PYRIMETHAMINE AND SULFONAMIDES

Serious pancytopenia and megaloblastic anaemia have been described in patients
given pyrimethamine and either co-trimoxazole (which contains sulfamethoxazole) or other sulfonamides.
Pyrimethamine is usually given with a sulfonamide for toxoplasmosis and malaria.
Nevertheless, caution should be used in prescribing the combination, especially in
the presence of other drugs (e.g. methotrexate) or disease states that may
predispose to folate deficiency. When high-dose pyrimethamine is used for the
treatment of toxoplasmosis, the manufacturer recommends that all patients should receive a folate supplement. Note that the manufacturer of sulfadoxine/pyrimethamine recommends that the concurrent use of sulfonamides (including co-trimoxazole) should be avoided.
(34)
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