phil@wubios.wustl.edu (for an anomous poster) (07/27/89)
I am seeking some information......I have been on AZT for twenty months now, with no bad side effects. However, my T cell count, after going up to the low 300's from the low 100's, has gone back down to the very low 100's. My Dr. has suggested that I start some additional preventitive measures. He is a leader in providing AIDS care in San Francisco. He suggested that Aerosol Pent. has become "trendy" and even more is not systemic to the entire body. Therefore I am on Fansidar, once a week. I have been for six weeks, with no side effects that I am aware of. My blood is monitored ever two weeks for "internal" problems. In looking Fansidar up in the PDR, it only talks about it as a drug for Malaria. Does anyone have additional information.......? Please respond to sci.med.aids if you do. THANKS
dyer@spdcc.COM (Steve Dyer) (07/28/89)
In article <26079@shemp.CS.UCLA.EDU> phil@wubios.wustl.edu writes: >My Dr. has suggested that I start some additional preventitive >measures. He is a leader in providing AIDS care in San Francisco. He >suggested that Aerosol Pent. has become "trendy" and even more is not >systemic to the entire body. Therefore I am on Fansidar, once a week. >I have been for six weeks, with no side effects that I am aware of. My >blood is monitored ever two weeks for "internal" problems. In looking >Fansidar up in the PDR, it only talks about it as a drug for Malaria. >Does anyone have additional information.......? Please respond to >sci.med.aids if you do. THANKS First, understand that I'm not a doctor and am not intimately familiar with recent trends in chemoprophylaxis for AIDS-related infections. There is a lot of nuance which gets lost in answering things over the net, and you should ask your doctor these questions also. I can give you only general information, and not any opinions informed by practice and experience. If your doctor is a leader in AIDS care in SF, he must be pretty good. One of the pluses for aerosolized pentamidine is precisely that it delivers the drug to the lungs, sparing the rest of the body. Pentamidine had previously had a reputation for being a rather toxic drug because it had to be given systemically. It's much less toxic as a localized aerosol. Fansidar is a combination consisting of a long-acting sulfa drug (sulfadoxine) and a long-acting dihydrofolate reductase inhibitor, pyrimethamine. Given once a week, these drugs persist in the body for about a week. Fansidar is frequently used for malarial chemo- prophylaxis in areas where chloroquine is no longer effective. This, and the treatment of malaria, are still its only FDA-approved indications. The mechanism of action of Fansidar is similar to that of Bactrim or Septra, a similar combination drug which uses the short-acting agents sulfa- methoxazole and trimethoprim. Such a combination suppresses the growth of _P . carinii_. Bactrim or Septra has been very effective in treating active PCP infections, but many AIDS patients tolerate it very poorly, exhibiting side-effects which are infrequent in other populations. The concern about Fansidar is that the so-called long-acting sulfa drugs can be very toxic, in unpredictable and idiosyncratic ways. Drugs like sulfadoxine were popular in the early 60's but were ultimately withdrawn because of their propensity to cause dangerous side-effects at a rate much higher than the ordinary sulfa drugs which need to be taken several times a day. Some of the side effects include a variety of blood disorders, including dangerously low white cell counts and halting of red cell production, and skin reactions ranging from rashes and sun sensitivity to much more serious syndromes. These are unpredictable reactions, and still rare, but more frequent than people on other sulfa drugs. Now, you are having your blood tested every two weeks to make sure that you aren't exhibiting early signs of a reaction. Similarly, you should probably report any rash which occurs to your doctor. The question which I cannot answer, but your doctor probably can, is whether Fansidar is effective enough in preventing PCP flareups that the small risk of potentially dangerous side-effects is worth taking. It might very well be, given the debilitating nature of PCP infections in many people with AIDS. -- Steve Dyer dyer@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer dyer@arktouros.mit.edu
Mark.Downs@f5000.n106.z1.fidonet.org (Mark Downs) (02/03/90)
Does anyone have any good information on the use of Fansidar (500 Mg
sulfadoxine and 25 mg pyrimethamine) as a prophylactic for PCP, either in lieu
of or in combination with aerosolized Pentamadine?
Thanks.
Mark Downs
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Uucp: ...{gatech,ames,rutgers}!ncar!asuvax!stjhmc!106!5000!Mark.Downs
Internet: Mark.Downs@f5000.n106.z1.fidonet.orgKen.Green@p5.f180.n221.z1.fidonet.org (Ken Green) (02/11/90)
-> In a message to All <01-31-90 16:48> Mark Downs wrote:
->
-> MD> Does anyone have any good information on the use of
-> MD> Fansidar (500 Mg sulfadoxine and 25 mg pyrimethamine) as a
well Mark, I don't have any NEW specific information about Fansidar; but my
feeling is that aerasolized Pentamadine, taken properly is sufficient
prophylactic for PCP
my personal attitude toward drug taking is to not complicate unnecessarily
the drug intake because of side effects/ and unpredicable drug interactions
the drug situation in Canada is a lot different than that in the U.S. as
you know; it could be that one of the drugs you mentioned may assist rather
than hinder pentamadine in its role, sorry i can't offer more at the moment
but i'll keep my eyes and ears open for you for sure
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Internet: Ken.Green@p5.f180.n221.z1.fidonet.org