Yes

Antibiotic, Sulfonamide Derivative

Treatment of urinary tract infections, otitis media, Chlamydia; nocardiosis; treatment of acute pelvic inflammatory disease in prepubertal children; often used in combination with trimethoprim

B/D (at term)

Hypersensitivity to any sulfa drug or any component, porphyria, pregnancy during 3rd trimester, infants <2 months of age (sulfas compete with bilirubin for protein binding sites), patients with urinary obstruction, sunscreens containing PABA

Use with caution in patients with G-6-PD deficiency (hemolysis may occur), hepatic or renal impairment; dosage modification required in patients with renal impairment; risk of crystalluria should be considered in patients with impaired renal function

>10%:

Central nervous system: Fever, dizziness, headache

Dermatologic: Itching, rash, photosensitivity

Gastrointestinal: Anorexia, nausea, vomiting, diarrhea

1% to 10%:

Dermatologic: Lyell's syndrome, Stevens-Johnson syndrome

Hematologic: Granulocytopenia, leukopenia, thrombocytopenia, aplastic anemia, hemolytic anemia

Hepatic: Hepatitis

<1%: Vasculitis, thyroid function disturbance, crystalluria, jaundice, hematuria, acute nephropathy, interstitial nephritis, serum sickness-like reactions

Symptoms of overdose include drowsiness, dizziness, anorexia, abdominal pain, nausea, vomiting, hemolytic anemia, acidosis, jaundice, fever, agranulocytosis; doses of as little as 2-5 g/day may produce toxicity; the aniline radical is responsible for hematologic toxicity

High volume diuresis may aid in elimination and prevention of renal failure

Decreased effect with PABA or PABA metabolites of drugs (ie, procaine, proparacaine, tetracaine); cyclosporine levels may be decreased

Increased effect/toxicity of oral anticoagulants, oral hypoglycemic agents, hydantoins, uricosuric agents, methotrexate when administered with sulfonamides

Increased toxicity of sulfonamides with diuretics, indomethacin, methenamine, probenecid, and salicylates

Protect from light

Interferes with bacterial growth by inhibiting bacterial folic acid synthesis through competitive antagonism of PABA

Absorption: Sulfisoxazole acetyl is hydrolyzed in the GI tract to sulfisoxazole which is readily absorbed

Distribution: Crosses the placenta; excreted into breast milk

Ratio of CSF to blood level (%): Normal meninges: 50-80; Inflamed meninges: 80+

Protein binding: 85% to 88%

Metabolized: In the liver by acetylation and glucuronide conjugation to inactive compounds

Half-life: 4-7 hours, prolonged with renal impairment

Time to peak serum concentration: Within 2-3 hours

Elimination: Primarily in urine (95% within 24 hours), 40% to 60% as unchanged drug

Not for use in patients <2 months of age:

Pelvic inflammatory disease: 100 mg/kg/day in divided doses every 6 hours; used in combination with ceftriaxone

Chlamydia trachomatis: 100 mg/kg/day in divided doses every 6 hours

Adults: Oral: Initial: 2-4 g, then 4-8 g/day in divided doses every 4-6 hours

Pelvic inflammatory disease: 500 mg every 6 hours for 21 days; used in combination with ceftriaxone

Chlamydia trachomatis: 500 mg every 6 hours for 10 days

Dosing interval in renal impairment:

Cl_cr 10-50 mL/minute: Administer every 8-12 hours

Cl_cr <10 mL/minute: Administer every 12-24 hours

Hemodialysis: >50% removed by hemodialysis

Children and Adults: Ophthalmic:

Solution: Instill 1-2 drops to affected eye every 2-3 hours

Ointment: Apply small amount to affected eye 1-3 times/day and at bedtime

Should be administered with a glass of water on an empty stomach; interferes with folate absorption

CBC, urinalysis, renal function tests, temperature

False-positive protein in urine; false-positive urine glucose with Clinitest®

Dizziness is common; sulfonamides reported to cause restlessness, irritability, depression, euphoria, disorientation, panic, hallucinations, and delusions

Photosensitivity is common; use caution with concurrent psychotropics; may cause leukopenia; caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

Take as directed, at regular intervals around-the-clock. Take 1 hour before or 2 hours after meals with a full glass of water. Take full course of therapy even if you are feeling better. Avoid aspirin or aspirin-containing products and avoid large quantities of vitamin C. It is very important to maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake) to prevent kidney damage. You may experience dizziness or headache (use caution when driving or engaging in tasks requiring alertness until response to drug is known); photosensitivity (use sunscreen, wear protective clothing and eyewear, and avoid direct sunlight); nausea, vomiting, or loss of appetite (small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help). Diabetics: Drug may cause false tests with Clinitest® urine glucose monitoring; use of glucose oxidase methods (Clinistix®) or serum glucose monitoring is preferable. Report persistent nausea, vomiting, diarrhea, or abdominal pain; skin rash; persistent or severe sore throat, mouth sores, fever, or vaginal itching or discharge; unusual bruising or bleeding; blackened stool; fatigue; or difficulty breathing. Pregnancy precautions: Inform prescriber if you are pregnant.

Maintain adequate fluid intake

Solution, ophthalmic, as diolamine: 4% [40 mg/mL] (15 mL)

Suspension, oral, pediatric, as acetyl (raspberry flavor): 500 mg/5 mL (480 mL)

Tablet: 500 mg

Boisvert A, Barbeau G, and Belanger PM, "Pharmacokinetics of Sulfisoxazole in Young and Elderly Subjects," Gerontology, 1984, 30(2):125-31.

Kaplan SA, Weinfold RE, Abruzzo CW, et al, "Pharmacokinetic Profile of Sulfisoxazole Following IM, IV, and PO Administration to Man," J Pharm Sci, 1972, 61:773.

Liston TE and Harbison R, "Sulfisoxazole Chemoprophylaxis for Frequent Otitis Media," Pediatrics, 1983, 71:524-30.

Thoene DE and Johnson CE, "Pharmacotherapy of Otitis Media," Pharmacotherapy, 1991, 11(3):212-21.