October 1, 2015
Pyrimethamine is no longer available in retail pharmacies in the United States, though it is available through a commercial specialty pharmacy program (the application process, approval, and delivery of the medication will take at least 2 days; for information on ordering, click here). If treatment for toxoplasmosis, Pneumocystis jiroveci pneumonia (PCP), or Isospora infection must be started urgently, before pyrimethamine can be obtained, alternative regimens should be started. For toxoplasmosis, the OI Guidelines Panel recommends the use of trimethoprim-sulfamethoxazole (for patients not allergic to the components) until pyrimethamine can be obtained for use in preferred regimens (eg, pyrimethamine + sulfadiazine). Information on recommended and alternative regimens is included in the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.
Additionally, the new manufacturer of pyrimethamine substantially increased the price of the drug in September 2015, by more than 5,000%. While some portion of the cost increase may be rolled back in response to protests from the medical community, the price may remain prohibitive to some payers.
Susa Coffey is medical editor of the NCRC. She is a Professor of Medicine at UCSF in the Division of HIV, Infectious Diseases and Global Medicine and a longtime clinician and educator in the HIV at San Francisco General Hospital clinic (“Ward 86”). She also is medical editor of HIV InSite.