GlobalRPh Renal Dosing Masterv6.6
GlobalRPh source record

Trimethoprim/sulfamethoxazole (TMP/SMX)

Local RX List renal extractBase record retrieved 2026-09-05See the evidence for this drug4 sources available - open source summaries, references and comparisons
READ THE SOURCE-SPECIFIC ANSWER

Renal guidance at a glance

Cautions / source differences (1)
Review first - source-specific qualification

A half-regimen instruction is not a tablet rule

The oral mirror expresses renal adjustment as a proportion of the indication-specific regimen. Renal impairment also increases potassium-monitoring relevance.

Before applying: Review indication, trimethoprim amount, potassium and interactions. Do not generate an IV or Pneumocystis regimen from this fraction alone.

Evidence for this qualification

Source-specific interpretation; independent clinician adjudication pending.

Confirm the product, indication and renal measure. The selected summary is not a complete prescribing monograph.

Choose a source to read (4)

Display order is not a clinical ranking. Date of retrieval is not the label revision date. Sources are never merged into one regimen. Other sources and conflicts remain below.

Rxlist source

GlobalRPh RX List - BACTRIM

Product / population
BACTRIM / BACTRIM DS oral-product renal table and precautions.
Renal measure
Source-specific renal measure; see text

RX mirror: this is not independent corroboration of its underlying label. Check dated-label and formulation limitations.

Before using this finding

A half-regimen instruction is not automatically half a tablet. Review potassium and the full indication-specific regimen.

No new official-label card was obtained for this product in v6.1. Earlier source layers, if present, were retained but not rechecked.

Renal guidance and important limits

The selected renal table gives a fraction of the indication-specific usual regimen, not a universal tablet schedule.

CrCl (mL/min)Source recommendation
Above 30Usual regimen
15-30One-half the usual regimen
Below 15Use not recommended

Choose the indication, route and trimethoprim-based regimen separately; this oral table is not an IV or Pneumocystis-specific dosing calculation. Even usual trimethoprim doses can cause hyperkalemia with renal insufficiency or potassium-raising medicines. The source calls for close potassium surveillance in those patients and frequent blood counts/chemistry, urinalysis and renal-function assessment. Significant electrolyte abnormalities, renal insufficiency or falling blood counts require reassessment and discontinuation as directed by the label.

Source revision: Revision not established in selected retrieval | Retrieved: 2026-09-10. Retrieval date is not the revision date.

Source: https://globalrph.com/rx-list/bactrim-drug/

Scope: Selected source sections stored locally. Not a complete monograph or independent clinical approval. GlobalRPh v6.6.

Full source card / provenance

All sources, comparison tools and evidence navigation
Source-specific interpretation

What the dialysis evidence actually supports

Removal information alone does not define a maintenance dose, supplemental dose or dialysis schedule. A reported regimen still requires its product, indication, renal measure and dialysis assumptions to match the patient.

GlobalRPh RX List - BACTRIM

Authored v6.1; retrieved 2026-09-10 - retained source, not freshly reviewed in this release

A regimen is reported in selected content

Read the source and its limits

These manual classifications apply only to the identified selected sections, not every retained source or the entire prescribing information. They are not dosing clearance.

Source-first renal review

Evidence sources and renal implications

Choose a source to jump directly to its locally stored result. Qualitative precautions and evidence gaps remain visible even when no numerical clearance schedule is supplied.

Read 1 source difference / applicability notes

Preserved GlobalRPh source

Preserved original GlobalRPh source

Preserved historical content; not revalidated as current prescribing guidance.

Renal method: Read the measure and population stated in the original source sections.
Retrieved: 2026-09-05

Read local renal resultOpen original reference
GlobalRPh RX List

GlobalRPh RX List - BACTRIM

Dose or interval guidance. Use only the product, indication, renal metric and population described in this source.
Before using this finding

A half-regimen instruction is not automatically half a tablet. Review potassium and the full indication-specific regimen.

Dialysis evidence: A regimen is reported in selected content

BACTRIM / BACTRIM DS oral-product renal table and precautions.

Renal method: Source-specific renal measure; see text
Retrieved: 2026-09-10

Read local renal resultOpen original reference
Professional guidance

Nebraska - TMP/SMX renal adjustment and source inconsistency

Adults; source-specific institutional guidance. Match route, indication and renal replacement modality.

Renal method: CrCl in mL/min where specified; no equation inferred.
Retrieved: 2026-09-05

Read local renal resultOpen original reference
Professional guidance

NIH OI table - PCP treatment in renal insufficiency

Adults/adolescents with HIV; PCP treatment; intermittent HD, not CRRT/PD

Renal method: Renal function in mL/min as tabulated; verify the measure used for the patient
Retrieved: 2026-09-05

Read local renal resultOpen original reference

Source presence is not independent validation. A label mirror is not a second independent source; review the original reference and exact formulation.

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Search the stored clinical text

Locate a word or phrase within this drug's source summaries. Choose all sources or one source to focus the search. The selection never hides warnings or source text, changes a dose, or proves that a renal finding is absent.

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All source summaries, original wording and provenance
Before applying a renal protocol

Check the setting. Compare whole sources.

No patient-specific dose is calculated. Context choices only display reminders; they do not validate, hide or change any regimen.

Share a reproducible source review

Choose sources below, then open a print-ready comparison with product scope, renal method, dates and cautions. Links can pin the exact local cards; they never contain patient values or choose a dose.

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Jump to renal guidanceRead 1 difference / caution notesClinician guide

Select two distinct source versions. The complete stored summaries will appear below.

Build a source-review outline for documentation

This creates a blank decision outline with the source identities you select, not a dose recommendation or completed clinical assessment. No patient fields are collected, saved or sent. Complete the clinical decisions in your approved documentation system.

Choose one or two sources above or use the source checkboxes below.

Renal-context checklist: population, kidney trend and dialysis

These prompts are a reading aid, not a prescription checklist or proof that all requirements have been met. No selections are stored or sent to a server.

Read the exact source scope, renal metric and date before selecting a row. No applicability assessment has been performed.

See source-specific renal methods and the clinical interpretation guide for the supporting context.

Read before choosing a regimen

Source differences and product cautions

Search differences across all drugs

These are specific issues found during source review, not an automated judgment that one source is universally correct. A label mirror and its original label are not independent evidence.

source scope and renal guidance

A half-regimen instruction is not a tablet rule

The oral mirror expresses renal adjustment as a proportion of the indication-specific regimen. Renal impairment also increases potassium-monitoring relevance.

How to use this: Review indication, trimethoprim amount, potassium and interactions. Do not generate an IV or Pneumocystis regimen from this fraction alone.

GlobalRPh RX List - BACTRIM

Source-specific interpretation; independent clinician adjudication pending.

Go directly to the relevant source section

Renal dosing and precautions

Choose a source, then jump to its renal or dialysis section. These links locate stored text; they do not merge regimens or certify that sources agree.

New source summary - independent clinical review pending. Summaries of the identified label sections are included locally. Source import and numeric transcription checks are not independent two-reference validation. Do not treat this card as an approved institutional dosing protocol.

No dialysis or renal heading shown? Read the complete source summary. Absence of a heading is not evidence that dose adjustment is unnecessary.

Compare or copy source versions

All content below is stored locally. Read a whole source version; do not combine its dose with another source's interval, renal metric or dialysis assumptions.

Original content / product scopeGlobalRPh RX List - BACTRIMNebraska - TMP/SMX renal adjustment and source inconsistencyNIH OI table - PCP treatment in renal insufficiency
Choose two source checkboxes below.
Historical source content is not a current prescription. Original GlobalRPh recommendations are preserved, not automatically certified as current. Product-label and professional additions below are separately attributed. Confirm indication, population, kidney-function method, monitoring and the full prescribing information before applying a regimen.

Important source distinctions

High-priority historical-source disagreement. Large pre/post-HD doses and per-dose versus per-day wording are retained exactly in meaning to expose the original discrepancy, not endorsed as a current regimen. Use a current indication-specific source before prescribing.

NIH PCP treatment and Nebraska specialist alternatives at very low kidney function are not the same as the manufacturer general not-recommended restriction. Doses expressed as mg/kg refer to trimethoprim, not combined TMP-SMX mass.

Locally stored source content

Original GlobalRPh protocol

Clinical facts and comments transcribed into a structured reading format. This is not a byte-for-byte HTML archive. Original source: https://globalrph.com/renal/tmp-smx/

Usual dosing and administration

All weight-based doses on this page are based on the TRIMETHOPRIM component, not total combined drug.

General IV dose: 8-10 mg/kg/day in doses every 6-12 hours. Pneumocystis pneumonia: 15-20 mg/kg/day in 3-4 doses every 6-8 hours for up to 14 days in the original source. One investigator reported 10-15 mg/kg/day sufficient in 10 adults with normal renal function.

Severe UTI or shigellosis: 8-10 mg/kg/day in 2-4 doses every 6, 8 or 12 hours, up to 14 days for UTI or 5 days for shigellosis. Adult oral UTI: one DS tablet (160 mg TMP/800 mg SMX) every 12 hours.

Contraindicated in infants under 2 months. The source injection instructions require dilution in D5W, no mixing with other drugs/solutions and no rapid infusion or bolus.

GRPH-tmp-smx-01 · Source section: Usual dosing and administrationRenal section finder

Package-insert renal table

CrCl above 30 mL/min: standard regimen. 15-30: half the standard regimen. Below 15: not recommended.

GRPH-tmp-smx-02 · Source section: Package-insert renal tableRenal section finder

GlobalRPh alternatives - explicitly less supported in the original

Non-PCP: above CrCl 30 no change; 15-30, 2.5 mg/kg every 12 hours; below 15, manufacturer does not recommend use. Its less-supported alternative is 2.5 mg/kg every 24 hours; avoid when possible because of crystalluria/nephrolithiasis risk.

PCP: above 30 no change; 15-30, 5 mg/kg every 12 hours; below 15, manufacturer does not recommend use. Less-supported alternative 5 mg/kg every 24 hours, with the same avoidance warning.

HD: not recommended by the manufacturer discussion. Less-supported alternatives, only if unavoidable: oral one SS or DS tablet every 24 hours, or IV 5 mg/kg every 24 hours.

GRPH-tmp-smx-03 · Source section: GlobalRPh alternatives - explicitly less supported in the originalRenal section finder

Separately attributed historical Micromedex / Paap and Nahata schedules

The original source separately attributes these schedules to Paap and Nahata (1989; 1995), through Micromedex. They are not newly checked independent references in this build.

PCP treatment:

  • CrCl above 30: 15-20 mg/kg/day divided every 6-8 hours.
  • 15-30: 15-20 mg/kg/day divided every 6-8 hours for 48 hours, then 7-10 mg/kg/day divided every 12 hours.
  • Below 15: 15-20 mg/kg PER DOSE every 48 hours, or 7-10 mg/kg/day divided every 12-24 hours.
  • HD: the historical table lists 15-20 mg/kg PER DOSE before dialysis and 7-10 mg/kg PER DOSE after dialysis.

PCP prophylaxis:

  • Above 30: 5 mg/kg every 24 hours for 3-7 doses/week.
  • 15-30: 5 mg/kg every 24-48 hours for 3-7 doses/week.
  • Below 15: 5 mg/kg every 48-72 hours.
  • HD: 5 mg/kg after dialysis.

Other infections:

  • Above 30: 8-12 mg/kg/day divided every 12 hours for 14 days, then 4-6 mg/kg every 24 hours.
  • 15-30: 8-12 mg/kg/day divided every 12 hours for 1-2 days, then 4-6 mg/kg/day every 24 hours.
  • Below 15: 8-12 mg/kg PER DOSE every 48 hours, or 4-6 mg/kg/day divided every 12-24 hours.
  • HD: the historical table lists 8-12 mg/kg PER DOSE before dialysis and 4-6 mg/kg PER DOSE after dialysis.
GRPH-tmp-smx-04 · Source section: Separately attributed historical Micromedex / Paap and Nahata schedulesRenal section finder

Hemodialysis

See the distinctly attributed alternatives above; they must not be blended into a single regimen.

GRPH-tmp-smx-05 · Source section: HemodialysisRenal section finder
Locally imported selected renal sections

GlobalRPh RX List renal information

Rxlist

GlobalRPh RX List - BACTRIM

Open original reference

Open / share this exact local source

GlobalRPh-hosted RX List · BACTRIM / BACTRIM DS oral-product renal table and precautions.

Renal method: Source-specific renal measure; see text
Source date: Revision not established in selected retrieval
Retrieved: 2026-09-10

Label mirror, not independent corroboration. This is selected locally stored RX List content. Full monograph import and current official-label review are not implied.
Dose or interval guidance. Use only the product, indication, renal metric and population described in this source.
Before using this finding

A half-regimen instruction is not automatically half a tablet. Review potassium and the full indication-specific regimen.

Dialysis evidence: A regimen is reported in selected content

Selected source sections stored locally. Not a complete monograph or independent clinical approval.

Renal guidance and important limits

The selected renal table gives a fraction of the indication-specific usual regimen, not a universal tablet schedule.

CrCl (mL/min)Source recommendation
Above 30Usual regimen
15-30One-half the usual regimen
Below 15Use not recommended

Choose the indication, route and trimethoprim-based regimen separately; this oral table is not an IV or Pneumocystis-specific dosing calculation. Even usual trimethoprim doses can cause hyperkalemia with renal insufficiency or potassium-raising medicines. The source calls for close potassium surveillance in those patients and frequent blood counts/chemistry, urinalysis and renal-function assessment. Significant electrolyte abnormalities, renal insufficiency or falling blood counts require reassessment and discontinuation as directed by the label.

RDM61-rxlist-tmp-smx-64346846d8-C1 · Source locator: Dosage and Administration: renal impairment; named precautions

Source-specific limits

No new official-label card was obtained for this product in v6.1. Earlier source layers, if present, were retained but not rechecked.

Source identity and provenance
Source family
product_label_mirror
Source
https://globalrph.com/rx-list/bactrim-drug/
Retrieved
2026-09-10
Renal-function method
Source-specific renal measure; see text
Source date/version
Revision not established in selected retrieval
Hash meaning
Local authored summary, not source HTML/XML/PDF bytes
Local summary SHA-256
58af103070f5deb04c5d2d23b43fef6eedaf475e9191a97d74d9175b9170c901
Separate professional-source layer

University and professional protocols

Professional

Nebraska - TMP/SMX renal adjustment and source inconsistency

Open original reference

Open / share this exact local source

University of Nebraska Medical Center · Adults; source-specific institutional guidance. Match route, indication and renal replacement modality.

Renal method: CrCl in mL/min where specified; no equation inferred.
Source date: Published 2024-06-28
Retrieved: 2026-09-05

Locally included source-specific summary. Regimen differences are not automatically resolved.

Dosing / renal protocol and limits

The article's final summary uses CrCl >30 mL/min for standard indication-specific dosing, 15-30 for half the usual dose, and <15 for the FDA not-recommended category. Its embedded tables incorrectly print "<30" beside standard dosing, conflicting with that final summary; this discrepancy is not copied as a usable threshold.

Nebraska's separately described institutional alternative for CrCl <15 is 25-50% of the indication-specific total daily dose, with caution and monitoring; on HD days administer after dialysis. This is not the FDA recommendation.

Monitor potassium, sodium and kidney function. Trimethoprim can cause hyperkalemia/hyponatremia, while sulfamethoxazole metabolites can contribute to crystal-associated kidney injury. The article's modality-specific alternative doses are not generalized here because indication and dialysis details matter.

RDM30-094-tmp-smx-1 · Source locator: Nebraska - TMP/SMX renal adjustment and source inconsistency; renal/dosing sections and stated qualifiers

Source-specific limits

Source contains an internal inequality inconsistency. Institutional alternatives and FDA-described restrictions are distinct.

Source identity and provenance
Source
https://blog.unmc.edu/infectious-disease/2024/06/28/pharmtoexamtable-part-2-why-should-sulfamethoxazole-trimethoprim-bactrim-be-used-with-caution-in-patients-with-renal-impairment-or-those-on-dialysis/
Retrieved
2026-09-05
Renal-function method
CrCl in mL/min where specified; no equation inferred.
Source date/version
Published 2024-06-28
Hash meaning
Locally authored summary text; not original SPL, HTML or PDF bytes
Local summary SHA-256
538668d618bec804f8bfe07f9bc672083fd688e71ee89a7d1ea9195c5bdb3e1f
Professional

NIH OI table - PCP treatment in renal insufficiency

Open original reference

Open / share this exact local source

NIH ClinicalInfo opportunistic infection panel · Adults/adolescents with HIV; PCP treatment; intermittent HD, not CRRT/PD

Renal method: Renal function in mL/min as tabulated; verify the measure used for the patient
Source date: Page updated 2025-04-23
Retrieved: 2026-09-05

Locally included source-specific summary. Regimen differences are not automatically resolved.

Dosing / renal protocol and limits

For PCP treatment in adults/adolescents with HIV, the baseline is TMP 5 mg/kg IV every 6-8 hours or two double-strength tablets orally every 8 hours.

Renal adjustmentPCP treatment
15-30 mL/minTMP 5 mg/kg IV every 12 hours or two DS tablets every 12 hours
<15 mL/minTMP 5 mg/kg IV daily, or one DS tablet every 12 hours (alternative: two DS daily)
Intermittent HDTMP 5 mg/kg IV daily or two DS tablets daily; administer after HD on dialysis days

NIH suggests considering TMP-level monitoring, targeting 5-8 mcg/mL. This is a PCP-specific expert regimen, not the manufacturer's general <15 not-recommended restriction, and not a CRRT/PD protocol. All weight-based doses refer to trimethoprim, not combined ingredient mass.

RDM30-101-tmp-smx-1 · Source locator: NIH OI table - PCP treatment in renal insufficiency; renal/dosing sections and stated qualifiers

Source identity and provenance
Source
https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/dosing-recommendations-drugs-used
Retrieved
2026-09-05
Renal-function method
Renal function in mL/min as tabulated; verify the measure used for the patient
Source date/version
Page updated 2025-04-23
Hash meaning
Locally authored summary text; not original SPL, HTML or PDF bytes
Local summary SHA-256
34ad551e9bb69bd0030ee9755e66f87b1ba49fcc23ff61a35cf1ece09498c573

Provenance and preservation

Additional summaries stored on this page: 0 official-label, 1 RX List, 2 professional, 0 handbook. Empty additional-source groups are not shown. A missing layer is not a no-adjustment recommendation.

Original source
https://globalrph.com/renal/tmp-smx/
Source retrieval
2026-09-05. This is not the source publication or label revision date.
Original source type
globalrph individual
Local text SHA-256
9083d62f33279468514a2e6d0007ea8d7ebd3f26f5ee02ed9682bbc5c59ab9ac
Import versus clinical validation
Source-section locators identify where retained content came from. A source-section identifier does not assert that every numeric statement has been independently corroborated. The local text hash is not a hash of original HTML, an FDA PDF or SPL XML.

The original individual GlobalRPh pages commonly cite NIH/NLM DailyMed and instruct readers to review the applicable package insert for updates. That historical reference is preserved as context; it is not counted as an independently retrieved current label.

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