It’s an underappreciated fact that that the sulphonamides provide a stable backbone for many commonly used drugs, including hydrochlorothiazide, celecoxib and furosemide. This has led several regulatory bodies around the world to advise avoiding certain drugs among patients who’ve had an adverse reaction to sulphonamides, probably most famously with respect to celecoxib (Celebrex).

While it’s important to be prudent with respect to drug safety, a certain amount of common sense also helps. There is well-established cross-reactivity among the antimicrobial sulphonamides, and it’s speculated that this is related to their common tertiary amine, the basis of their antimicrobial activity. In contrast, the non-antimicrobial sulphonamides, while sharing the sulphonamide backbone, don’t share the tertiary amine in question. So a patient who has had an adverse reaction to an antimicrobial sulphonamide — such
as a rash after taking Septra — wouldn’t be expected to have an adverse reaction to the usual dose of a non-antimicrobial sulphonamide such as hydrochlorothiazide. This has been demonstrated most convincingly with celecoxib, and there are several papers demonstrating that there’s no reason to avoid the use of celecoxib in patients sensitive to antimicrobial sulphonamide.

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