Are there foods to avoid while taking Bactrim?

Key takeaways

• Bactrim can cause nausea, vomiting, and loss of appetite, so you may want to avoid alcohol, spicy or fatty foods, and acidic foods while taking it. Probiotic and prebiotic foods can help restore healthy gut bacteria after you finish treatment.
• If you have kidney disease or take angiotensin converting enzyme (ACE) inhibitors, Bactrim may raise your potassium levels. Talk with your doctor about whether you should limit high-potassium foods like lima beans, baked potatoes, yams, and spinach.
• You can take Bactrim (sulfamethoxazole/trimethoprim) with or without food and continue your regular diet. However, drinking plenty of water is important.

Overview

Bactrim is a brand-name antibiotic. It kills bacteria in the body that cause illness. It’s available in a generic version called sulfamethoxazole/trimethoprim.

Some foods and beverages, like alcohol and foods high in potassium, can interact with certain antibiotics, reducing their efficacy or creating a risk of toxicity. With Bactrim, the risk of interaction is small unless you have specific medical conditions. 

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What foods should I avoid?

You can typically continue with your regular diet while taking Bactrim, and you can take it with or without food. However, if you experience an upset stomach, you may want to start taking the medication with food. 

Common side effects of Bactrim include:

• nausea
• vomiting
• loss of appetite

Although your doctor may not advise you to change your diet, you may want to avoid or limit some foods and beverages to help prevent these and other side effects.

Let’s look at some of these in more detail.

Alcohol 

Many antibiotics come with a warning to avoid alcohol. The evidence regarding not taking Bactrim with alcohol is uncertain.

A 2020 review of studies looked at how alcohol affects the efficacy of specific antibiotics. The review also assessed whether alcohol created a toxic interaction or otherwise affected how the drug worked.

According to the review, some antibiotics have a negative interaction with alcohol. These include the following:

• erythromycin (Erythrocin)
• ketoconazole (Extina)
• griseofulvin (Grifulvin V)
• isoniazid (Rimifon)
• cephalosporins like cefamandole (Mandol) and cefmetazole (Zefazone)

It’s important to avoid alcohol if you take any of these antibiotics.

However, the evidence around alcohol and Bactrim in particular is unclear. According to limited research, alcohol might cause facial flushing when consumed while taking Bactrim. Your doctor may recommend avoiding alcohol just to be safe.

Some people also experience indigestion if they consume too many alcoholic beverages. Because Bactrim may increase the risk of an upset stomach, you may want to avoid drinking alcohol if you’re concerned about indigestion or other digestive issues. 

Potassium-rich foods

Bactrim may increase the risk of developing hyperkalemia (high potassium levels) if you have a condition that affects how your body uses potassium or if you have weakened kidney function.

Bactrim can also raise the risk of hyperkalemia if you take angiotensin converting enzyme (ACE) inhibitors while you’re taking Bactrim. ACE inhibitors can also raise blood potassium levels. Talk with your doctor about the risks of Bactrim if you take ACE inhibitors such as:

• benazepril (Lotensin)
• fosinopril
• quinapril (Accupril)

If you’re at risk for hyperkalemia, ask your doctor whether you should limit high-potassium foods while taking Bactrim. 

High potassium foods include:

• lima beans
• baked potatoes
• yams
• spinach
• carrot juice

Foods that may upset your stomach 

Because Bactrim can cause digestive issues like nausea, vomiting, and loss of appetite, you might want to avoid taking it alongside foods that may also upset your stomach.

Some common foods that can lead to an upset stomach include:

• caffeinated or fizzy beverages
• spicy, fatty, or greasy foods
• acidic foods like tomatoes or oranges

Foods not on this list can also cause digestive issues. If you know that certain foods can upset your stomach, try to avoid them while you’re taking Bactrim.

What foods should I include more of?

Antibiotics like Bactrim can kill some of the good bacteria in the gut while killing the bad bacteria that cause illness. Eating foods that contain good bacteria can help balance your gut.

Probiotics are foods that contain good bacteria. Prebiotic foods don’t contain good bacteria but have complex carbohydrates that help the good bacteria to grow in your gut. 

Probiotic foods include:

• yogurt
• kimchi
• kefir
• buttermilk
• tempeh
• pickles

Prebiotic foods include:

• asparagus
• whole grains
• onions
• garlic
• soybeans

It’s important to drink plenty of water while taking Bactrim (sulfamethoxazole/trimethoprim). This is because it may increase the risk of crystalluria, which is crystals forming in your urine. If these crystals clump together, they can form kidney stones.

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What other medications could I try?

If you’d prefer not to take Bactrim, your doctor can recommend a different type of antibiotic.

Alternatives to Bactrim depend on the condition you need to treat. Some examples include antibiotics in other classes, such as:

• Penicillin antibiotics: One example is amoxicillin (Amoxil), which you can take with or without food. You can add another liquid, like milk or fruit juice, to the suspension version. You can continue your usual diet.
• Cephalosporin antibiotics: An example is cephalexin (Keflex), which you can take with or without food. You can continue your usual diet.
• Macrolide antibiotics: One example is azithromycin (Zithromax) in tablet form, which you can take with or without food. Azithromycin is also available as a suspension (Zmax), which you need to take on an empty stomach. If you take an antacid, ask a doctor or pharmacist how long to wait after the antacid for your azithromycin dose. You can continue your usual diet. 

A doctor might recommend a different antibiotic or other treatment not on this list as an alternative to Bactrim. 

Next steps

If you’ve been prescribed Bactrim, here are some next steps to consider:

• Think about your routine. You can take Bactrim with or without food, but try to take it at a consistent time to help you stick with the treatment.
• Keep track of your side effects. If you find Bactrim makes you feel nauseous, you might consider eating bland foods to settle your stomach.
• Discuss your other medications. If you take ACE inhibitors, you may consider avoiding high-potassium foods.

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