ST合剤を処方する際の留意事項

Considerations when prescribing trimethoprim–sulfamethoxazole
CMAJ. 2011 Nov 8;183(16):1851-8. Epub 2011 Oct 11.
Ho JM, Juurlink DN.

コメント：
・一般的な内容（骨髄抑制についてあまり留意していない）

N: Neurologic effects
→脳脊髄関門を容易に通過するため。（薬剤性髄膜炎等もおこす）

O: Decreased oxygen-carrying capacity and other hematologic abnormalities
Methemoglobinemia
oxidative hemolysis：感性のある場合でも耐えられるとのレポートはあるが注意

T: Toxic epidermal necrolysis and other hypersensitivity reactions

R: Reproductive toxicity
→特に妊娠第一期

I: Interactions with other drugs
→Interactions involving the cytochrome P450 enzyme system
→2C8 isoform is inhibited by trimethoprim and the 2C9 isoform is inhibited by sulfamethoxazole→同部位で代謝される薬剤が蓄積
2C8 isoform is inhibited by trimethoprim and the 2C9 isoform is inhibited by sulfamethoxazole

S: Sugar (hypoglycemia)
→SU剤との併用で多い　

K: Hyperkalemia and other kidney effects
・trimethoprim inhibits potassium elimination in the distal nephron
Other kidney effects：trimethoprim-mediated blockade of epithelial sodium channels in the distal nephron may also increase the risk of hyponatremia

Y: Why not consider an alternate antimicrobial?