PLASMA-LYTE 148 and Glucose 5% w/v (Baxter) Price

Overview

Welcome to Dwaey, specifically on PLASMA-LYTE 148 and Glucose 5% w/v (Baxter) page.
This medicine contains an important and useful components, as it consists of
Glucose monohydrate - Sodium Chloride - Potassium Chloride - Magnesium Chloride hexahydrate - Sodium Acetate trihydrate - Sodium Gluconate -is available in the market in concentration

Name

Sulphamethoxazole + Trimethoprim (Co-trimoxazole)

Precaution

Before using **Sulphamethoxazole + Trimethoprim (Co-trimoxazole)**, patients must consult their healthcare provider due to the following precautions: - **Allergic Reactions**: Co-trimoxazole may cause severe allergic reactions, including **rash**, **fever**, and more serious conditions like **Stevens-Johnson syndrome** or **toxic epidermal necrolysis** (TEN). Any signs of allergic reactions require immediate medical attention. - **Renal Impairment**: Since both **sulphamethoxazole** and **trimethoprim** are excreted by the kidneys, Co-trimoxazole should be used cautiously in patients with **renal impairment**. Dosing adjustments may be necessary in patients with compromised kidney function to prevent **drug accumulation** and **toxicity**. - **Hematological Disorders**: Co-trimoxazole can cause **blood disorders**, including **leukopenia**, **thrombocytopenia**, and **anemia**. These can be more pronounced in individuals with a history of blood disorders or in the elderly. Regular **blood count monitoring** is recommended during prolonged use. - **Pregnancy and Breastfeeding**: Co-trimoxazole is **contraindicated during pregnancy**, especially in the **first trimester** and near **term**. It can cross the placenta and may cause harm to the developing fetus. It should also be avoided during **breastfeeding**, as it can pass into breast milk and potentially affect the infant. Consult a healthcare provider if you are pregnant or breastfeeding. - **Folate Deficiency**: Co-trimoxazole may interfere with **folate metabolism**, potentially worsening conditions like **megaloblastic anemia**. **Folic acid supplementation** may be necessary in patients at risk of deficiency, such as those with **malnutrition** or **alcoholism**.

Indication

**Sulphamethoxazole + Trimethoprim (Co-trimoxazole)** is primarily prescribed for: - **Urinary Tract Infections (UTIs)**: Co-trimoxazole is commonly used to treat **urinary tract infections**, including **cystitis**, **pyelonephritis**, and **urethritis** caused by susceptible bacteria like **E. coli**. - **Respiratory Infections**: It is effective against respiratory infections such as **bronchitis**, **pneumonia**, and **sinusitis**. - **Gastrointestinal Infections**: Co-trimoxazole is used in treating **gastrointestinal infections**, especially **enteritis** caused by **Shigella**, **Salmonella**, and **other Gram-negative bacteria**. - **Skin and Soft Tissue Infections**: It can treat **skin infections**, including **cellulitis**, **impetigo**, and **abscesses** caused by susceptible organisms. - **Pneumocystis jirovecii Pneumonia (PCP)**: Co-trimoxazole is a first-line treatment for **PCP**, a severe lung infection commonly seen in **HIV/AIDS patients**. - **Toxoplasmosis**: It is also used in combination with other agents to treat **toxoplasmosis**, a parasitic infection.

Contra indication

Co-trimoxazole is contraindicated in the following conditions: - **Hypersensitivity to Sulfonamides or Trimethoprim**: It should not be used in individuals with a history of **allergic reactions** to **sulfonamides** or **trimethoprim** due to the risk of severe skin reactions or anaphylaxis. - **Severe Liver or Renal Disease**: It is contraindicated in patients with **severe liver** or **kidney failure**, as the drug is excreted through the kidneys, and its use can exacerbate renal toxicity. - **Blood Disorders**: Co-trimoxazole should not be used in patients with a history of **bone marrow suppression**, **megaloblastic anemia**, or **severe blood dyscrasias**. - **Pregnancy (Especially First Trimester)**: It should not be used during pregnancy, especially in the first trimester, as it may cause **birth defects**. It should also be avoided near the **term** due to risks of **kernicterus** (a type of brain damage caused by **bilirubin buildup**) in the newborn. - **Neonates and Infants**: Co-trimoxazole is contraindicated in **newborns** and **infants under 2 months** due to the risk of **kernicterus** and **blood disorders**.

Side Effect

Common side effects of **Sulphamethoxazole + Trimethoprim (Co-trimoxazole)** include: - **Gastrointestinal Discomfort**: **Nausea**, **vomiting**, and **diarrhea** are common, especially when starting the medication. - **Skin Reactions**: **Rashes**, **itching**, and more severe skin reactions such as **Stevens-Johnson syndrome** or **toxic epidermal necrolysis** (rare but serious). **Photosensitivity** can also occur, increasing sensitivity to sunlight. - **Blood Abnormalities**: Co-trimoxazole can cause **leukopenia**, **thrombocytopenia**, or **anemia**. Symptoms include **fatigue**, **pale skin**, **easy bruising**, and **frequent infections**. - **Liver Toxicity**: **Elevated liver enzymes** or **hepatitis** can occur in some patients. Symptoms include **jaundice** (yellowing of the skin or eyes) and **dark urine**. - **Hyperkalemia**: Elevated potassium levels can cause **cardiac arrhythmias**. Symptoms include **muscle weakness**, **fatigue**, and **palpitations**. Serious side effects (less common but severe): - **Severe Allergic Reactions**: **Anaphylaxis**, **angioedema**, or **serious skin reactions** may occur. Seek immediate medical attention if any of these occur. - **Kernicterus in Newborns**: When used near term or in infants, Co-trimoxazole can cause **bilirubin encephalopathy**, a life-threatening condition.

Pregnancy Category ID

4

Mode of Action

Co-trimoxazole is a **combination antibiotic** that works by inhibiting two crucial enzymes in the bacterial folate synthesis pathway: - **Sulphamethoxazole**: Inhibits **dihydropteroate synthase**, preventing the formation of **dihydrofolic acid**, a precursor to **folic acid**, which bacteria need for DNA and RNA synthesis. - **Trimethoprim**: Inhibits **dihydrofolate reductase**, which is involved in converting **dihydrofolic acid** into its active form, **tetrahydrofolic acid**. This enzyme inhibition further impedes folic acid metabolism, affecting bacterial **DNA replication**. Together, these two drugs act synergistically to prevent bacterial replication and growth, making the combination **bacteriostatic** (inhibits bacterial growth) or **bactericidal** (kills bacteria) depending on the bacteria and concentration.

Interaction

Co-trimoxazole may interact with several drugs and substances, altering their effects or causing adverse reactions: - **Warfarin**: Co-trimoxazole can **increase the anticoagulant effect** of **warfarin**, leading to an increased risk of **bleeding**. Regular monitoring of **INR** (International Normalized Ratio) levels is recommended for patients on both medications. - **Methotrexate**: When used together, **Co-trimoxazole** can increase the **toxicity** of **methotrexate**, especially in high doses, leading to increased risk of **bone marrow suppression** and **gastrointestinal toxicity**. Caution is advised when combining these drugs. - **Diuretics**: **Diuretics**, particularly **thiazides**, may increase the risk of **hyperkalemia** (elevated potassium levels) when used with Co-trimoxazole. Regular monitoring of potassium levels is advised. - **Phenytoin**: Co-trimoxazole can **increase phenytoin levels**, which may enhance its **toxicity**. Blood tests should be conducted to monitor phenytoin levels. - **ACE Inhibitors**: The combination of **ACE inhibitors** (such as **lisinopril**) and Co-trimoxazole may increase the risk of **hyperkalemia**. - **Oral Contraceptives**: Co-trimoxazole may decrease the effectiveness of **oral contraceptives**, so alternative methods of contraception should be considered.

Pregnancy Category Note

Information not available

Adult Dose

The typical adult dose of **Co-trimoxazole** for most infections is: - **For mild to moderate infections**: **1 double-strength tablet (800 mg sulphamethoxazole + 160 mg trimethoprim)** every **12 hours**. - **For severe infections**: **2 double-strength tablets** every **12 hours**. For **Pneumocystis jirovecii pneumonia (PCP)**, the dose is typically higher and used for an extended period.

Child Dose

In children, the dose is usually based on **weight** and the severity of the infection: - **For urinary tract infections or respiratory infections**: **6 mg/kg trimethoprim and 30 mg/kg sulphamethoxazole** daily in **2 divided doses**. - **For Pneumocystis jirovecii pneumonia (PCP)**, the dosing is higher and may vary, with up to **20 mg/kg trimethoprim** and **100 mg/kg sulphamethoxazole** in divided doses. As always, the pediatric dose should be determined by a healthcare provider to ensure safety and efficacy. **Consultation** with a healthcare provider is essential before starting treatment with **Co-trimoxazole** to ensure the appropriate dosage and to manage any potential risks or interactions.

Renal Dose

For patients with **renal impairment**, dosage adjustments are required: - For **creatinine clearance** less than 15 mL/min, **Co-trimoxazole** should generally be avoided or administered at **reduced doses** with extended dosing intervals. - Patients with moderate renal impairment (creatinine clearance between 15 and 30 mL/min) may require a **dose reduction** or monitoring to avoid drug accumulation.

Administration

Information not available