Availability of Septra (Trimethoprim/Sulfamethoxazole) in Liquid Formulation
Yes, Septra (trimethoprim/sulfamethoxazole) is available in liquid formulation for patients who cannot swallow tablets, particularly for pediatric use.
Liquid Formulation Details
- Trimethoprim/sulfamethoxazole (TMP-SMX) is available as an oral suspension with the following characteristics:
Stability Information
Research has demonstrated that extemporaneously compounded oral suspensions of TMP-SMX (8 mg/mL trimethoprim and 40 mg/mL sulfamethoxazole) prepared from bulk powder remain stable for at least 90 days when stored in:
- Amber plastic bottles at either refrigerated (5°C) or room temperature (25°C)
- Amber plastic syringes at either refrigerated or room temperature 2
Dosing Considerations
- For pediatric patients: The recommended dosing is 8-12 mg/kg/day based on the trimethoprim component
- This is typically divided into 2 doses given every 12 hours 1
Clinical Applications
While the FDA has not approved TMP-SMX specifically for acne vulgaris treatment 3, it has been used off-label in dermatology for various skin conditions including acne 4.
The medication is officially approved for:
- Urinary tract infections
- Shigellosis
- Acute otitis media in pediatric patients
- Pneumocystis pneumonia 4
Important Precautions
- TMP-SMX should not be used during pregnancy, especially in the third trimester, due to risks of neural tube defects, preterm birth, low birth weight, and kernicterus in newborns 1
- Rare but serious adverse reactions include Stevens-Johnson syndrome and other severe skin reactions 3
- Hematologic reactions such as anemia, thrombocytopenia, and agranulocytosis can occur, though rarely 5
- The most common adverse effects are gastrointestinal intolerance and skin eruptions 5
Formulation Considerations
When compounding is necessary, it's important to note that suspensions prepared from commercial tablets may produce an unacceptable formulation with persistent foam that could result in inconsistent dosing. Suspensions prepared from bulk powder are preferred for stability and dosing accuracy 2.