{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:22:59Z","timestamp":1777418579782,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[1998,2,1]],"date-time":"1998-02-01T00:00:00Z","timestamp":886291200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[1998,2]]},"abstract":"\n OBJECTIVE:<\/jats:title>\n To report a case of trimethoprim\/sulfamethoxazole (TMP\/SMX)-induced tremor responsive to a reduction in dosage.<\/jats:p>\n <\/jats:sec>\n \n CASE SUMMARY:<\/jats:title>\n A 55-year-old white man with AIDS and Pneumocystis carinii pneumonia (PCP) developed a tremor after receiving 5 days of therapy with TMP\/SMX 19.4 mg\/kg\/d (TMP). The tremor resolved completely 3 days after a dosage reduction to TMP\/SMX 15.1 mg\/kg\/d.<\/jats:p>\n <\/jats:sec>\n \n DISCUSSION:<\/jats:title>\n Central nervous system adverse reactions to TMP\/SMX have been reported in both the AIDS and non-AIDS populations. To our knowledge, this is the first reported case of TMP\/SMX-induced tremor responsive to a reduction in dosage. Pharmacokinetic and clinical data suggest a concentration-dependent etiology for various adverse effects, including tremor. The mechanism of the tremor is unknown; however, toxic metabolites of SMX and disruptions of biogenic amine neurotransmission by TMP have been hypothesized.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n TMP\/SMX remains the drug of first choice for treating PCP, but it is clearly not well tolerated by patients with AIDS. Concentration-dependent toxicities such as tremor may lead to premature discontinuation of proven, effective TMP\/SMX therapy. Using the lower end of the recommended dosing range for TMP\/SMX (TMP 15 mg\/kg\/d) may reduce the incidence of these toxicities while still achieving acceptable TMP concentrations and antimicrobial efficacy.<\/jats:p>\n <\/jats:sec>\n \n OBJETIVO:<\/jats:title>\n Informar el caso de una reacci\u00f3n de temblores asociados al uso de trimetoprim\/sulfametoxazol (TMP\/SMX) que respondi\u00f3 a una reducci\u00f3n en dosis.<\/jats:p>\n <\/jats:sec>\n \n RESUMEN DEL CASO:<\/jats:title>\n Un hombre de 55 a\u00f1os de edad con diagn\u00f3stico de SIDA desarroll\u00f3 temblores tras el uso por 5 d\u00edas de TMP\/SMX para el tratamiento de una pulmonia por Pneumocystis carinii (PCP). El paciente estaba recibiendo una dosis de 19.4 mg\/kg\/d\u00eda del componente de trimetoprim (TMP). Los temblores desaparecieron completamente 3 d\u00edas luego de que la dosis TMP\/SMX fuera reducida a 15.1 mg\/kg\/d\u00eda.<\/jats:p>\n <\/jats:sec>\n \n DISCUSI\u00d3N:<\/jats:title>\n Las reacciones adversas a TMP\/SMX se han reportado tanto en pacientes con SIDA como en pacientes que no padecen de esta condici\u00f3n. Seg\u00fan entienden los autores, este es el primer informe de temblores inducidos por TMP\/SMX que responde a una reducci\u00f3n en dosis. Los datos farmacocin\u00e9ticos y cl\u00ednicos sugieren una etiolog\u00eda relacionada a la dosis para varios de los efectos adversos, incluyendo los temblores. El mecanismo mediante el cual ocurren los temblores no es conocido, sin embargo se ha sugerido que metabolitos t\u00f3xicos de SMX y alteraciones en la neurotransmisi\u00f3n de aminas pueden ser factores contribuyentes.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONES:<\/jats:title>\n TMP\/SMX contin\u00faa siendo el agente de selecci\u00f3n para el tratamiento de PCP, pero es claramente no muy bien tolerado en pacientes que padecen del SIDA. Reacciones t\u00f3xicas que pueden estar relacionadas a la concentraci\u00f3n del f\u00e1rmaco, como por ejemplo, los temblores, pueden llevar a la descontinuaci\u00f3n prematura del tratamiento con TMP\/SMX. El utilizar la dosis m\u00e1s baja dentro del rango de dosis recomendado (15 mg\/kg\/d\u00eda de TMP) podr\u00eda reducir la incidencia de toxicidad, alcanzando a\u00fan concentraciones de TMP aceptables que mantienen la efectividad antimicrobial.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIF:<\/jats:title>\n Signaler un cas de tremblement associ\u00e9 au TMP\/SMX qui a r\u00e9pondu \u00e0 une diminution de la dose.<\/jats:p>\n <\/jats:sec>\n \n R\u00c9SUM\u00c9 DU CAS:<\/jats:title>\n Un homme \u00e2g\u00e9 de 55 ans souffrant du SIDA a d\u00e9velopp\u00e9 un tremblement \u00e0 la suite d'un traitement de 5 jours pour une pneumonie \u00e0 Pneumocystis carinii (PPC) \u00e0 l'aide de TMP\/SMX \u00e0 la dose de 19.4 mg\/kg\/jour TMP. Le tremblement est disparu compl\u00e8tement 3 jours apr\u00e8s une diminution de la dose de TMP\/SMX \u00e0 15.1 mg\/kg\/jour.<\/jats:p>\n <\/jats:sec>\n \n DISCUSSION:<\/jats:title>\n Des effets ind\u00e9sirables au niveau du syst\u00e8me nerveux central associ\u00e9s au TMP\/SMX ont d\u00e9j\u00e0 \u00e9t\u00e9 signal\u00e9s tant chez la population sid\u00e9enne que non-sid\u00e9enne. \u00c0 la connaissance des auteurs, il s'agit du premier cas signal\u00e9 de tremblement induit par le TMP\/SMX qui r\u00e9pond \u00e0 une diminution de la dose. Des donn\u00e9es pharmacin\u00e9tiques et cliniques sugg\u00e8rent un lien entre plusieurs effets ind\u00e9sirables, y compris les tremblements, et la concentration du m\u00e9dicament. Le m\u00e9canisme expliquant le tremblement n'est pas connu, mais on a \u00e9mis l'hypoth\u00e8se de l'existence de m\u00e9tabolites toxiques du SMX ou encore le bris de la neurotransmission des amines biog\u00e8nes par le TMP.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Le TMP\/SMX demeure le m\u00e9dicament de premier choix dans le traitement de la PPC, mais il est d\u00e9finitivement mal tol\u00e9r\u00e9 chez les patients sid\u00e9ens. Des toxicit\u00e9s reli\u00e9es \u00e0 la dose, tel le tremblement, peut conduire \u00e0 un arr\u00eat pr\u00e9matur\u00e9 du TMP\/SMX, une th\u00e9rapie prouv\u00e9e efficace. Utiliser le TMP\/SMX \u00e0 la dose minimale efficace (15 mg\/kg\/jour de TMP) peut diminuer l'incidence de ces toxicit\u00e9s tout en assurant des taux acceptables de TMP et une efficacit\u00e9 antimicrobienne.<\/jats:p>\n <\/jats:sec>","DOI":"10.1345\/aph.17173","type":"journal-article","created":{"date-parts":[[2004,3,11]],"date-time":"2004-03-11T17:08:19Z","timestamp":1079024899000},"page":"189-192","source":"Crossref","is-referenced-by-count":15,"title":["Trimethoprim\/Sulfamethoxazole-Induced Tremor in a Patient with AIDS"],"prefix":"10.1177","volume":"32","author":[{"given":"Richard S","family":"Slavik","sequence":"first","affiliation":[{"name":"Richard S Slavik PharmD, at time of writing, PharmD Student, College of Pharmacy and Allied Health, Wayne State University, Detroit, MI; now, Clinical Pharmacy Specialist-Critical Care, Pharmacy Department, Royal Columbian Hospital, New Westminster, British Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J","family":"Rybak","sequence":"additional","affiliation":[{"name":"Michael J Rybak PharmD FCCP, Professor of Pharmacy and Medicine, Wayne State University, and Director, The Anti-Infective Research Laboratory, Department of Pharmacy Services, Detroit Receiving Hospital and University Health Center, Detroit"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen A","family":"Lerner","sequence":"additional","affiliation":[{"name":"Stephen A Lerner MD, Professor of Medicine, Vice Chief and Director of Research, Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Wayne State University"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[1998,2,1]]},"reference":[{"key":"bibr1-aph.17173","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/4.2.196"},{"key":"bibr2-aph.17173","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1994.00420210028004"},{"key":"bibr3-aph.17173","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.1990.tb08549.x"},{"key":"bibr4-aph.17173","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-199104000-00019"},{"key":"bibr5-aph.17173","doi-asserted-by":"publisher","DOI":"10.1177\/070674379303800114"},{"key":"bibr6-aph.17173","doi-asserted-by":"publisher","DOI":"10.1080\/00325481.1994.11945926"},{"key":"bibr7-aph.17173","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/00006454-198407000-00018","volume":"3","author":"Theodoru AA","year":"1984","journal-title":"Pediatr Infect Dis J"},{"key":"bibr8-aph.17173","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-104-3-448_1"},{"key":"bibr9-aph.17173","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.48.2.537-a"},{"key":"bibr10-aph.17173","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/22.3.598"},{"key":"bibr11-aph.17173","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-109-1-77"},{"key":"bibr12-aph.17173","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.35.9.1884"},{"key":"bibr13-aph.17173","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.37.3.448"},{"key":"bibr14-aph.17173","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(78)80028-6"},{"key":"bibr15-aph.17173","first-page":"47S","volume":"112","author":"Hughes WT","year":"1975","journal-title":"Can Med Assoc J"},{"key":"bibr16-aph.17173","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)91046-W"},{"key":"bibr17-aph.17173","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-109-4-280"},{"key":"bibr18-aph.17173","unstructured":"Fong IW. Correlation of side effects of trimethoprim\u2014sulfamethoxazole with blood levels in AIDS patients treated for Pneumocystis carinii pneumonia (abstract). 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