Product Summary

1. Trade Name of the Medicinal Product Trimethoprim 50 mg/ 5 ml suspension

2    QUALITATIVE AND QUANTITATIVE COMPOSITION

Each 5 ml dose contains 50 mg of Trimethoprim. For the full list of excipients, see section 6.1

3.    Pharmaceutical Form

Suspension

A white, opalescent, viscous suspension.

Clinical Particulars

4.1. Therapeutic Indications

Trimethoprim is indicated for the treatment of susceptible infections caused by trimethoprim -sensitive organisms including urinary tract and respiratory tract infections.

Trimethoprim is also indicated for the prevention of recurrent urinary tract infections.

4.2 Posology and method of administration

For oral administration

Acute infections:

Adults and children over 12 years of age: 200 mg (20 ml) twice daily Children 6years to 12 years: 100 mg (10 ml) twice daily Children 6 months to 5 years: 50 mg (5 ml) twice daily Children 6 weeks to 5 months: 25 mg (2.5 ml) twice daily

The approximate dosage in children is 8 mg trimethoprim per kg body weight per day.

Elderly: Depending on kidney function, see special dosage schedule.

Treatment should continue for at least one week but not last longer than two weeks. The first dose can be doubled.

Long-term treatment and prophylactic therapy:

Adults and children over 12 years: 100 mg (10 ml) at night Children 6years to 12 years: 50 mg (5 ml) at night Children 6 months to 5 years: 25 mg (2.5 ml) at night

The approximate dosage in children is 2 mg trimethoprim per kg body weight per day.

Elderly: Depending on kidney function, see special dosage schedule.

Dosage advised where there is reduced kidney function:

Creatinine clearance ml/sec	Plasma creatinine micromol/1	Dosage advised
Over 0.45	Men<250	Normal

	Women <175
0.25-0.45	Men 250-600 Women 175-400	Normal for 3 days then half dose.
Under 0.25	Men > 600 Women > 400	Half the normal dose.

Trimethoprim is removed by dialysis. It should not, however, be administered to dialysis patients unless plasma concentrations can be estimated regularly.

4.3 Contraindications

Trimethoprim is contra-indicated in pregnancy, hypersensitivity to trimethoprim or to any of the excipients listed in section 6.1, blood dyscrasias, severe hepatic insufficiency and also in severe renal insufficiency, unless blood trimethoprim concentrations can be monitored regularly.

4.4 Special warnings and precautions for use

In patients with marked impairment of renal function, care should be taken to avoid accumulation and resulting adverse haematological effects.

Caution should be exercised in the administration of trimethoprim to patients with actual or potential folate deficiency (e.g. the elderly). Administration of a folate supplement should be considered. Although an effect on folic acid metabolism is possible, interference with haematopoiesis rarely occurs at the recommended dose. If any such change occurs, folinic acid should reverse the effect. Elderly people may be more susceptible and a lower dose may be advisable.

Regular haematological tests should be undertaken in patients receiving long term treatment and those predisposed to folate deficiency. Particular care should be exercised in the haematological monitoring of children on long term therapy. The usual caution in prescribing any drug for women of child bearing age should be exercised with trimethoprim.

Trimethoprim should be used under careful medical supervision in neonates.

4.5 Interaction with other medicinal products and other forms of interaction

Anti-arrhythmics: Trimethoprim increases plasma concentrations of procainamide.

Antimalarials: Increased antifolate effect when trimethoprim is given with pyrimethamine.

Cytotoxics: Increased risk of haematological toxicity when trimethoprim is given with azathioprine or mercaptopurine. Trimethoprim increases the antifolate effect of methotrexate therefore use should be avoided.

Rifampicin may increase the elimination and shorten the elimination half-life of trimethoprim. With bone marrow depressants, trimethoprim may increase the potential for bone marrow aplasia.

Digoxin and phenytoin: Trimethoprim may increase the elimination half-life of phenytoin and digoxin therefore patients should be carefully controlled.

Ciclosporin may increase the nephrotoxicity of trimethoprim.

Trimethoprim may potentiate the anticoagulant effect of warfarin.

4.6 Fertility, pregnancy and lactation

Pregnancy

Trimethoprim is contra-indicated in pregnant women.

Breast-feeding

Trimethoprim is excreted in breast milk but is not contra-indicated for short term use in lactating mothers.

4.7. Effects on Ability to Drive and Use Machines

None known.

4.8 Undesirable effects

The frequencies of adverse events are ranked according to the following: very common

(> 1/10), common (> 1/100 to < 1/10), uncommon (> 1/1,000 to < 1/100), rare (> 1/10,000 to

< 1/1,000), very rare (< 1/10,000), not known (cannot be estimated from the available data).

The most frequent adverse effects at usual doses are pruritus and skin rash (in about 3 to 7% of patients) and mild, gastrointestinal disturbances including nausea, vomiting and glossitis. These effects are generally mild and quickly reversible on withdrawal of the drug.

Infections and infestations Aseptic meningitis has been reported.

Blood and lymphatic system disorders

Isolated cases of megaloblastic anaemia during prolonged therapy with trimethoprim, with higher doses than those recommended, have been reported. These effects are reversible with discontinuation of therapy and administration of calcium folinate.

Leucopenia, thrombocytopenia, agranulocyctosis, methaemoglobinaemia

Trimethoprim may affect haematopoiesis.

Immune system disorders

Rare: Anaphylactic reactions, anaphylactoid reactions have been reported.

Metabolism and nutrition disorders

Hyperkalaemia (particularly in the elderly and in HIV patients)

Nervous system disorders Rare: Headache Gastrointestinal disorders Glossitis, sore mouth

Rare: Nausea, vomiting, gastrointestinal disturbances Hepatobiliary disorders

Disturbances in liver enzyme values, cholestatic jaundice Renal and Urinary disorders

Raised serum creatinine and blood urea nitrogen levels. It is not known however, whether this represents inhibition of creatinine tubular secretion or genuine renal dysfunction

Skin and subcutaneous tissue disorders

Pruritus, skin rashes, exfoliative dermatitis, urticaria

Rare: More severe skin sensitivity or allergic reactions such as photosensitivity, angioedema, erythema multiforme, Stevens-Johnson Syndrome and toxic epidermal necrolysis

Musculoskeletal system disorders Myalgia

General disorders and administration site conditions

Drug fever

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.

Overdose

Symptomatic treatment, gastric lavage and forced diuresis can be used. Depression of haematopoiesis by trimethoprim can be counteracted by intramuscular administration of calcium folinate.

5.    Pharmacological Properties

5.1    Pharmacodynamic properties

ATC code:    J01EA01 Sulfonamides And Trimethoprim (Trimethoprim and derivatives)

Trimethoprim inhibits dihydrofolate reductase and thus prevents the synthesis of tetrahydrofolic acid from dihydrofolic acid. It therefore affects the nucleoprotein metabolism of microorganisms.

5.2.    Pharmacokinetic Properties

Trimethoprim is readily absorbed from the gastro-intestinal tract and peak concentrations in the circulation occur about 3 hours after a dose is taken. About 45% is bound to plasma proteins. Tissue concentrations are reported to be higher than serum concentrations with particularly high concentrations in the kidneys and lungs. Concentrations in the CSF are about half that of those in blood. The half life is about 10-16 hours. 40-50% of the dose is excreted unchanged in the urine within 24 hours.

5.3. Preclinical Safety Data

Pre-clinical information has not been included because the safety profile of trimethoprim has been established after many years of clinical use. Please refer to Section 4.

6.    Pharmaceutical Particulars

6.1.    List of Excipients

The suspension contains:

Sorbitol

Agar

Methylparaben Propylparaben Polysorbate Saccharin Sodium.

6.2.    Incompatibilities

Not applicable.

6.3.    Shelf Life

36 months.

6.4. Special Precautions for Storage

Not applicable.

Nature and Contents of Container

Glass bottles with screwcap or pilfer proof cap, pack size of 100 ml.

6.6.    Instructions for Use/Handling

Not applicable.

7    MARKETING AUTHORISATION HOLDER

TEVA UK Limited Brampton Road, Hampden Park,

Eastbourne, East Sussex, BN22 9AG

8.    Marketing Authorisation Numbers

PL 0289/0203

9    DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION

20/12/2005

10    DATE OF REVISION OF THE TEXT

15/04/2016