Wechselwirkungen von Trimethoprim

Co-administration of such combinations of a CYP2C9 inhibitor plus a strong or moderate CYP3A inhibitor with TRACLEER is not recommended. (Fachinformation zu Bosentan, Arzneimittelwechselwirkungen)

The concomitant use of verapamil or the cation transport system inhibitors cimetidine, trimethoprim (alone or in combination with sulfamethoxazole), or ketoconazole with dofetilide is contraindicated (see WARNINGS and PRECAUTIONS, Drug-Drug Interactions ), as each of these drugs cause a substantial increase in dofetilide plasma concentrations. (Fachinformation zu Dofetilid, Gegenanzeigen)

Trimethoprim-Sulfamethoxazole Avoid concomitant use of VYKOURA with trimethoprim-sulfamethoxazole . (Fachinformation zu Folinsäure (Leucovorin), Arzneimittelwechselwirkungen)

CONTRAINDICATIONS Trimethoprim is contraindicated in individuals hypersensitive to trimethoprim and in those with documented megaloblastic anemia due to folate deficiency. (Fachinformation zu Trimethoprim, Gegenanzeigen)

Moderate dual CYP3A4 and CYP2C9 inhibitors (fluconazole, amiodarone) or use of combined CYP3A4 and CYP2C9 inhibitors may increase exposure to macitentan: avoid co-administration with OPSUMIT ( 7.3 , 12.3 ). (Fachinformation zu Macitentan, Arzneimittelwechselwirkungen)

Dihydrofolate Reductase (DHFR) Inhibitors : Avoid concomitant use (e.g., trimethoprim, methotrexate, trimetrexate, pemetrexed, pralatrexate, raltitrexed, or piritrexim). (Fachinformation zu Sepiapterin, Arzneimittelwechselwirkungen)

HIV Protease inhibitor — Ritonavir (600 mg twice daily), a strong CYP3A4 inhibitor, which also inhibits CYP2C9, increased avanafil 50 mg single-dose C max and AUC equal to approximately 2-fold and 13-fold, and prolonged the half-life of avanafil to approximately 9 hours in healthy volunteers. (Fachinformation zu Avanafil, Arzneimittelwechselwirkungen)

Amiodarone Amiodarone and its metabolite desethyl amiodarone, inhibitors of CYP2C9, and P- glycoprotein increased concentrations of the S(-)-enantiomer of carvedilol by at least 2 fold [see Clinical Pharmacology (12.5) ]. (Fachinformation zu Carvedilol, Arzneimittelwechselwirkungen)

Co-administration of celecoxib with drugs that are known to inhibit CYP2C9 (e.g., fluconazole) may enhance the exposure and toxicity of celecoxib whereas co-administration with CYP2C9 inducers (e.g., rifampin) may lead to compromised efficacy of celecoxib. (Fachinformation zu Celecoxib, Arzneimittelwechselwirkungen)

…amphotericin B azapropazon cimetidine tacrolimus fibric acid derivatives (e.g., bezafibrate, fenofibrate) gentamicin ketoconazole colchicine ranitidine methotrexate tobramycin diclofenac trimethoprim with sulfamethoxazole naproxen vancomycin sulindac During the concomitant use of a drug that may exhibit additive or synergistic renal impairment with cyclosporine, close… (Fachinformation zu Ciclosporin, Arzneimittelwechselwirkungen)

However, an earlier report 2 also by Lee et al, in 78 HIV infected patients with acute Pneumocystis carinii pneumonia, receiving dapsone, 100 mg/day and higher trimethoprim dose, 20 mg/kg/day, demonstrated that the serum levels of dapsone were increased by 40% and trimethoprim levels were increased by 48% when the drugs were administered concurrently. (Fachinformation zu Dapson, Arzneimittelwechselwirkungen)

Co-administration of diclofenac with CYP2C9 inhibitors (e.g. voriconazole) may enhance the exposure and toxicity of diclofenac whereas co- administration with CYP2C9 inducers (e.g. rifampin) may lead to compromised efficacy of diclofenac. (Fachinformation zu Diclofenac, Arzneimittelwechselwirkungen)

Co-administration of diclofenac with CYP2C9 inhibitors (e.g., voriconazole) may enhance the exposure and toxicity of diclofenac [see Clinical Pharmacology (12.3) ] whereas co-administration with CYP2C9 inducers (e.g., rifampin) may lead to compromised efficacy of diclofenac. (Fachinformation zu Diclofenac und Misoprostol, Arzneimittelwechselwirkungen)

…15% Nifedipine 45% NA Propantheline 24% 24% Quinine NA 33% Rabeprazole 29% 19% Saquinavir 27% 49% Spironolactone 25% NA Telmisartan 20 to 49% NA Ticagrelor 31% 28% Tolvaptan 30% 20% Trimethoprim 22 to 28% NA Digoxin Concentrations Increased, but Magnitude is Unclear Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen,… (Fachinformation zu Digoxin, Arzneimittelwechselwirkungen)

Monitor for increased dronabinol-related adverse reactions when dronabinol oral solution is co-administered with inhibitors of CYP2C9 (e.g., amiodarone, fluconazole) and inhibitors of CYP3A4 enzymes (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir, erythromycin, grapefruit juice). (Fachinformation zu Dronabinol, Arzneimittelwechselwirkungen)

The possibility of interactions with other drugs administered concurrently should be considered, particularly when their main route of elimination is active renal secretion via the organic cationic transport system (e.g., trimethoprim) [see Clinical Pharmacology (12.3) ] . (Fachinformation zu Efavirenz, Lamivudin und Tenofovir, Arzneimittelwechselwirkungen)

Effect of TRIKAFTA on Other Drugs CYP2C9 Substrates Ivacaftor may inhibit CYP2C9; therefore, monitoring of the international normalized ratio (INR) during concomitant use of TRIKAFTA with warfarin is recommended. (Fachinformation zu Elexacaftor, Tezacaftor und Ivacaftor, Arzneimittelwechselwirkungen)

…Fluoxetine, fluvoxamine, sertraline Gastric acid reducing agents H 2 antagonists (cimetidine), omeprazole Sulfonamides Sulfamethizole, sulfaphenazole, sulfadiazine, sulfamethoxazole-trimethoprim Other Acute alcohol intake, amiodarone, chloramphenicol, chlordiazepoxide, disulfiram, estrogen, fluvastatin, isoniazid, methylphenidate, phenothiazines, salicylates, ticlopidine,… (Fachinformation zu Fosphenytoin, Arzneimittelwechselwirkungen)

Other drugs associated with myelosuppression or nephrotoxicity (e.g., dapsone, doxorubicin, flucytosine, hydroxyurea, pentamidine, tacrolimus, trimethoprim/ sulfamethoxazole, vinblastine, vincristine and zidovudine) Unknown Because of potential for higher toxicity, coadministration with Ganciclovir should be considered only if the potential benefits are judged… (Fachinformation zu Ganciclovir, Arzneimittelwechselwirkungen)

Strong CYP3A4 or CYP2C9 Inhibitors Patients with renal or hepatic impairment who are taking strong inhibitors of CYP3A4 and CYP2C9 may have a significant increase in exposure to VIMPAT. (Fachinformation zu Lacosamid, Arzneimittelwechselwirkungen)

The possibility of interactions with other drugs administered concurrently should be considered, particularly when their main route of elimination is active renal secretion via the organic cationic transport system (e.g., trimethoprim) [see Clinical Pharmacology (12.3)]. (Fachinformation zu Lamivudin, Arzneimittelwechselwirkungen)

Drug Interaction with Trimethoprim-Sulfamethoxazole : Increased rates of treatment failure and morbidity with concomitant use of d, l -leucovorin with trimethoprim-sulfamethoxazole for Pneumocystis jiroveci pneumonia in patients with HIV. (Fachinformation zu Levofolinsäure (Levoleucovorin), Warnhinweise und Vorsichtsmaßnahmen)

CYP2C8 Inhibitors Gemfibrozil When a single 4 mg dose of loperamide hydrochloride was coadministered with 600 mg gemfibrozil, a strong inhibitor of CYP2C8, on day 3 of a 5-day treatment with gemfibrozil twice daily, the mean peak plasma concentration and the systemic exposure to loperamide was increased by 1.6-fold and 2.2-fold, respectively. (Fachinformation zu Loperamid, Arzneimittelwechselwirkungen)

Thus concomitant usage of CYP2C9 inhibitors (such as amiodarone, fluconazole, and sulphaphenazole) may lead to abnormally high plasma levels of meloxicam due to reduced metabolic clearance [ see Use in Specific Populations ( 8.8 ); and Clinical Pharmacology ( 12.3 , 12.5 ) ]. (Fachinformation zu Meloxicam, Arzneimittelwechselwirkungen)

Enhanced myelosuppression has been noted in some patients also receiving trimethoprim-sulfamethoxazole. (Fachinformation zu Mercaptopurin, Arzneimittelwechselwirkungen)

Trimethoprim/sulfamethoxazole has been reported to increase bone marrow suppression in patients receiving methotrexate. (Fachinformation zu Methotrexat, Arzneimittelwechselwirkungen)

Drugs Metabolized by CYP2C8/2C9 Because mifepristone is an inhibitor of CYP2C8/2C9, concurrent use of mifepristone with a drug whose metabolism is largely or solely mediated by CYP2C8/2C9 is likely to result in increased plasma concentrations of the drug. (Fachinformation zu Mifepriston, Arzneimittelwechselwirkungen)

Examples Cyclosporine A, trimethoprim/sulfamethoxazole, bile acid sequestrants (cholestyramine), rifampin as well as aminoglycoside, cephalosporin, fluoroquinolone and penicillin classes of antimicrobials Drugs Modulating Glucuronidation Clinical Impact Concomitant use with drugs inducing glucuronidation decreases MPA systemic exposure, potentially reducing mycophenolate… (Fachinformation zu Mycophenolat, Arzneimittelwechselwirkungen)

…salicylates, monoamine oxidase inhibitors, non-selective beta-adrenergic-blocking agents, anabolic hormones (e.g., methandrostenolone), guanethidine, gymnema sylvestre, glucomannan, thioctic acid, and inhibitors of CYP2C9 (e.g., amiodarone, fluconazole, voriconazole, sulfinpyrazone) or in patients known to be poor metabolizers of CYP2C9 substrates, alcohol. (Fachinformation zu Nateglinid, Arzneimittelwechselwirkungen)

Trimethoprim, given at a common clinical dosage, increased the phenytoin half-life by 51% and decreased the phenytoin metabolic clearance rate by 30%. (Fachinformation zu Trimethoprim, Arzneimittelwechselwirkungen)

• Strong CYP2C8 inhibitors (e.g., gemfibrozil) increase pioglitazone concentrations. (Fachinformation zu Pioglitazon, Arzneimittelwechselwirkungen)

Strong CYP2C8 inhibitors (e.g., gemfibrozil) increase pioglitazone concentrations. (Fachinformation zu Pioglitazon und Glimepirid, Arzneimittelwechselwirkungen)

Strong CYP2C8 inhibitors (e.g., gemfibrozil): Limit ACTOPLUS MET dose to 15 mg/850 mg daily. (Fachinformation zu Pioglitazon und Metformin, Arzneimittelwechselwirkungen)

However, the concomitant use of other antifolic drugs or agents associated with myelosuppression including sulfonamides or trimethoprim- sulfamethoxazole combinations, proguanil, zidovudine, or cytostatic agents (e.g., methotrexate), while the patient is receiving pyrimethamine, may increase the risk of bone marrow suppression. (Fachinformation zu Pyrimethamin, Arzneimittelwechselwirkungen)

Fluconazole (strong CYP2C9 inhibitor): Increases systemic exposure of ramelteon; administer with caution. (Fachinformation zu Ramelteon, Arzneimittelwechselwirkungen)

ND ↓ AUC by 27 – 40% Sulfamethoxazole-Trimethoprim 800/160 mg 300 mg once a day HIV-infected patients (12) ↔ ↓ AUC by 15–20% ANTI-MAC (Mycobacterium avium intracellulare complex) Azithromycin 500 mg once a day for 1 day, then 250 mg once a day for 9 days 300 mg once a day Healthy subjects (6) ↔ ↔ Clarithromycin 500 mg twice a day 300 mg once a day HIV-infected… (Fachinformation zu Rifabutin, Arzneimittelwechselwirkungen)

Rosuvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP2C9 and transporters. (Fachinformation zu Rosuvastatin, Arzneimittelwechselwirkungen)

Inhibitors of Folate Synthesis (e.g., methotrexate, valproic acid, phenobarbital, trimethoprim) Clinical Impact In vitro and in vivo nonclinical data suggest that drugs that inhibit folate synthesis may decrease the bioavailability of endogenous BH4 by inhibiting the enzyme dihydrofolate reductase, which is involved in the recycling (regeneration) of BH4. (Fachinformation zu Sapropterin, Arzneimittelwechselwirkungen)

…drugs that can increase potassium include: ACE inhibitors angiotensin receptor blockers aldosterone blockers non-steroidal anti-inflammatory drugs (NSAIDs) heparin and low molecular weight heparin trimethoprim 7.2 Lithium Like other diuretics, spironolactone oral suspension reduces the renal clearance of lithium, thus increasing the risk of lithium toxicity. (Fachinformation zu Spironolacton, Arzneimittelwechselwirkungen)

The influence of terbinafine on the pharmacokinetics of fluconazole, cotrimoxazole (trimethoprim and sulfamethoxazole), zidovudine or theophylline was not considered to be clinically significant. (Fachinformation zu Terbinafin, Arzneimittelwechselwirkungen)

CYP2C9: Concomitant use with CYP2C9 inhibitors can decrease torsemide clearance. (Fachinformation zu Torasemid, Arzneimittelwechselwirkungen)

Other drugs associated with myelosuppression or nephrotoxicity (e.g., adriamycin, dapsone, doxorubicin, flucytosine, hydroxyurea, pentamidine, tacrolimus, trimethoprim/ sulfamethoxazole, vinblastine, vincristine, and zidovudine) Unknown Because of potential for higher toxicity, coadministration with valganciclovir hydrochloride should be considered only if the… (Fachinformation zu Valganciclovir, Arzneimittelwechselwirkungen)

Inhibitors of CYP2C9, 1A2, and/or 3A4 have the potential to increase the effect (increase INR) of warfarin by increasing the exposure of warfarin. (Fachinformation zu Warfarin, Arzneimittelwechselwirkungen)

Zafirlukast exposure is likely to be increased by other moderate and strong CYP2C9 inhibitors. (Fachinformation zu Zafirlukast, Vorsichtsmaßnahmen)

Atazanavir is a weak inhibitor of CYP2C8. (Fachinformation zu Atazanavir, Arzneimittelwechselwirkungen)

However, at high concentrations in vitro , clopidogrel inhibits CYP2C9. (Fachinformation zu Clopidogrel, Arzneimittelwechselwirkungen)

Effect on CYP2C8 Substrates Teriflunomide is an inhibitor of CYP2C8 in vivo . (Fachinformation zu Leflunomid, Arzneimittelwechselwirkungen)

Based on known metabolic profiles, clinically significant drug interactions are not expected between KALETRA and dapsone, trimethoprim/sulfamethoxazole, azithromycin, erythromycin, or fluconazole. (Fachinformation zu Lopinavir und Ritonavir, Arzneimittelwechselwirkungen)

Drugs that are known to inhibit CYP2C8 include trimethoprim, gemfibrozil, montelukast, deferasirox, and clopidiogrel. (Fachinformation zu Repaglinid, Arzneimittelwechselwirkungen)

Effect of AUBAGIO on CYP2C8 Substrates Teriflunomide is an inhibitor of CYP2C8 in vivo . (Fachinformation zu Teriflunomid, Arzneimittelwechselwirkungen)

Toremifene is a weak inhibitor of CYP2C9. (Fachinformation zu Toremifen, Arzneimittelwechselwirkungen)

The interaction is a consequence of blocking hepatic metabolism of vardenafil by ritonavir, a HIV protease inhibitor and a highly strong CYP3A4 inhibitor, which also inhibits CYP2C9. (Fachinformation zu Vardenafil, Arzneimittelwechselwirkungen)

CYP2C9 Venlafaxine did not inhibit CYP2C9 in vitro . (Fachinformation zu Venlafaxin, Arzneimittelwechselwirkungen)

…information regarding table. albuterol, systemic and inhaled amoxicillin ampicillin, with or without sulbactam atenolol azithromycin caffeine, dietary ingestion cefaclor co-trimoxazole (trimethoprim and sulfamethoxazole) diltiazem dirithromycin enflurane famotidine felodipine finasteride hydrocortisone isoflurane isoniazid isradipine influenza vaccine ketoconazole… (Fachinformation zu Aminophyllin, Arzneimittelwechselwirkungen)

…ampicillin, with or without methylprednisolone sulbactam metronidazole atenolol metoprolol azithromycin nadolol caffeine, dietary ingestion nifedipine cefaclor nizatidine co-trimoxazole (trimethoprim and sulfamethoxazole) norfloxacin ofloxacin diltiazem omeprazole dirithromycin prednisone, prednisolone enflurane ranitidine famotidine rifabutin felodipine roxithromycin… (Fachinformation zu Theophyllin, Arzneimittelwechselwirkungen)