Acute Megaloblastic Anemia Induced by High-Dose Trimethoprim-Sulfamethoxazole
Authors: NATHAN L. KOBRINSKY
Journal: Annals of Internal Medicine (1981)

Brief Reports1 June 1981Acute Megaloblastic Anemia Induced by High-Dose Trimethoprim-SulfamethoxazoleNATHAN L. KOBRINSKY, M.D., NORMA K. C. RAMSAY, M.D.NATHAN L. KOBRINSKY, M.D., NORMA K. C. RAMSAY, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-94-6-780 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTrimethoprim-sulfamethoxazole is used in a wide range of bacterial infections and is the preferred treatment for pneumocystis pneumonia. Despite the theoretical potential for inducing an acute megaloblastic state by synergistic inhibition of tetrahydrofolate synthesis, hematologic toxicities are rarely described after oral administration because of specificity for bacterial and protozoan systems (1). The development of pancytopenia after treatment with high-dose trimethoprim-sulfamethoxazole (20 and 100 mg/kg of body weight) in a patient with low folate stores illustrates the importance of recognizing high-risk situations in preventing toxicity from this drug.A 22-year-old white woman was admitted to the University of Minnesota Hospitals because...References1. BRUMFITTHAMILTON-MILLERKOSMIDIS WJJ. Trimethoprim-sulfamethoxazole: the present position. J Infect Dis. 1973;128(suppl):S778-91. CrossrefGoogle Scholar2. GIRDWOOD R. The nature of possible adverse reactions to co-trimoxazole. Scand J Infect Dis. 1976;8(suppl 8):10-7. Google Scholar3. MARKSKAZEMIHALESNEIMS MMBA. Pharmacokinetic studies of trimethoprim-sulfamethoxazole in children with gastroenteritis. J Infect Dis. 1973;128(suppl):S622-5. CrossrefGoogle Scholar4. WAXMAN S. Mechanism of trimethoprim-induced deranged folic acid metabolism in human bone marrow. Clin Res. 1971; 19:434. Abstract. Google Scholar5. SIVEGREENMETZ JRJ. Effect of trimethoprim on folate-dependent DNA synthesis in human bone marrow. J Clin Pathol. 1972;25:194-7. CrossrefMedlineGoogle Scholar6. CHANARINENGLAND IJ. Toxicity of trimethoprim-sulfamethoxazole in patients with megaloblastic haemopoiesis. Br Med J. 1972;1:651-3. CrossrefMedlineGoogle Scholar7. HILLKERR AD. Toxicity of co-trimoxazole in nutritional haematinic deficiency. Postgrad Med J. 1973;49:596-8. CrossrefMedlineGoogle Scholar8. ARDATITHIRUMOORTHIDAJANI KMA. Intravenous trimethoprim-sulfamethoxazole in the treatment of serious infections in children. J Pediatr. 1979;95:801-6. CrossrefMedlineGoogle Scholar9. BUSHBY S. Trimethoprim-sulfamethoxazole: in vitro microbiological aspects. J Infect Dis. 1973;128(suppl):S447-62. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: University of Minnesota Minneapolis, Minnesota PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byExploring the drug-induced anemia signals in children using electronic medical recordsA Destabilizing Domain Allows for Fast, Noninvasive, Conditional Control of Protein Abundance in the Mouse Eye – Implications for Ocular Gene TherapyClinically Significant Drug–Drug Interactions Between Oral Anticancer Agents and Nonanticancer Agents: Profiling and Comparison of Two Drug CompendiaHuman immunodeficiency virus (HIV)-related pulmonary complications in pregnancyLiteraturverzeichnisDrug interactions with cytotoxic agentsDeath from drug-induced hemolytic anemiaHIV-disease and bone marrow changes: A study of 60 casesEffects of Some Drugs and Alcohol on Folate and Cobalamin MetabolismRecurrent Fever, Chills, Pyuria, and Bacteriuria in an Adult Male Following Urinary CatheterizationEffect of folinic acid on the capacity of trimethoprim-sulfamethoxazole to prevent and treat Pneumocystis carinii pneumonia in ratsAngioimmunoblastic lymphadenopathy with associated selective myeloid hypoplasiaCOMPLICATIONS OF CO-TRIMOXAZOLE IN TREATMENT OF AIDS-ASSOCIATED PNEUMOCYSTIS CARINII PNEUMONIA IN HOMOSEXUAL MENOther Antibacterial DrugsOral Antimicrobial DrugsMiscellaneous antibacterial and antiviral drugsTrimethoprim-Sulfamethoxazole and GranulocytopeniaKAMAL M. BAKRI, LARRY P. WASSERIntravenous Sulfamethoxazole-Trimethoprim: Pharmacokinetics, Therapeutic Indications, and Adverse ReactionsMegaloblastosis and Low-Dose Trimethoprim-SulfamethoxazoleF. MAGEE, M.B., H. O'SULLIVAN, B.SC., S.R. MCCANN, M.B. 1 June 1981Volume 94, Issue 6Page: 780-781KeywordsFolic acidHematology and oncologyMegaloblastic anemiaOral administrationPatientsPneumocystisPneumoniaProtozoansSpecificityToxicity Issue Published: 1 June 1981 PDF downloadLoading ...