SULFONAMIDES (Systemic)
Some commonly used brand names are:
In the U.S.?
- Gantanol 3
- Gantrisin 4
- Thiosulfil Forte 2
- Urobak 3
In Canada?
- Apo-Sulfamethoxazole 3
- Apo-Sulfisoxazole 4
- Novo-Soxazole 4
- Sulfizole 4
Note: | For quick reference, the following sulfonamides are numbered to matchthe corresponding brand names. |
Category
- Antibacterial, systemic?Sulfadiazine; Sulfamethoxazole; Sulfisoxazole
- Antibacterial, urinary?Sulfamethizole
- Antiprotozoal?Sulfamethoxazole; Sulfisoxazole
Description
Sulfonamides (sul-FON-a-mides) or sulfamedicines are used to treat infections. They will not work for colds, flu,or other virus infections.
Sulfonamides are available only with your doctor's prescription, in thefollowing dosage forms:
Oral- Sulfadiazine
- Tablets (U.S. and Canada)
- Sulfamethizole
- Sulfamethoxazole
- Tablets (U.S. and Canada)
- Sulfisoxazole
- Oral suspension (U.S.)
- Syrup (U.S.)
- Tablets (U.S. and Canada)
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For sulfonamides, thefollowing should be considered:
Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to sulfa medicines, furosemide (e.g., Lasix) or thiazidediuretics (water pills), oral antidiabetics (diabetes medicine you take bymouth), glaucoma medicine you take by mouth (for example, acetazolamide [e.g.,Diamox], dichlorphenamide [e.g., Daranide], or methazolamide [e.g., Neptazane]).Also tell your health care professional if you are allergic to any other substances,such as foods, preservatives, or dyes.
Pregnancy?Studies have not been done in pregnant women. However,studies in mice, rats, and rabbits have shown that some sulfonamides causebirth defects, including cleft palate and bone problems. Sulfonamides arenot recommended for use at the time of labor and delivery. These medicinesmay cause unwanted effects in the baby.
Breast-feeding?Sulfonamides pass into the breast milk. This medicineis not recommended for use during breast-feeding. It may cause liver problems,anemia, and other unwanted effects in nursing babies, especially those withglucose-6-phosphate dehydrogenase (G6PD) deficiency.
Children?Sulfonamides should not be given to infants under2 months of age unless directed by the child's doctor, because they may causeunwanted effects.
Older adults?Elderly people are especially sensitive to the effectsof sulfonamides. Severe skin problems and blood problems may be more likelyto occur in the elderly. These problems may also be more likely to occur inpatients who are taking diuretics (water pills) along with this medicine.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingsulfonamides, it is especially important that your health care professionalknows if you are taking any of the following:
- Acetaminophen (e.g., Tylenol) (with long-term, high-dose use) or
- Amiodarone (e.g., Cordarone) or
- Anabolic steroids (nandrolone [e.g., Anabolin], oxandrolone [e.g.,Anavar], oxymetholone [e.g., Anadrol], stanozolol [e.g., Winstrol]) or
- Androgens (male hormones) or
- Antithyroid agents (medicine for overactive thyroid) or
- Carbamazepine (e.g., Tegretol) or
- Carmustine (e.g., BiCNU) or
- Chloroquine (e.g., Aralen) or
- Dantrolene (e.g., Dantrium) or
- Daunorubicin (e.g., Cerubidine) or
- Disulfiram (e.g., Antabuse) or
- Divalproex (e.g., Depakote) or
- Estrogens (female hormones) or
- Etretinate (e.g., Tegison) or
- Gold salts (medicine for arthritis) or
- Hydroxychloroquine (e.g., Plaquenil) or
- Mercaptopurine (e.g., Purinethol) or
- Naltrexone (e.g., Trexan) (with long-term, high-dose use) or
- Oral contraceptives (birth control pills) containing estrogens or
- Other anti-infectives by mouth or by injection (medicine for infection)or
- Phenothiazines (acetophenazine [e.g., Tindal], chlorpromazine [e.g.,Thorazine], fluphenazine [e.g., Prolixin], mesoridazine [e.g., Serentil],perphenazine [e.g., Trilafon], prochlorperazine [e.g., Compazine], promazine[e.g., Sparine], promethazine [e.g., Phenergan], thioridazine [e.g., Mellaril],trifluoperazine [e.g., Stelazine], triflupromazine [e.g., Vesprin], trimeprazine[e.g., Temaril]) or
- Plicamycin (e.g., Mithracin) or
- Valproic acid (e.g., Depakene)?Use of sulfonamides with thesemedicines may increase the chance of side effects affecting the liver
- Acetohydroxamic acid (e.g., Lithostat) or
- Dapsone or
- Furazolidone (e.g., Furoxone) or
- Nitrofurantoin (e.g., Furadantin) or
- Primaquine or
- Procainamide (e.g., Pronestyl) or
- Quinidine (e.g., Quinidex) or
- Quinine (e.g., Quinamm) or
- Sulfoxone (e.g., Diasone) or
- Vitamin K (e.g., AquaMEPHYTON, Synkayvite)?Use of sulfonamideswith these medicines may increase the chance of side effects affecting theblood
- Anticoagulants (blood thinners) or
- Ethotoin (e.g., Peganone) or
- Mephenytoin (e.g., Mesantoin)?Use of sulfonamides with thesemedicines may increase the chance of side effects of these medicines
- Antidiabetics, oral (diabetes medicine you take by mouth)?Useof oral antidiabetics with sulfonamides may increase the chance of side effectsaffecting the blood and/or the side effects of oral antidiabetics
- Methenamine (e.g., Mandelamine)?Use of this medicine with sulfonamidesmay increase the chance of side effects of sulfonamides
- Methotrexate (e.g., Mexate) or
- Phenytoin (e.g., Dilantin)?Use of these medicines with sulfonamidesmay increase the chance of side effects affecting the liver and/or the sideeffects of these medicines
- Methyldopa (e.g., Aldomet)?Use of methyldopa with sulfonamidesmay increase the chance of side effects affecting the liver and/or the blood
Other medical problems?The presence of other medicalproblems may affect the use of sulfonamides. Make sure you tell your doctorif you have any other medical problems, especially:
- Anemia or other blood problems or
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency?Patientswith these problems may have an increase in side effects affecting the blood
- Kidney disease or
- Liver disease?Patients with kidney and/or liver disease mayhave an increased chance of side effects
- Porphyria?This medicine may bring on an attack of porphyria
Proper Use of This Medicine
Sulfonamides should not be given to infants less than 2 months of ageunless directed by the patient's doctor because sulfonamides may cause seriousunwanted effects.
Sulfonamides are best taken with a full glass (8 ounces)of water. Several additional glasses of watershould be taken every day, unless otherwise directed by your doctor.Drinking extra water will help to prevent some unwanted effects of sulfonamides.
For patients taking the oral liquid form ofthis medicine:
- Use a specially marked measuring spoon or other device to measureeach dose accurately. The average household teaspoon may not hold the rightamount of liquid.
To help clear up your infection completely, keep takingthis medicine for the full time of treatment, even if you begin tofeel better after a few days. If you stop taking this medicine too soon, yoursymptoms may return.
This medicine works best when there is a constant amount in the blood orurine. To help keep the amount constant, do not missany doses. Also, it is best to take the doses at evenly spaced times day andnight. If you need help in planning the best times to take your medicine,check with your health care professional.
Dosing?The dose of these medicines will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of these medicines. If your dose isdifferent, do not change it unless your doctor tells you to do so.
For sulfadiazine- For tablet dosage form:
- For bacterial or protozoal infections:
- Adults and teenagers?2 to 4 grams for the first dose, then1 gram every four to six hours.
- Children up to 2 months of age?Use is not recommended.
- Children 2 months of age and older?Dose is based on body weight.The usual dose is 75 milligrams (mg) per kilogram (kg) (34 mg per pound) ofbody weight for the first dose, then 37.5 mg per kg (17 mg per pound) of bodyweight every six hours, or 25 mg per kg (11.4 mg per pound) of body weightevery four hours.
For sulfamethizole- For tablet dosage form:
- For bacterial infections:
- Adults and teenagers?500 milligrams (mg) to 1 gram every sixto eight hours.
- Children up to 2 months of age?Use is not recommended.
- Children 2 months of age and older?Dose is based on body weight.The usual dose is 7.5 to 11.25 mg per kilogram (kg) (3.4 to 5.1 mg per pound)of body weight every six hours.
For sulfamethoxazole- For tablet dosage form:
- For bacterial or protozoal infections:
- Adults and teenagers?2 to 4 grams for the first dose, then1 to 2 grams every eight to twelve hours.
- Children up to 2 months of age?Use and dose must be determinedby your doctor.
- Children 2 months of age and older?Dose is based on body weight.The usual dose is 50 to 60 milligrams (mg) per kilogram (kg) (22.7 to 27.3mg per pound) of body weight for the first dose, then 25 to 30 mg per kg (11.4to 13.6 mg per pound) of body weight every twelve hours.
For sulfisoxazole- For suspension, syrup, or tablet dosageforms:
- For bacterial or protozoal infections:
- Adults and teenagers?2 to 4 grams for the first dose, then750 milligrams (mg) to 1.5 grams every four hours; or 1 to 2 grams every sixhours.
- Children up to 2 months of age?Use and dose must be determinedby your doctor.
- Children 2 months of age and older?Dose is based on body weight.The usual dose is 75 mg per kilogram (kg) (34 mg per pound) of body weightfor the first dose, then 25 mg per kg (11.4 mg per pound) of body weight everyfour hours, or 37.5 mg per kg (17 mg per pound) of body weight every six hours.
Missed dose?If you miss a dose of this medicine, take it assoon as possible. This will help to keep a constant amount of medicine inthe blood or urine. However, if it is almost time for your next dose, skipthe missed dose and go back to your regular dosing schedule. Do not doubledoses.
Storage?To store this medicine:
- Keep out of the reach of children.
- Store away from heat and direct light.
- Do not store the tablet form of this medicine in the bathroom, nearthe kitchen sink, or in other damp places. Heat or moisture may cause themedicine to break down.
- Keep the oral liquid forms of this medicine from freezing.
- Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
It is very important that your doctor check your progress atregular visits. This medicine may cause blood problems, especiallyif it is taken for a long time.
If your symptoms do not improve within a few days, or if they become worse,check with your doctor.
Sulfonamides may cause blood problems. These problems may result in a greaterchance of certain infections, slow healing, and bleeding of the gums. Therefore,you should be careful when using regular toothbrushes, dental floss, and toothpicks.Dental work should be delayed until your blood counts have returned to normal.Check with your medical doctor or dentist if you have any questions aboutproper oral hygiene (mouth care) during treatment.
Sulfonamides may cause your skin to be more sensitive to sunlight thanit is normally. Exposure to sunlight, even for brief periods of time, maycause a skin rash, itching, redness or other discoloration of the skin, ora severe sunburn. When you begin taking this medicine:
- Stay out of direct sunlight, especially between the hours of 10:00a.m. and 3:00 p.m., if possible.
- Wear protective clothing, including a hat. Also, wear sunglasses.
- Apply a sun block product that has a skin protection factor (SPF)of at least 15. Some patients may require a product with a higher SPF number,especially if they have a fair complexion. If you have any questions aboutthis, check with your health care professional.
- Apply a sun block lipstick that has an SPF of at least 15 to protectyour lips.
- Do not use a sunlamp or tanning bed or booth.
If you have a severe reaction from the sun, check withyour doctor.
This medicine may also cause some people to become dizzy. Make sure you know how you react to this medicine before you drive, use machines,or do anything else that could be dangerous if you are dizzy or are not alert. If this reaction is especially bothersome, check with your doctor.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects.Although not all of these side effects may occur, if they do occur they mayneed medical attention.
Also, checkwith your doctor as soon as possible if the following side effect occurs:
Other sideeffects may occur that usually do not need medical attention. These side effectsmay go away during treatment as your body adjusts to the medicine. However,check with your doctor if any of the following side effects continue or arebothersome:
Other side effects not listed above may also occur insome patients. If you notice any other effects, check with your doctor.
Revised: 08/25/1995
