Clinical safety rating: caution
Combination used for Intermittent Preventive Treatment in Pregnancy (IPTp) — a WHO-recommended malaria prevention strategy for sub-Saharan Africa. Given at each ANC visit from 13 weeks onward (not T1) at least 4 weeks apart. Reduces risk of maternal anaemia, LBW, and perinatal mortality in malaria-endemic settings. Pyrimethamine is a folate antagonist — co-administer with folic acid 5 mg/day. Avoid in T1 (folate antagonism during organogenesis). Sulfadoxine carries sulfonamide risk at term.
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Dosing varies by indication and patient profile. Always follow your institution's current prescribing guidelines.
| Renal impairment | Consult protocols for adjustment. |
| Liver impairment | Consult protocols for adjustment. |
| 1st trimester | Avoid. Pyrimethamine is a folate antagonist with teratogenic risk in organogenesis. |
| 2nd trimester | Safe and recommended from 13 weeks for IPTp in malaria-endemic areas (with folic acid 5 mg/day). |
| 3rd trimester | Safe for IPTp. Avoid after 36 weeks (sulfonamide-related neonatal jaundice risk). |
Clinical note
Combination used for Intermittent Preventive Treatment in Pregnancy (IPTp) — a WHO-recommended malaria prevention strategy for sub-Saharan Africa. Given at each ANC visit from 13 weeks onward (not T1) at least 4 weeks apart. Reduces risk of maternal anaemia, LBW, and perinatal mortality in malaria-endemic settings. Pyrimethamine is a folate antagonist — co-administer with folic acid 5 mg/day. Avoid in T1 (folate antagonism during organogenesis). Sulfadoxine carries sulfonamide risk at term.
| Breastfeeding | Caution. Pyrimethamine and sulfadoxine pass into breast milk. Avoid in mothers breastfeeding infants with jaundice or G6PD deficiency. |
Avoid in patients with known hypersensitivity to this drug or any of its components.
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