Pharmaceutisch Weekblad

, Volume 9, Issue 2, pp 117–124 | Cite as

Deterioration of kidney function by high doses of co-trimoxazole in man

  • T. B. Vree
  • M. Martea
  • Y. A. Hekster
  • E. F. S. Termond
  • R. Van Klaveren
  • J. W. Lammers
  • J. H. M. Berden
Pharmacokinetics and Organ Dysfunction


High doses of co-trimoxazole in a patient withPneumocystis carinii and impaired kidney function (creatinine clearance 10 ml/min) resulted in a declining renal clearance of the drug but did not affect the average creatinine clearance. The renal clearance of sulfamethoxazole and its metabolites 5-hydroxy-, N4-acetyl-, N4-acetyl-5-hydroxysulfamethoxazole decreased 80%, while the renal clearance of trimethoprim decreased 60%. The renal clearance of all compounds was evidently dependent on urine flow. The observed phenomena may be explained by the assumption that crystalluria occurred, obstructing kidney tubules. The crystalluria effect can be reversed by cessation of the drug or by lowering its dosage.

Key words

Clearance, renal Crystalluria Kidney diseases Metabolism Pharmacokinetics Pneumocystis carinii Sulfamethoxazole Trimethoprim 


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Copyright information

© Royal Dutch Association for Advancement of Pharmacy 1987

Authors and Affiliations

  • T. B. Vree
    • 1
    • 2
  • M. Martea
    • 1
  • Y. A. Hekster
    • 1
  • E. F. S. Termond
    • 1
  • R. Van Klaveren
    • 3
  • J. W. Lammers
    • 3
  • J. H. M. Berden
    • 4
  1. 1.Department of Clinical PharmacySt. Radboud HospitalHB NijmegenThe Netherlands
  2. 2.Department of AnaesthesiologySt. Radboud HospitalNijmegen
  3. 3.Department of PulmonologySt. Radboud HospitalNijmegen
  4. 4.Department of NephrologySt. Radboud HospitalNijmegen

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