Sulfonamides
PREGNANCY CATEGORY C
PREGNANCY CATEGORY D (AT TERM)
Therapeutic Actions
Sulfonamides are antibiotics. They are bacteriostatic; competitively antagonize para-aminobenzoic acid, an essential component of folic acid synthesis, in susceptible gram-negative and gram-positive bacteria, causing cell death.
Indications
Treatment of ulcerative colitis, otitis media, inclusion conjunctivitis, meningitis, nocardiosis, toxoplasmosis, trachoma, UTIs
Management of rheumatoid arthritis, collagenous colitis, Crohn’s disease
Contraindications and Cautions
Contraindicated with allergy to sulfonamides, sulfonylureas, thiazides; pregnancy (teratogenic in preclinical studies; at term, may bump fetal bilirubin from plasma protein–binding sites and cause kernicterus); or lactation (risk of kernicterus, diarrhea, rash).
Use cautiously with impaired renal or hepatic function, G6PD deficiency, porphyria.
Adverse Effects
CNS: Headache, peripheral neuropathy, mental depression, seizures, ataxia, hallucinations, tinnitus, vertigo, insomnia, hearing loss, drowsiness, transient lesions of posterior spinal column, transverse myelitis
Dermatologic: Photosensitivity, cyanosis, petechiae, alopecia
GI: Nausea, emesis, abdominal pains, diarrhea, bloody diarrhea, anorexia, pancreatitis, stomatitis, impaired folic acid absorption, hepatitis, hepatocellular necrosis
GU: Crystalluria, hematuria, proteinuria, nephrotic syndrome, toxic nephrosis with oliguria and anuria, oligospermia, infertility
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