Is adaport a contraindication for trimethoprim (TMP) use?

Adaport is Not a Contraindication for Trimethoprim Use

Adaport (adapalene) is not a contraindication for trimethoprim use, as there are no documented interactions between these medications that would prevent their concurrent use.

Understanding the Medications

Trimethoprim

• An antibiotic commonly used for urinary tract infections and as prophylaxis for Pneumocystis jirovecii pneumonia
• Often combined with sulfamethoxazole (TMP-SMX or co-trimoxazole)
• Works by inhibiting bacterial dihydrofolate reductase, preventing bacterial DNA synthesis

Adaport (Adapalene)

• A topical retinoid used for acne treatment
• Works by normalizing follicular hyperkeratinization and reducing inflammation
• Applied topically with minimal systemic absorption

Known Contraindications for Trimethoprim

According to guidelines, trimethoprim is contraindicated in:

1. Patients with known hypersensitivity to trimethoprim 1
2. Documented megaloblastic anemia caused by folate deficiency 1
3. Infants younger than 2 months (when combined with sulfamethoxazole) due to risk of kernicterus 1, 2
4. Pregnant women and nursing mothers (when combined with sulfamethoxazole) due to potential risk for kernicterus 1

Drug Interactions with Trimethoprim

Trimethoprim has known interactions with:

• Phenytoin
• Tests for creatinine
• Tests for methotrexate 1

When combined with sulfamethoxazole (TMP-SMX), additional interactions include:

• Amantadine
• Tricyclic antidepressants
• Cyclosporine
• Digoxin
• Diuretics
• Oral hypoglycemic agents
• Indomethacin
• Methotrexate
• Warfarin 1

Safety Considerations

When prescribing trimethoprim, be aware of:

1. Potential adverse effects:

   • Rash, pruritus, photosensitivity
   • Gastrointestinal disturbances
   • Hematologic effects (thrombocytopenia, leukopenia)
   • Hyperkalemia, hyponatremia 1

2. Special populations:

   • Use with caution in patients with impaired renal function
   • Dose adjustment needed for creatinine clearance 15-30 mL/min 2
   • Not recommended for creatinine clearance <15 mL/min 2

Clinical Decision Making

When considering concurrent use of adapalene and trimethoprim:

1. Review patient's complete medication list for other potential interactions
2. Consider the primary indication for trimethoprim (alone or as TMP-SMX)
3. Monitor for adverse effects, particularly skin reactions, as both medications can cause skin-related side effects

Conclusion

Based on current guidelines and available evidence, adapalene (Adaport) is not listed as a contraindication for trimethoprim use. There are no documented significant interactions between these medications that would prevent their concurrent use. However, as with any medication combination, monitor for unexpected adverse effects and adjust therapy as needed.