Sulfonamides

Definition
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Bacteriostatically active chemotherapeutic agents, e.g. DADPS, sulfadiazine or cotrimoxazole.

Pharmacodynamics (Effect)
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Antimetabolites (competitive inhibitors) of p-aminobenzoic acid (PABA), the key enzyme in folic acid synthesis.

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Limited indication
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Desiccosis, newborns, thyroid dysfunction.

Undesirable effects
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Flu-like symptoms, pneumonia, BB changes, oligospermia, gastrointestinal disorders, jaundice, hepatitis, oliguria, nephrotic syndrome, allergic reactions, purpura, photosensitization, drug-induced LE, induction of panarteritis nodosa, DDS syndrome, cross-allergy with sulfonylureas, thiazides and carbonic anhydrase inhibitors, myocarditis, cyanosis, fatigue, headache, neuropathy, visual and hearing disturbances, dizziness, arthralgias, myopathies.

Interactions
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See Table 1.

Contraindication
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Pregnancy, lactation, hypersensitivity to sulfonamides, glucose-6-phosphate dehydrogenase deficiency, anemia, currently erythema exsudativum multiforme or toxic epidermal necrolysis, hemoglobin abnormalities, ileus, severe liver damage, leukopenia, acute hepatic porphyria, renal failure.

Tables
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Significant interactions of sulfonamides

Barbiturates	Blood formation disorders
Benzocaine	Sulfonamide effect ↓
Chloramphenicol	Blood formation disorder
Clofazemin	Sulfonamide effect ↓
Daunorubicin	Hyperuricemia
Didanosine	Sulfonamide effect ↓
Doxorubicin	Hyperuricemia
Contraceptives, oral	Contraception ↓
Methotrexate	MTX toxicity ↑
Phenytoin	Phenytoin levels ↑
Primaquine	Agranulocytosis
Probenecid	Sulfonamide toxicity ↑
Pyrimethamine	mutual effect ↑ (combination only recommended for toxoplasmosis)
Rifampicin	Sulfonamide effect ↓
Sulfonylureas	Hypoglycemia
Theophylline	Theophylline plasma levels ↑
Trimethoprim	Trimethoprim plasma mirror ↑