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Sulphadoxine + Pyrimethamine: Brands, Price & Uses in Bangladesh
Sulphadoxine + Pyrimethamine is a fixed-dose combination antimalarial (a sulfonamide plus an antifolate) used for: Established use: Treatment of acute and more.
About Sulphadoxine + Pyrimethamine
Indications of Sulphadoxine + Pyrimethamine
Sulphadoxine + Pyrimethamine is a fixed-dose combination antimalarial (a sulfonamide plus an antifolate) used for:
- Established use: Treatment of acute, uncomplicated malaria caused by Plasmodium falciparum, given as a single dose, particularly in areas where chloroquine resistance is present or suspected.
- Guideline-supported use: Chemoprophylaxis of malaria for travelers to areas with chloroquine-resistant P. falciparum, only when better-tolerated alternatives are unavailable or contraindicated.
- Guideline-supported public health use: Intermittent Preventive Treatment of malaria in pregnancy (IPTp) in malaria-endemic settings, following World Health Organization (WHO) guidance and local antenatal care protocols, using a fixed schedule distinct from standard treatment dosing.
Sulphadoxine + Pyrimethamine is not effective against chloroquine-sensitive strains alone and is not used for severe or complicated malaria, for which parenteral antimalarials are required.
Dosage & Administration of Sulphadoxine + Pyrimethamine
| Indication | Population | Dose |
|---|---|---|
| Acute uncomplicated P. falciparum malaria (treatment) | Adults | 2–3 tablets (sulfadoxine 500 mg/pyrimethamine 25 mg each) as a single oral dose |
| Children (over 2 months of age) | Weight/age-based single dose, ranging from about ¼–½ tablet in infants to 3 tablets in older children/adolescents; a physician should calculate the exact weight-based dose | |
| Malaria chemoprophylaxis (travelers, when alternatives are unsuitable) | Adults | 1 tablet once weekly, or 2 tablets every 2 weeks, starting 1–2 days before travel and continued for 4–6 weeks after leaving the endemic area |
| Children | Weight-based fraction of the adult dose, on the same weekly/biweekly schedule | |
| IPTp (intermittent preventive treatment in pregnancy), endemic areas | Pregnant women, per WHO/antenatal care schedule | A single treatment-dose course given under direct observation at each scheduled antenatal visit starting in the second trimester, spaced at least one month apart, per national malaria control program guidance |
Tablets should be swallowed whole with plenty of fluid, generally after a meal to reduce gastrointestinal upset. Complete the full prescribed dose exactly as directed by the physician; do not repeat or extend dosing beyond what is prescribed, and do not share Sulphadoxine + Pyrimethamine with others, as inappropriate use promotes resistance and increases the risk of serious adverse reactions.
Side Effects of Sulphadoxine + Pyrimethamine
Most patients receiving single-dose Sulphadoxine + Pyrimethamine for malaria treatment tolerate it well. Reported adverse effects include:
- Common: nausea, vomiting, loss of appetite, headache, mild skin rash or itching.
- Serious but rare, especially with repeated/prophylactic dosing: severe cutaneous hypersensitivity reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, which can be fatal; blood dyscrasias (agranulocytosis, aplastic anemia, leukopenia, thrombocytopenia); hepatic necrosis; erythema multiforme; and, rarely, convulsions or peripheral neuritis.
Sulphadoxine + Pyrimethamine should be discontinued immediately and medical attention sought at the first sign of skin rash, mucosal lesions, unexplained bruising/bleeding, sore throat, fever, pallor, or jaundice, as these may herald a serious hypersensitivity or hematologic reaction.
Contraindications of Sulphadoxine + Pyrimethamine
Sulphadoxine + Pyrimethamine is contraindicated in:
- Known hypersensitivity to sulfonamides, pyrimethamine, or any component of the formulation.
- Documented megaloblastic anemia due to folate deficiency.
- Severe renal impairment or severe hepatic impairment, particularly for repeated (prophylactic) dosing.
- Infants younger than 2 months of age, due to the risk of kernicterus and bilirubin displacement from the sulfonamide component, and immature drug-metabolizing pathways.
- Known glucose-6-phosphate dehydrogenase (G6PD) deficiency, due to the risk of hemolysis with the sulfonamide component.
- Pregnancy at term and during breastfeeding of infants younger than 2 months, for routine (non-IPTp) prophylactic use, because of the risk of kernicterus in the newborn (see Pregnancy and Lactation for IPTp-specific guidance).
Frequently Asked Questions about Sulphadoxine + Pyrimethamine
What is Sulphadoxine + Pyrimethamine used for?
Sulphadoxine + Pyrimethamine is an antimalarial combination used to treat acute, uncomplicated malaria caused by Plasmodium falciparum as a single dose, and in some settings for malaria prevention (chemoprophylaxis in travelers, or intermittent preventive treatment during pregnancy in endemic areas) under medical guidance.
How is Sulphadoxine + Pyrimethamine taken?
For treatment, it is usually taken as a single dose of 2–3 tablets swallowed whole with plenty of fluid, preferably after a meal. For prevention, it is taken weekly or every two weeks, or per a specific antenatal schedule if used for IPTp in pregnancy. Always follow your physician's exact instructions and do not repeat, skip, or share doses.
Can Sulphadoxine + Pyrimethamine be used during pregnancy?
Routine self-treatment or prophylactic use of Sulphadoxine + Pyrimethamine late in pregnancy is generally avoided due to a theoretical risk of newborn kernicterus. However, in malaria-endemic areas, the WHO specifically recommends Sulphadoxine + Pyrimethamine for Intermittent Preventive Treatment in pregnancy (IPTp) from the second trimester onward because the benefit of preventing malaria outweighs the risk in that context. Any use in pregnancy should be under a physician's direct advice.
What are the serious warning signs to watch for while taking Sulphadoxine + Pyrimethamine?
Stop Sulphadoxine + Pyrimethamine immediately and seek urgent medical attention if you develop a skin rash, mouth or eye sores, unusual bruising or bleeding, sore throat, fever, unusual paleness, or yellowing of the skin/eyes. These can be signs of rare but serious reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, or blood disorders, which have been fatal in rare cases.
Who should not take Sulphadoxine + Pyrimethamine?
Sulphadoxine + Pyrimethamine should not be used by people with a known allergy to sulfonamides or pyrimethamine, those with folate-deficiency megaloblastic anemia, severe kidney or liver disease (for repeated dosing), infants under 2 months of age, or people with G6PD deficiency. Tell your doctor about your full medical history before starting Sulphadoxine + Pyrimethamine.
What should I do if I miss a dose or think I've taken too much Sulphadoxine + Pyrimethamine?
If Sulphadoxine + Pyrimethamine is used for prevention and a dose is missed, take it as soon as you remember and consult your physician about the schedule; do not double the dose. If you suspect an overdose (symptoms may include nausea, vomiting, headache, or convulsions), seek immediate medical attention or contact emergency/poison control services right away rather than treating it at home.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.