Megaloblastosis and Low-Dose Trimethoprim-Sulfamethoxazole
Authors: F. MAGEE
Journal: Annals of Internal Medicine (1981)

Letters and Corrections1 November 1981Megaloblastosis and Low-Dose Trimethoprim-SulfamethoxazoleF. MAGEE, M.B., H. O'SULLIVAN, B.SC., S.R. MCCANN, M.B.F. MAGEE, M.B.Search for more papers by this author, H. O'SULLIVAN, B.SC.Search for more papers by this author, S.R. MCCANN, M.B.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-95-5-657_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: We read with interest the report by Korbinsky and Ramsay (1) of acute megaloblastic anemia after intravenous administration of high-dose trimethoprim-sulfamethoxazole. Trimethoprim has a relatively low affinity for mammalian dihydrofolate reductase (DHF reductase) when compared with the bacterial enzyme (2); therefore, at therapeutic doses the drug should have little effect on the host's metabolism. We report that low dosages of the combination of these drugs may cause pancytopenia in a patient with apparently normal folate metabolism.A 68-year-old woman was transferred to the haematology department for investigation of pancytopenia. One week before transfer, she had been started...References1. KOBRINSKY N and RAMSAY N. Acute megaloblastic anemia induced by high dose trimethoprim-sulphamethoxazole. Ann Intern Med. 1981;94:780-1. LinkGoogle Scholar2. DAVIS R and JACKSON J. Trimethoprim-sulphamethoxazole: effect as folate metabolism. Med J Aust. 1973;(suppl.)30-33. CrossrefGoogle Scholar3. KILLMAN S. Effects of deoxyuridine on incorporation of tritiated thymidine: differences between normoblasts and megaloblasts. Acta Med Scand. 1964;175:483-8. CrossrefMedlineGoogle Scholar4. CHANARIN I and ENGLAND J. Toxicity of trimethoprim-sulphamethoxazole in patients with megaloblastic haemapoiesis. Br Med J. 1972;1:651-3. CrossrefMedlineGoogle Scholar5. BRADLEY P, WARDEN G, MAXWELL J, and ROTHSTEIN G. Neutropenia and thrombocytopenia in renal allocraft recipients treated with trimethoprim-sulphamethoxazole. Ann Intern Med. 1980;93:560-2. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: F. MAGEE, M.B.; H. O'SULLIVAN, B.SC.; S.R. MCCANN, M.B.Affiliations: Trinity College and St. James's Hospital 8 Dublin Ireland PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDrug‑induced hemolytic anemiaThe anemia of vitamin A deficiency: epidemiology and pathogenesisCompetitive inhibition of folate absorption by dihydrofolate reductase inhibitors, trimethoprim and pyrimethamineTrimethoprim and Folinic AcidBETTY J. KINZIE, PHARM.D., JERRY W. TAYLOR, PHARM.D.Angioimmunoblastic lymphadenopathy with associated selective myeloid hypoplasiaMiscellaneous antibacterial and antiviral drugsTrimethoprim-Sulfamethoxazole and GranulocytopeniaKAMAL M. BAKRI, LARRY P. WASSER 1 November 1981Volume 95, Issue 5Page: 657-657KeywordsDrug metabolismDrug therapyDrugsEnzyme metabolismEnzymesFolic acidHematology and oncologyMegaloblastic anemia ePublished: 1 December 2008 Issue Published: 1 November 1981 PDF downloadLoading ...