title: Trimethoprim/sulfamethoxazole-induced tremor in a patient with AIDS.
abstract: OBJECTIVE
  To report a case of trimethoprim/sulfamethoxazole (TMP/SMX)-induced tremor responsive to a reduction in dosage.
  
  
  METHODS
  A 55-year-old white man with AIDS and Pneumocystis carinii pneumonia (PCP) developed a tremor after receiving 5 days of therapy with TMP/SMX 19.4 mg/kg/d (TMP). The tremor resolved completely 3 days after a dosage reduction to TMP/SMX 15.1 mg/kg/d.
  
  
  CONCLUSIONS
  Central nervous system adverse reactions to TMP/SMX have been reported in both the AIDS and non-AIDS populations. To our knowledge, this is the first reported case of TMP/SMX-induced tremor responsive to a reduction in dosage. Pharmacokinetic and clinical data suggest a concentration-dependent etiology for various adverse effects, including tremor. The mechanism of the tremor is unknown; however, toxic metabolites of SMX and disruptions of biogenic amine neurotransmission by TMP have been hypothesized.
  
  
  CONCLUSIONS
  TMP/SMX remains the drug of first choice for treating PCP, but it is clearly not well tolerated by patients with AIDS. Concentration-dependent toxicities such as tremor may lead to premature discontinuation of proven, effective TMP/SMX therapy. Using the lower end of the recommended dosing range for TMP/SMX (TMP 15 mg/kg/d) may reduce the incidence of these toxicities while still achieving acceptable TMP concentrations and antimicrobial efficacy.
authors.affiliation: College of Pharmacy and Allied Health, Wayne State University, Detroit, MI, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Slavik
authors.forename: M J
authors.initials: MJ
authors.lastname: Rybak
authors.forename: S A
authors.initials: SA
authors.lastname: Lerner
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy*; D013420:Sulfamethoxazole / Q000008:administration & dosage* / Q000009:adverse effects*; D014202:Tremor / Q000139:chemically induced*; D014295:Trimethoprim / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D000890:Anti-Infective Agents; D014295:Trimethoprim; D013420:Sulfamethoxazole