Generic Suprax ( Cefixime )

Buy Generic Suprax (Cefixime) without prescription in Canada

In our Canadian pharmacy, you can buy Suprax (Cefixime) without a prescription, with delivery across Canada within 5‑14 days. Discreet and anonymous packaging.

Suprax (cefixime) is a third‑generation oral cephalosporin antibiotic used to treat a wide variety of mild to moderate bacterial infections, including those of the respiratory tract, middle ear, sinuses, throat, urinary tract, and uncomplicated gonorrhoea. It works by binding to penicillin‑binding proteins (PBPs) and interfering with the synthesis of the bacterial cell wall, leading to osmotic instability and cell death. Cefixime is highly stable against a broad range of beta‑lactamases and is active against many Gram‑positive and Gram‑negative organisms, making it a valuable option when narrower‑spectrum agents are not appropriate.

Usual adult dose: For most infections, the recommended dose is 400 mg taken orally once daily, either as a single dose or in two divided doses of 200 mg every 12 hours. For uncomplicated gonorrhoea, a single oral dose of 400 mg is given. The 100 mg tablet is often used for paediatric patients or for lower‑dose regimens in adults with renal impairment. The tablet should be swallowed whole with a full glass of water and may be taken with or without food. Therapy is typically continued for 7 to 10 days, depending on the site and severity of infection, and for at least 48 to 72 hours after symptoms have resolved.

Dosage form: Oral film‑coated tablets: 100 mg and 200 mg of cefixime (as cefixime trihydrate). An oral suspension (100 mg/5 mL and 200 mg/5 mL) is also available for paediatric use.

Onset of action: Cefixime is absorbed relatively slowly, with peak serum concentrations reached approximately 2 to 4 hours after an oral dose. Clinical improvement, such as fever reduction and symptom relief, is usually seen within 48 to 72 hours of starting therapy, though the full course must be completed to ensure bacterial eradication.

Duration of action: The elimination half‑life of cefixime is approximately 3 to 4 hours in patients with normal renal function. Despite this relatively short half‑life, therapeutic concentrations in plasma and tissues remain above the minimum inhibitory concentration (MIC) for susceptible organisms with once‑ or twice‑daily dosing. Excretion is predominantly renal, and dose adjustment is required for patients with creatinine clearance below 60 mL/min.

Alcohol recommendation: Alcohol consumption does not directly interfere with the antibacterial action of Suprax. However, alcohol should be limited during treatment because it can worsen gastrointestinal side effects such as nausea and diarrhoea, impair the body’s immune response, and contribute to dehydration. There is no disulfiram‑like reaction with this cephalosporin.

Most common side effects: Diarrhoea, loose stools, nausea, abdominal pain, dyspepsia, and headache. These are generally mild and self‑limiting. Skin rash, urticaria, and pruritus may occur, particularly in patients with a history of penicillin allergy, as cross‑sensitivity between cephalosporins and penicillins is possible. Rare but serious adverse effects include Clostridioides difficile‑associated diarrhoea, anaphylaxis, severe cutaneous adverse reactions (Stevens‑Johnson syndrome, toxic epidermal necrolysis), and blood dyscrasias.

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General Information about Suprax (Cefixime)

• INN (International Nonproprietary Name): Cefixime (as cefixime trihydrate).
• Brand names available in Canada: The brand‑name product Suprax® was previously marketed in Canada but has been discontinued. Generic cefixime tablets are not currently listed as marketed by Health Canada, although the drug is available in many other countries. Our pharmacy supplies internationally sourced Suprax tablets through the international supply chain for personal importation.
• ATC code: J01DD08 (cefixime; third‑generation cephalosporins).
• Dosage forms and strengths: Oral film‑coated tablets: 100 mg and 200 mg of cefixime (as cefixime trihydrate). Powder for oral suspension: 100 mg/5 mL and 200 mg/5 mL after reconstitution.
• Manufacturers in Canada: None. Suprax is not manufactured in Canada. Internationally, it is produced by various pharmaceutical companies (e.g., Lupin, Sanofi) and imported for personal use.
• Registration status in Canada: Not currently marketed. Suprax was previously approved (DINs 02087354, 02087362) but has been discontinued. Generic cefixime tablets have not received a Notice of Compliance. The drug is, however, approved in many other jurisdictions and is supplied through the international supply chain for personal importation.
• OTC / Rx classification: Prescription only (Rx). A valid prescription from a licensed Canadian healthcare professional is required. Our pharmacy fulfills this prescription for the internationally sourced product.

Mechanism of Action and Pharmacology

Cefixime is a third‑generation cephalosporin antibiotic with bactericidal activity. It inhibits bacterial cell wall synthesis by binding to specific penicillin‑binding proteins (PBPs), primarily PBP 3, which are essential for the cross‑linking of peptidoglycan strands. This disruption results in a weakened cell wall, osmotic instability, and eventual cell lysis. Cefixime is highly resistant to hydrolysis by a wide variety of beta‑lactamases produced by Gram‑positive and Gram‑negative bacteria, including many extended‑spectrum beta‑lactamases (ESBLs) that inactivate penicillins and first‑ and second‑generation cephalosporins. Its spectrum of activity includes Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, Moraxella catarrhalis, Neisseria gonorrhoeae, Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae. It is not active against Staphylococcus aureus (including methicillin‑susceptible strains), Enterococcus species, Pseudomonas aeruginosa, or Bacteroides fragilis.

The absolute oral bioavailability of cefixime is approximately 40% to 50%, and absorption is not significantly affected by food. Peak plasma concentrations are reached 2 to 4 hours after oral administration. Cefixime is approximately 65% to 70% bound to plasma proteins. It is not significantly metabolized and is excreted primarily unchanged in the urine, with about 20% to 30% of an oral dose eliminated via the kidneys. The elimination half‑life is 3 to 4 hours in adults with normal renal function, and this is prolonged in proportion to the degree of renal impairment. Dose adjustment is required when creatinine clearance falls below 60 mL/min. Cefixime is not removed by haemodialysis to a clinically significant extent.

Indications

• Respiratory tract infections: Acute exacerbations of chronic bronchitis, community‑acquired pneumonia (mild to moderate), acute bacterial sinusitis, and pharyngitis/tonsillitis caused by Streptococcus pyogenes.
• Otitis media: Acute otitis media in children, caused by susceptible strains of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae.
• Urinary tract infections: Uncomplicated cystitis and pyelonephritis caused by susceptible Gram‑negative organisms such as Escherichia coli and Proteus mirabilis.
• Uncomplicated gonorrhoea: A single oral dose of 400 mg for the treatment of uncomplicated cervical, urethral, or rectal gonococcal infections caused by Neisseria gonorrhoeae. However, due to the emergence of resistance, cefixime is no longer recommended as first‑line monotherapy for gonorrhoea in Canada; combination therapy with azithromycin or doxycycline and ceftriaxone is preferred.
• Enteric infections (off‑label): Typhoid fever and shigellosis, particularly in regions where fluoroquinolone resistance is prevalent.

Important Warnings and Precautions

At‑risk groups

• Pregnancy: Cefixime is classified as FDA Pregnancy Category B. Animal studies have not demonstrated teratogenic effects, and there is extensive clinical experience with cephalosporins in pregnancy. It should be used during pregnancy only when clearly needed and under medical supervision.
• Breastfeeding: Cefixime is excreted in human breast milk in low concentrations. It is generally considered compatible with breastfeeding, but the infant should be monitored for gastrointestinal disturbances such as diarrhoea, candidiasis, or allergic sensitization. A decision should be made whether to discontinue breastfeeding or to discontinue the drug, taking into account the importance of the medication to the mother.
• Paediatrics: Cefixime is widely used in children aged 6 months and older. Dosing is weight‑based (typically 8 mg/kg/day, given as a single dose or in two divided doses). The oral suspension is the preferred formulation for young children. Safety and efficacy in infants younger than 6 months have not been established.
• Elderly: No specific dose adjustment is required for age alone. However, elderly patients are more likely to have age‑related renal impairment, and dosage should be adjusted according to creatinine clearance. Monitor for gastrointestinal side effects, including Clostridioides difficile‑associated diarrhoea.
• Renal impairment: Cefixime is primarily excreted by the kidneys. For patients with a creatinine clearance of 20 to 60 mL/min, the recommended dose is 75% of the standard dose, administered at the same interval. For those with creatinine clearance below 20 mL/min, or on haemodialysis, the dose should be reduced to 50% of the standard dose. No supplemental dose is required after dialysis.
• Allergy and hypersensitivity: Cephalosporins can cause allergic reactions, ranging from mild rash to life‑threatening anaphylaxis. Approximately 5% to 10% of penicillin‑allergic patients may be cross‑allergic to cephalosporins, particularly those with a history of immediate (IgE‑mediated) penicillin reactions. If a hypersensitivity reaction occurs, the drug should be discontinued immediately and appropriate emergency treatment instituted. Suprax is contraindicated in patients with a history of severe, immediate hypersensitivity to penicillins or other cephalosporins.
• Clostridioides difficile‑associated diarrhoea (CDAD): As with many antibacterial agents, cefixime can cause overgrowth of C. difficile and lead to pseudomembranous colitis, which may range from mild diarrhoea to fatal colitis. CDAD must be considered in any patient who develops diarrhoea during or up to 2 months after antibiotic therapy. Anti‑motility agents should be avoided if CDAD is suspected.
• Drug‑resistant bacteria: To reduce the development of antibiotic resistance, cefixime should be used only to treat infections proven or strongly suspected to be caused by susceptible bacteria. Culture and sensitivity information should guide therapy when available. Cefixime should not be used for gonorrhoea as first‑line monotherapy due to widespread resistance.
• Blood dyscrasias: Very rare cases of agranulocytosis, aplastic anaemia, and haemolytic anaemia have been reported with cephalosporins. Monitoring of complete blood counts may be warranted in patients on prolonged therapy.

Driving and alcohol

Cefixime is not known to impair the ability to drive or operate machinery. Some patients may experience dizziness or headache as part of their underlying infection. Alcohol consumption does not have a direct pharmacokinetic interaction with cefixime, but it should be limited during treatment because it can exacerbate gastrointestinal side effects such as nausea and diarrhoea, and may impair the immune response. There is no disulfiram‑like reaction with this cephalosporin.

Dosage Instructions

• Adults and adolescents (≥ 12 years or weighing ≥ 50 kg) — standard infections: 400 mg once daily, either as two 200 mg tablets or one 400 mg tablet (if available), or 200 mg every 12 hours. The 100 mg and 200 mg tablets are used to achieve these doses. For uncomplicated gonorrhoea: a single oral dose of 400 mg (four 100 mg tablets or two 200 mg tablets). Therapy for other infections is typically continued for 7 to 10 days.
• Paediatric dosing: 8 mg/kg body weight once daily, or 4 mg/kg every 12 hours, depending on the severity of infection. The oral suspension is used for younger children; the 100 mg tablet can be split or crushed for those able to swallow tablets. For acute otitis media, the standard regimen is 8 mg/kg once daily for 5‑10 days.
• Renal impairment: For patients with creatinine clearance 20‑60 mL/min, reduce the daily dose by 25%. For creatinine clearance below 20 mL/min or those on haemodialysis, reduce the daily dose by 50%. In these patients, using the 100 mg tablet to adjust dosing may be appropriate.
• Administration: Swallow the tablet whole with a full glass of water. It may be taken with or without food; taking it with a meal can help reduce mild gastrointestinal upset. The tablet may be crushed and mixed with soft food for patients who have difficulty swallowing. The oral suspension must be shaken well before each use and measured with the calibrated dosing device provided. Complete the entire prescribed course, even if symptoms improve earlier.
• Missed dose: If a dose is missed, take it as soon as remembered on the same day. If it is close to the time of the next scheduled dose, skip the missed dose and resume the regular schedule. Do not double the dose.

Side Effects and Contraindications

• Common side effects (incidence ≥ 1%): Diarrhoea (up to 15%), loose stools, abdominal pain, nausea, dyspepsia, vomiting, and headache. Skin rash and urticaria are also reported.
• Uncommon but serious side effects: Clostridioides difficile‑associated diarrhoea (may be severe and life‑threatening), anaphylaxis (rare), Stevens‑Johnson syndrome, toxic epidermal necrolysis, acute interstitial nephritis, and blood dyscrasias (agranulocytosis, thrombocytopenia, haemolytic anaemia). Elevations in hepatic transaminases (ALT/AST) and serum creatinine have been observed.
• Contraindications: Known hypersensitivity to cefixime, other cephalosporins, or any excipient in the formulation. A history of severe, immediate‑type hypersensitivity (e.g., anaphylaxis) to penicillins or other beta‑lactam antibiotics is a contraindication.

Drug Interactions

• Probenecid: Probenecid competitively inhibits the renal tubular secretion of cefixime, leading to higher and more prolonged plasma concentrations. While this interaction may be used therapeutically, no dose adjustment is routinely recommended, but renal function should be monitored.
• Oral contraceptives: Like other antibiotics, cefixime may transiently reduce the efficacy of combined hormonal contraceptives by interfering with the enterohepatic circulation of ethinyl estradiol. A backup barrier method of contraception is recommended during therapy and for at least 7 days after completing the course.
• Warfarin and oral anticoagulants: Cefixime may enhance the anticoagulant effect of warfarin, possibly by reducing vitamin K production by gut flora. The International Normalised Ratio (INR) should be monitored more frequently during and after therapy, and the warfarin dose adjusted as needed.
• Nephrotoxic drugs: Concomitant use with other potentially nephrotoxic agents (e.g., aminoglycosides, vancomycin, amphotericin B, loop diuretics) may increase the risk of renal impairment, particularly in patients with pre‑existing renal disease. Renal function should be monitored.
• Laboratory test interactions: Cefixime may cause false‑positive results for urine glucose with Benedict’s or Fehling’s solution. Enzyme‑based tests (e.g., Clinistix) are recommended. A positive direct Coombs test has been reported with some cephalosporins.

Practical Advice

• Administration: Take cefixime at the same time(s) each day. Swallow the tablet whole with water; it may be taken with or without food. If you miss a dose, take it as soon as you remember on the same day. Complete the full course of therapy, even if you feel better. Do not share this antibiotic with anyone else.
• Monitoring: No routine laboratory monitoring is required for healthy individuals on short‑term therapy. In patients with known renal impairment, renal function should be assessed before and during treatment. For those on warfarin, monitor INR. If diarrhoea develops, especially if watery or bloody, contact your doctor before using anti‑diarrhoeal medications.
• Storage: Store tablets at room temperature (15‑30 °C) in a tightly closed container, protected from moisture and light. The oral suspension should be refrigerated (2‑8 °C) after reconstitution and used within 14 days; discard any unused portion. Do not freeze. Keep all forms out of the reach and sight of children.
• Lifestyle: Drink plenty of fluids to stay hydrated. Avoid alcohol to minimize gastrointestinal side effects. Inform any healthcare provider that you are taking cefixime, especially if you are scheduled for surgery, dental work, or laboratory tests. If you have a penicillin allergy, be sure to inform your doctor.
• When to seek medical review: Contact your doctor immediately if you develop signs of an allergic reaction (rash, hives, swelling of the face or throat, difficulty breathing), severe or bloody diarrhoea, or signs of liver or kidney problems (jaundice, dark urine, decreased urination).
• Disposal: Return unused or expired medication to a pharmacy for safe disposal. Do not flush down the toilet or discard in household waste.

Alternative Medications

• Amoxicillin (Amoxil®): A first‑line penicillin for streptococcal pharyngitis and some respiratory and urinary infections. It is not beta‑lactamase stable and is ineffective against resistant organisms.
• Amoxicillin‑clavulanate (Clavulin®, Augmentin®): Adds a beta‑lactamase inhibitor, extending coverage to many beta‑lactamase‑producing strains. It is an alternative for resistant respiratory and urinary infections.
• Cefuroxime axetil (Ceftin®): A second‑generation cephalosporin with a similar spectrum. It is active against some Gram‑positive organisms not covered by cefixime, but less active against certain Gram‑negative bacteria.
• Azithromycin (Zithromax®) or clarithromycin (Biaxin®): Macrolide antibiotics used for respiratory infections, particularly when atypical organisms are suspected. They are alternatives for penicillin‑allergic patients, but resistance rates are a concern.
• Trimethoprim‑sulfamethoxazole (Septra®, Bactrim®): For uncomplicated urinary tract infections and some respiratory infections. It is an alternative when cephalosporins cannot be used.
• Ceftriaxone (injectable): A parenteral third‑generation cephalosporin that is the first‑line treatment for gonorrhoea and severe infections. Cefixime is an oral step‑down or alternative for mild infections.
• Non‑pharmacological measures: Rest, adequate hydration, and symptomatic relief with acetaminophen or ibuprofen are important supportive therapies.

Clinical Efficacy

Cefixime has demonstrated high clinical and bacteriological cure rates in a variety of community‑acquired infections. In acute otitis media, a 5‑ to 10‑day course of cefixime (8 mg/kg once daily) achieves clinical cure rates of 80% to 90%, comparable to amoxicillin‑clavulanate and cefuroxime. For streptococcal pharyngitis, a 10‑day course of cefixime 8 mg/kg once daily (or 400 mg daily in adults) results in eradication rates exceeding 90%, making it a suitable second‑line option after penicillin. In uncomplicated urinary tract infections, cefixime 400 mg once daily for 3 to 7 days is effective against susceptible Enterobacteriaceae, with clinical success rates of over 90%. For uncomplicated gonorrhoea, a single 400 mg dose was historically very effective; however, the emergence of cephalosporin‑resistant Neisseria gonorrhoeae globally has led to recommendations against its use as monotherapy. Canadian guidelines now recommend a combination of ceftriaxone (intramuscular) with azithromycin or doxycycline as first‑line therapy, with cefixime retained as an alternative only when injectable ceftriaxone is not feasible and susceptibility is documented. Cefixime remains an important oral option for many respiratory and urinary infections, particularly when Gram‑negative coverage is required, and its once‑daily dosing improves patient compliance.

Important:

Suprax (cefixime) is a prescription cephalosporin antibiotic that should be used only under the supervision of a qualified healthcare professional. It is intended to treat bacterial infections only and is not effective against viral infections such as the common cold or flu. Take the full prescribed course of this medication, even if your symptoms improve earlier. Allergic reactions can occur and may be severe, particularly in patients with a history of penicillin allergy. Seek immediate medical attention if you develop signs of an allergic reaction such as rash, hives, itching, swelling of the face, lips, or tongue, or difficulty breathing. Diarrhoea is common, but if it becomes severe, watery, or bloody, contact your doctor immediately, as this may be a sign of a serious intestinal infection (C. difficile colitis). This medication is not approved for marketing in Canada and is imported for personal use under a valid prescription. Inform your doctor if you have kidney disease, are pregnant or breastfeeding, or are taking any other medications, particularly warfarin or oral contraceptives. This information is not a substitute for professional medical advice, diagnosis, or treatment.

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