Abstract
A child with dihydropteridine reductase (DHPR) deficiency developed signs of dopamine insufficiency after being given trimethoprim-sulfamethoxazole (TMP-SMX). She recovered function after the antibiotic was stopped, which suggests that it adversely influenced dopamine metabolism in the CNS. The authors speculate that TMP, a dihydrofolate reductase inhibitor, was the major cause of the patient's deterioration, and suggest that it and other dihydrofolate inhibitors, notably methotrexate, are contra-indicated for patients with DHPR deficiency.
MeSH terms
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Child, Preschool
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Dopamine / cerebrospinal fluid
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Epinephrine / cerebrospinal fluid
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Female
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Humans
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NADH, NADPH Oxidoreductases / deficiency*
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Norepinephrine / cerebrospinal fluid
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Phenylalanine / blood
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Phenylketonurias*
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Sinusitis / drug therapy*
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Tremor / chemically induced
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Trimethoprim, Sulfamethoxazole Drug Combination / administration & dosage
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Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects*
Substances
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Phenylalanine
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Trimethoprim, Sulfamethoxazole Drug Combination
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NADH, NADPH Oxidoreductases
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Dopamine
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Norepinephrine
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Epinephrine