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Symptoms: Signs and symptoms of overdosage include anorexia, colic, nausea, vomiting, dizziness, headache, drowsiness, and unconsciousness. Pyrexia, haematuria, and crystalluria may be noted. Blood dyscrasias and jaundice are potential late manifestations of overdosage. Signs of acute overdosage with trimethoprim include nausea, vomiting, dizziness, headache, mental depression, confusion, and bone marrow depression.
Treatment: Stop therapy. Treatment of overdose is supportive and symptomatic care. Force fluids orally or parenterally if renal function is normal. In extreme overdosage in patients with impaired renal function, consider haemodialysis which is moderately effective in removing sulfamethoxazole and trimethoprim. Peritoneal dialysis is ineffective.
No known antidote for sulfonamide poisoning exists, however, calcium folinate (the equivalent of 3 mg to 6 mg folinic acid intramuscularly for 5 to 7 days) is an effective antidote for adverse effects in the haemopoietic system caused by trimethoprim.
