co-trimoxazole and anaemia/folate deficiency

[fapumpkin]

I was wondering if anyone in the community has had any experience of taking Co-trimoxazole long term and anaemia/folate deficiency ?

I have been prescribed Co-trimoxazole for roughly 6 years, and over the last 9 months I have become more and more anaemic, even though I was taking Iron, I have just had an iron infusion and now have been told that I am folate deficient. I rang pharmacist as I have been prescribed some folate and one of the medication listed in the information leaflet that you should talk to your doctor about is co-trimoxazole, the pharmacist said that I would need a higher dose as co-trimoxazole can block folate absorption.

I also noticed in the co-trimoxazole information leaflet that its prescription should be discussed if some one is anaemic.

Would greatly appreciate the communities thoughts on this.

[SofiaDeo]

It's not so much that cotrimoxazole blocks folate absorption, as the trimethoprim component blocks the enzyme dihydrofolate reductase in our cells. The link below talks about how this, you have to scroll down a bit:

drugs.com/disease-interacti...

I have taken it as "folic acid" for various clinical trials, as well as one treatment that was on the "more immune suppressing" end of the spectrum. In the US the 1mg dose is the one available without a prescription; I am told Canada allows 5mg to be sold without one. I took 5mg. Some people prefer a more "bioavailable" form of folate, but at least some practitioners think if one is at risk for bacterial or other infections (as opposed to, say, taking low lose methotrexate for arthritis and one's immunity isn't impair but their folate gets depleted from the methotrexate), you should make sure you take "folic acid" and not "folinic acid"

ejhp.bmj.com/content/29/Sup...

The first link also talks about how "folic acid" doesn't interfere with antibacterial action of cotrimoxazole.

Do you generally eat a lot of leafy greens, eggs, and other food sources of folate? I wonder if that might nudge you over to where you don't need a pill. I personally think if I make sure I eat more iron, I avoid anemia and taking iron tablets. The months I eat more vegetarian/chicken, and fewer eggs and meat, seem to have the effect of my iron parameters dipping. Perhaps boosting your food sources could be sufficient, for you. Plus IMO food is always more enjoyable than a pill. I do love rationalizing the expense of shrimp, for iodine, and steak, for my iron! Plus steamed spinach with a little butter, Parmesan cheese, salt, and pepper!

ods.od.nih.gov/factsheets/F...

[fapumpkin in reply to SofiaDeo]

I did eat a lot of green leaved veg pre ibruntinib, until I started to have issues after being on ibrutinib for a couple of months, mainly diarrhoea. I have not been folate deficient before and only once before (late pregnancy) have I been anaemic. My GP has prescribed 5mg of folate, which I will now take and the clinical trial research fellow has said I can stop taking co-trimoxazole to allow full benefit of the folate medication. I tried eating some green leafed veg today, unfortunately have had diarrhoea. Have said to numerous consultants over 6 years about this issue but nothing has come of it. Pre ibrutinib, one of my favourite things to eat was a bowl of Rocket, grated carrot, parmesan with some olive oil based dressing.

[annmcgowan]

Hi I am on the Flair trial on ibrutinib. I take co tramazole as part of the trial. I am folic deficient now and taking prescribed supplements. Thank you for posting I will take this up with my CLL specialist.Ann

[fapumpkin in reply to annmcgowan]

hello ann, I am also on the ibrutinib/rituximab arm of the Flair trial, I finished 6 years of ibrunib in June. It has been agreed today (haematology research fellow phone call) that I can stop taking Co-trimoxazole and to take the prescribed folate medication.

[annmcgowan]

Thanks fapumpkin I didn’t know taking Co Tramazole continued once you stopped ibrutinib.Ann

[fapumpkin in reply to annmcgowan]

I was told to continue with the supporting medication to "give time for my immune system to recover".

[annmcgowan]

Hi thanks for your reply, that’s interesting. I guess the same will happen with me.Ann

[Aerobobcat]

Hi fapumpkin, your post interests me. I have been taking co-trimoxasol throughout my treatment, 9 years. Early on I had real problems with iron anemia deficiency. At the time I was also taking folic acid and feric formerate so maybe that was also my problem.