Adverse effects of trimethoprim-sulfamethoxazole in a child with dihydropteridine reductase deficiency.
A child with dihydropteridine reductase (DHPR) deficiency developed signs of dopamine insufficiency after being given trimethoprim-sulfamethoxazole (TMP-SMX). She recovered function after the antibiotic was stopped, which suggests that it adversely influenced dopamine metabolism in the CNS. The authors speculate that TMP, a dihydrofolate reductase inhibitor, was the major cause of the patient's deterioration, and suggest that it and other dihydrofolate inhibitors, notably methotrexate, are contra-indicated for patients with DHPR deficiency.
Woody
R C
RC
Department of Pediatrics, University of Maryland, Baltimore 21201.
Brewster
M A
MA
D002675:Child, Preschool; D004298:Dopamine / Q000134:cerebrospinal fluid; D004837:Epinephrine / Q000134:cerebrospinal fluid; D005260:Female; D006801:Humans; D009247:NADH, NADPH Oxidoreductases / Q000172:deficiency*; D009638:Norepinephrine / Q000134:cerebrospinal fluid; D010649:Phenylalanine / Q000097:blood; D010661:Phenylketonurias; D012852:Sinusitis / Q000188:drug therapy*; D014202:Tremor / Q000139:chemically induced; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects*
D010649:Phenylalanine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009247:NADH, NADPH Oxidoreductases; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine