Bactrim Interactions: Alcohol, Medications, and Others

Does Bactrim interact with other drugs?

Before you start taking Bactrim, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Bactrim interacts with herbs or vitamins or supplements, see the “Are there other interactions with Bactrim?” section below.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The table below lists drugs that may interact with Bactrim. Keep in mind that this table does not include all drugs that may interact with Bactrim. For more information about some of these interactions, see the “Drug interactions explained” section below.

* Bactrim and dofetilide are not typically taken together. To learn more, see the “When should I avoid Bactrim?” section below.

When should I avoid Bactrim?

Certain health conditions or other factors could raise your risk of harm if you take Bactrim. In such cases, your doctor may not prescribe Bactrim for you. These are known as contraindications. The list below includes contraindications of Bactrim.

Children younger than 2 months: Doctors likely won’t prescribe Bactrim for children who are less than 2 months old. It isn’t known whether the drug is safe in this age group. If your child is less than 2 months old, talk with your doctor about other treatment options.

If you’ve had a low platelet count before: If you’ve had a low platelet count when taking trimethoprim or sulfonamide drugs (sometimes called sulfa drugs) in the past, your doctor likely won’t prescribe Bactrim for you. This is because taking Bactrim could cause a low platelet count. (Bactrim contains trimethoprim and a sulfa drug called sulfamethoxazole.) You can talk with your doctor about other treatments that may be better options for you.

If you have megaloblastic anemia due to folate deficiency: If you have megaloblastic anemia that’s caused by a folate or folic acid deficiency, your doctor likely won’t prescribe Bactrim for you. This is because taking Bactrim could worsen your anemia. You can talk with your doctor about other treatments that may be safer for you.

If you have severe liver damage: If you have severe liver damage, your doctor likely won’t prescribe Bactrim for you. This is because taking Bactrim could worsen your liver damage. Your doctor can tell you about other treatments that may be safer options.

If you have severe kidney problems: If you have kidney problems, your doctor will usually monitor your kidney function during Bactrim treatment. In some cases, your doctor likely won’t prescribe Bactrim if you have severe kidney problems. This is because taking Bactrim could worsen your kidney function.

If you take dofetilide (Tikosyn): If you take the heart rhythm drug dofetilide (Tikosyn), your doctor likely won’t prescribe Bactrim for you. This is because taking Bactrim could increase the level of dofetilide in your system. This could raise your risk of side effects from dofetilide. In particular, it could raise your risk of dangerous irregular heart rhythms. You can ask your doctor about other treatments that may be better options for you.

If you’ve had an allergic reaction: If you’ve had an allergic reaction to Bactrim or any of its ingredients or to sulfonamide (sulfa) drugs, your doctor likely won’t prescribe Bactrim for you. This is because taking the drug could cause another allergic reaction. You and your doctor can discuss other treatment options.

Before you start taking Bactrim, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Bactrim is safe for you to take.

Does Bactrim interact with alcohol?

Bactrim is not known to have interactions with alcohol. But Bactrim and alcohol can cause some similar side effects, such as nausea, vomiting, and liver problems. You may be more likely to experience these side effects if you drink alcohol during your Bactrim treatment.

If you have questions about consuming alcohol while taking Bactrim, talk with your doctor or pharmacist.

Drug interactions explained

Learn more about certain drug interactions that can occur with Bactrim.

Interaction with diuretics

Bactrim can interact with diuretics, which are sometimes called water pills. Diuretics are used to treat fluid buildup and high blood pressure.

Bactrim can interact with certain types of diuretics called thiazide diuretics and potassium-sparing diuretics.

Examples of thiazide diuretics include:

• chlorothiazide (Diuril)
• chlorthalidone (Thalitone)
• hydrochlorothiazide (Microzide)
• metolazone

Examples of potassium-sparing diuretics include:

• amiloride (Midamor)
• eplerenone (Inspra)
• spironolactone (Aldactone, Carospir)
• triamterene (Dyrenium)

What could happen

Taking Bactrim with a thiazide diuretic can raise your risk of a low platelet count, which can cause unusual bruising or bleeding. If you’re 65 years old or older, you may have a higher risk of this side effect if you take Bactrim with a thiazide diuretic.

Bactrim and potassium-sparing diuretics can both cause high potassium levels, so taking these drugs together can raise your risk of this side effect. If you’re 65 years old or older or you have kidney problems, you may have a higher risk of this side effect if you take Bactrim with a potassium-sparing diuretic.

What you can do

Your doctor will typically avoid prescribing Bactrim with thiazide diuretics. If you take Bactrim and a thiazide diuretic together, tell your doctor right away if you have symptoms of a low platelet count, such as unusual bruising or bleeding.

If your doctor prescribes Bactrim with a potassium-sparing diuretic, they may monitor your potassium levels during your treatment. If you take these drugs together, tell your doctor right away if you have symptoms of high potassium levels. These may include:

• weakness
• numbness or a tingling feeling
• nausea
• vomiting
• heart palpitations

If you have questions about taking Bactrim with a diuretic medication, talk with your doctor or pharmacist.

Interaction with certain diabetes medications

Bactrim can interact with certain diabetes medications, which are used to help manage blood sugar levels in people with diabetes.

Diabetes medications that can interact with Bactrim include:

• glipizide (Glucotrol XL)
• glyburide (Diabeta)
• metformin (Fortamet, Glumetza)
• pioglitazone (Actos)
• repaglinide

What could happen

Taking Bactrim with a diabetes medication it interacts with can make the diabetes drug build up in your body. This can cause the drug to lower your blood sugar too much, which can raise your risk of hypoglycemia (low blood sugar).

What you can do

If your doctor prescribes Bactrim with a diabetes drug it interacts with, they may recommend that you monitor your blood sugar levels more closely during your treatment. Talk with your doctor about how often you should check your blood sugar levels.

You should also talk with your doctor about how to recognize symptoms of low blood sugar and what to do if you have these symptoms.

If you have questions about taking Bactrim with a diabetes medication, talk with your doctor or pharmacist.

Interaction with warfarin (Jantoven)

Bactrim can interact with warfarin (Jantoven), which is a blood thinner that’s used to treat and help prevent blood clots.

What could happen

Bactrim reduces the activity of an enzyme (a type of protein) that helps remove warfarin from your body. Taking Bactrim with warfarin can increase the level of warfarin in your body. This can raise your risk of side effects from warfarin, such as bruising or bleeding.

What you can do

If you take Bactrim with warfarin, your doctor will likely check your international normalized ratio (INR) more often than usual. Your INR is a calculation that corresponds to the amount of the time it takes for your blood to clot. Doctors use INR to monitor the effect of your warfarin treatment. Your doctor may adjust your warfarin dosage based on your INR.

If you take Bactrim and warfarin together, tell your doctor right away if you have any unusual bruising or bleeding.

If you have questions about taking Bactrim with warfarin, talk with your doctor or pharmacist.

Are there other interactions with Bactrim?

Bactrim may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Bactrim.

Does Bactrim interact with supplements?

Before you start taking Bactrim, talk with your doctor and pharmacist about any herbs or vitamins or supplements you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Bactrim and herbs

There are currently no reports of Bactrim interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Bactrim.

Bactrim and vitamins

There are currently no reports of Bactrim interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Bactrim.

Does Bactrim interact with food?

There are currently no reports of Bactrim interacting with food. There are no specific foods you need to avoid while taking Bactrim. If you have questions about eating certain foods during your treatment with Bactrim, talk with your doctor.

Does Bactrim interact with vaccines?

You should not receive the cholera vaccine or the oral typhoid vaccine while taking Bactrim. These are live vaccines.* Bactrim can kill the bacteria in these vaccines, which can make the vaccines less effective. You shouldn’t get the cholera vaccine until 2 weeks after stopping Bactrim treatment.

If you have questions about getting certain vaccines during your Bactrim treatment, talk with your doctor.

* Live vaccines contain weakened versions of the bacteria or virus that they’re meant to protect against.

Does Bactrim interact with lab tests?

Bactrim can interact with a certain lab test used to measure the blood level of a drug called methotrexate.

Bactrim can also interact with a certain lab test used to measure creatinine levels. Your doctor may order this test to check your kidney function.

If you have these lab tests done, be sure to tell the healthcare professional carrying out the test that you’re taking Bactrim.

If you have questions about having lab tests done during your Bactrim treatment, talk with your doctor.

Does Bactrim interact with cannabis or CBD?

Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Bactrim.

Bactrim reduces the activity of certain enzymes that remove cannabis and cannabis products from your body. If you use cannabis or cannabis products while taking Bactrim, the effect of cannabis may be increased. You may also be more likely to have side effects from cannabis.

Before you start treatment with Bactrim, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Does my health history affect whether I should take Bactrim?

Certain medical conditions or other health factors may raise the risk of interactions with Bactrim. Before taking Bactrim, talk with your doctor about your health history. They’ll determine whether Bactrim is right for you.

Health conditions or other factors that might interact with Bactrim include:

Older age: People 65 years old and older may have a higher risk of side effects with Bactrim than younger adults. These side effects include a low platelet count, high potassium levels, and kidney problems. If you’re 65 years old or older, your doctor will likely prescribe a lower dosage of Bactrim for you and monitor you closely for side effects.

Kidney problems: If you have kidney problems, Bactrim can build up in your body. This can raise your risk of Bactrim side effects, especially high potassium levels and megaloblastic anemia. Bactrim can also worsen your kidney problem. If your doctor prescribes Bactrim, they’ll likely prescribe a dosage that’s lower than usual. They’ll also likely monitor your kidney function.

Liver problems: If you have a liver problem, Bactrim could make it worse. Talk with your doctor about whether Bactrim is right for you. If you have severe liver damage, your doctor likely will not prescribe Bactrim for you.

Folate deficiency: If you have a folate or folic acid deficiency, you may have a higher risk of megaloblastic anemia with Bactrim. Your doctor can help determine whether Bactrim is a safe option for you.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency: If you have a G6PD deficiency, you may have a higher risk of hemolytic anemia with Bactrim. Talk with your doctor about whether Bactrim is right for you.

Porphyria: If you have porphyria, taking Bactrim could worsen your condition. Your doctor can help determine whether Bactrim is right for you.

Hypothyroidism: If you have an underactive thyroid gland, taking Bactrim could worsen your condition. Your doctor may monitor your thyroid hormone levels more closely while you’re taking Bactrim.

High potassium levels: If you have high potassium levels, taking Bactrim could worsen your condition. Your doctor will help determine whether this drug is right for you.

Pregnancy: Bactrim is not safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor about other treatments that may be better options for you.

Breastfeeding: It’s not known whether it’s safe to take Bactrim while breastfeeding. The drug passes into breast milk, but it isn’t known whether the drug may cause side effects in a child who’s breastfed. If you’re breastfeeding or planning to do so, talk with your doctor about your options.

Allergic reaction: If you’ve had an allergic reaction to Bactrim, any of its ingredients, or sulfonamide drugs, your doctor will likely not prescribe Bactrim. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

How can I prevent interactions?

Taking certain steps can help you avoid interactions with Bactrim. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• whether you drink alcohol or use cannabis
• other medications you take, as well as any vitamins, supplements, and herbs (they can also help you fill out a medication list)
• what to do if you start taking a new drug during your Bactrim treatment

It’s also important to understand Bactrim’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Bactrim, ask your pharmacist to print a copy for you.)

If you have trouble reading or understanding this information, your doctor or pharmacist can help.

Taking Bactrim exactly as prescribed can also help prevent interactions.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.