RENOQUID

Clinical safety rating: caution

Comprehensive clinical and safety monograph for RENOQUID (RENOQUID).

How it works

RENOQUID is a combination of sulfamethoxazole, an intermediate-acting sulfonamide, and trimethoprim, a dihydrofolate reductase inhibitor. It inhibits sequential steps in bacterial folic acid synthesis: sulfamethoxazole inhibits dihydropteroate synthase, and trimethoprim inhibits dihydrofolate reductase, leading to bactericidal activity.

What the body does with it

Metabolism	Sulfamethoxazole is metabolized in the liver via acetylation and glucuronidation; trimethoprim is metabolized in the liver via O-demethylation and alpha-hydroxylation. Both are excreted renally as metabolites and unchanged drug.
Excretion	Renal excretion accounts for approximately 70% of elimination, with 30% excreted unchanged in urine. Biliary/fecal excretion accounts for 30%, primarily as metabolites.
Half-life	Terminal elimination half-life is 2.5 hours (range 2–3 hours) in patients with normal renal function. In renal impairment (CrCl <30 mL/min), half-life may extend to 8–12 hours.
Protein binding	Protein binding is approximately 85% (80–90%), primarily to albumin.
Volume of Distribution	Volume of distribution is 0.8 L/kg (range 0.6–1.0 L/kg), indicating distribution into total body water and some tissue binding.
Bioavailability	Oral bioavailability is 90% (range 85–95%) for the immediate-release formulation; the extended-release formulation has approximately 80% bioavailability relative to immediate release.
Onset of Action	Oral: Onset of action occurs within 30–60 minutes after administration, with peak effects at 1–2 hours.
Duration of Action	Duration of action is approximately 6–8 hours for the standard formulation, as determined by sustained antibacterial concentrations. Extended-release formulations may provide up to 12 hours.

Classification & Brands

Dosing & administration

100 mg orally twice daily

Dosage form	TABLET
Renal impairment	CrCl 30-49 mL/min: 50 mg twice daily; CrCl 10-29 mL/min: 50 mg once daily; CrCl <10 mL/min: not recommended
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: 50 mg once daily; Child-Pugh C: not recommended
Pediatric use	2-17 years: 2 mg/kg orally twice daily, maximum 100 mg per dose
Geriatric use	Start at 50 mg twice daily; increase cautiously based on response and tolerability

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for RENOQUID (RENOQUID).

Breastfeeding	Not recommended. No data on excretion in human milk. M/P ratio unknown. Potential for serious adverse reactions in nursing infants. Discontinue drug or nursing.
Teratogenic Risk	Teratogenic risk profile not established. Animal reproduction studies not conducted. Unknown human risk. Caution advised in first trimester due to unknown effects. Second and third trimester risks not defined.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Fatal hypersensitivity reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia) may occur. Contraindicated in patients with a history of sulfonamide hypersensitivity.

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to sulfonamides, trimethoprim, or any component; megaloblastic anemia due to folate deficiency; severe hepatic damage; severe renal impairment (CrCl <15 mL/min) when repeated dosing is required; pregnancy (especially first trimester and near term); breastfeeding; infants <2 months of age.

Clinical Precautions

Precautions

Risk of severe hypersensitivity reactions; hemolytic anemia in G6PD-deficient patients; megaloblastic anemia due to folate deficiency; prolonged QT interval; hyperkalemia (especially in elderly or renal impairment); photosensitivity; administration with caution in patients with impaired renal or hepatic function, severe allergy, bronchial asthma, or folate deficiency.

Clinical Tips & Counseling

Drug interactions

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RENOQUID

Clinical safety rating: caution

Comprehensive clinical and safety monograph for RENOQUID (RENOQUID).

How it works

What the body does with it

Metabolism	Sulfamethoxazole is metabolized in the liver via acetylation and glucuronidation; trimethoprim is metabolized in the liver via O-demethylation and alpha-hydroxylation. Both are excreted renally as metabolites and unchanged drug.
Excretion	Renal excretion accounts for approximately 70% of elimination, with 30% excreted unchanged in urine. Biliary/fecal excretion accounts for 30%, primarily as metabolites.
Half-life	Terminal elimination half-life is 2.5 hours (range 2–3 hours) in patients with normal renal function. In renal impairment (CrCl <30 mL/min), half-life may extend to 8–12 hours.
Protein binding	Protein binding is approximately 85% (80–90%), primarily to albumin.
Volume of Distribution	Volume of distribution is 0.8 L/kg (range 0.6–1.0 L/kg), indicating distribution into total body water and some tissue binding.
Bioavailability	Oral bioavailability is 90% (range 85–95%) for the immediate-release formulation; the extended-release formulation has approximately 80% bioavailability relative to immediate release.
Onset of Action	Oral: Onset of action occurs within 30–60 minutes after administration, with peak effects at 1–2 hours.
Duration of Action	Duration of action is approximately 6–8 hours for the standard formulation, as determined by sustained antibacterial concentrations. Extended-release formulations may provide up to 12 hours.

Classification & Brands

Dosing & administration

100 mg orally twice daily

Dosage form	TABLET
Renal impairment	CrCl 30-49 mL/min: 50 mg twice daily; CrCl 10-29 mL/min: 50 mg once daily; CrCl <10 mL/min: not recommended
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: 50 mg once daily; Child-Pugh C: not recommended
Pediatric use	2-17 years: 2 mg/kg orally twice daily, maximum 100 mg per dose
Geriatric use	Start at 50 mg twice daily; increase cautiously based on response and tolerability

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for RENOQUID (RENOQUID).

Breastfeeding	Not recommended. No data on excretion in human milk. M/P ratio unknown. Potential for serious adverse reactions in nursing infants. Discontinue drug or nursing.
Teratogenic Risk	Teratogenic risk profile not established. Animal reproduction studies not conducted. Unknown human risk. Caution advised in first trimester due to unknown effects. Second and third trimester risks not defined.
Fetal Monitoring