisenatide
- Lorazepam
- Losartan
- Magnesium Salicylate
- Meglitinides
- Mepivacaine
- Mepivacaine; Levonordefrin
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methenamine
- Methenamine; Sodium Acid Phosphate
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methotrexate
- Methoxsalen
- Miglitol
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Omeprazole; Amoxicillin; Rifabutin
- Oral Contraceptives
- Oxacillin
- Penicillamine
- Penicillin G
- Penicillin G Benzathine
- Penicillin G Benzathine; Penicillin G Procaine
- Penicillin G Procaine
- Penicillin V
- Photosensitizing agents (topical)
- Piperacillin
- Piperacillin; Tazobactam
- Porfimer
- Pramlintide
- Prilocaine
- Prilocaine; Epinephrine
- Probenecid
- Pyrimethamine
- Rabies Vaccine
- Ropivacaine
- Salicylates
- Salsalate
- Sapropterin
- Semaglutide
- SGLT2 Inhibitors
- Sodium Iodide
- Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
- Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
- Sulfonamides
- Sulfonylureas
- Tetracaine
- Thiazolidinediones
- Tolazamide
- Tolbutamide
- Trimethoprim
- Trimetrexate
- Typhoid Vaccine
- Verteporfin
- Warfarin
- Zidovudine, ZDV
