Sulfa drugs include:

• Co-Trimoxazole (Septrin)
• Sulfadiazine
• Sulfamethoxazole (Gantanol)
• Trimethoprim-Sulfamethoxazole (Bactrim, Bactrim DS, Septra, and Septra DS)
• Trimethoprim (Trimpex, Proloprim, and Primsol)
• Sulfasalazine (Azulfidine EN-tabs, Azulfidine, and Sulfazine)
• Sulfisoxazole (Gantrisin)

Taking sulfa drugs may deplete good bacteria and vitamin B9

Good Bacteria

There are many types of good bacteria that live in your intestine. They help keep your digestive system healthy. Two of these bacteria are Lactobacillus acidophilus and Bifidobacterium bifidum.

Good bacteria help you to:

• Fight against infections and diseases
• Digest food

Use of some medicines may deplete good bacteria. If you do not have enough probiotics in your gut, you may have:

• Gas
• Stomach problems
• Diarrhea
• More serious infections in your intestine
• Increased risk of allergies

Some foods called probiotics contain good bacteria, and can help return your gut to normal.

Vitamin B9 (Folic Acid)

Low levels of folic acid in the body may be linked to:

• Anemia
• Heart disease
• Birth defects

Symptoms may include:

• Weakness
• Mouth sores
• Swollen tongue
• Depression
• Poor growth

The information presented here covers some of the nutrients that may be affected when you take certain medicines. If you have any of these signs and symptoms, it does not always mean you have low levels of these nutrients.

Factors that affect the level of nutrients are:

• Your medical history
• Diet
• Lifestyle
• How long you have been taking the medicine

Please talk to your health care provider. They can best address your health care needs and see if you are at risk for low levels of any nutrients.

Chen LA, Sears CL. Prebiotics, probiotics, and synbiotics. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 3.

Gold Standard Drug Database: Drug Monograph: Sulfasalazine 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-582. Accessed July 18, 2016.

Gold Standard Drug Database: Drug Monograph: Sulfisoxazole 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-583. Accessed July 18, 2016.

Harrison GJ. Probiotics. In: Cherry JD, Demmler-Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 242.

Sachdev HPS, Shah D. Vitamin B complex deficiencies and excess. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 49.

Shenkin A, Roberts NB. Vitamins and trace elements. In: Burtis CA, Ashwood ER, Bruns DE, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th ed. St. Louis, MO: Elsevier Saunders; 2012:chap 31