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Drug Interactions between Septra and torsemide

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

sulfamethoxazole torsemide

Applies to: Septra (sulfamethoxazole / trimethoprim) and torsemide

MONITOR: Coadministration with inhibitors of CYP450 2C9 may increase the plasma concentrations of torsemide. The interaction has not been evaluated in pharmacokinetic studies; however, torsemide has been shown to undergo metabolism by CYP450 2C9.

MANAGEMENT: Caution is advised when torsemide is prescribed with CYP450 2C9 inhibitors. Patients should be monitored for potentially increased adverse effects such as dehydration, hypotension, electrolyte imbalances, hyperglycemia, tinnitus, and hearing loss.

References (4)
  1. "Product Information. Demadex (torsemide)." Boehringer Mannheim
  2. Miners JO, Rees DLP, Valente L, Veronese ME, Birkett DJ (1995) "Human hepatic cytochrome p450 2c9 catalyzes the rate-limiting pathway of torsemide metabolism." J Pharmacol Exp Ther, 272, p. 1076-81
  3. Miners JO, Birkett DJ (1998) "Cytochrome P4502C9: an enzyme of major importance in human drug metabolism." Br J Clin Pharmacol, 45, p. 525-38
  4. Vormfelde SV, Engelhardt S, Zirk A, et al. (2004) "CYP2C9 polymorphisms and the interindividual variability in pharmacokinetics and pharmacodynamics of the loop diuretic drug torsemide." Clin Pharmacol Ther, 76, p. 557-66

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Drug and food interactions

Moderate

sulfamethoxazole food

Applies to: Septra (sulfamethoxazole / trimethoprim)

MONITOR: Two cases have been reported in which patients on sulfamethoxazole-trimethoprim therapy, after consuming beer, reported flushing, heart palpitations, dyspnea, headache, and nausea (disulfiram - alcohol type reactions). First-generation sulfonylureas have been reported to cause facial flushing when administered with alcohol by inhibiting acetaldehyde dehydrogenase and subsequently causing acetaldehyde accumulation. Since sulfamethoxazole is chemically related to first-generation sulfonylureas, a disulfiram-like reaction with products containing sulfamethoxazole is theoretically possible. However, pharmacokinetic/pharmacodynamic data are lacking and in addition, the two reported cases cannot be clearly attributed to the concomitant use of sulfamethoxazole-trimethoprim and alcohol.

MANAGEMENT: Patients should be alerted to the potential for this interaction and although the risk for this interaction is minimal, caution is recommended while taking sulfamethoxazole-trimethoprim concomitantly with alcohol.

References (2)
  1. Heelon MW, White M (1998) "Disulfiram-cotrimoxazole reaction." Pharmacotherapy, 18, p. 869-70
  2. Mergenhagen KA, Wattengel BA, Skelly MK, Clark CM, Russo TA (2020) "Fact versus fiction: a review of the evidence behind alcohol and antibiotic interactions." Antimicrob Agents Chemother, 64, e02167-19

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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