In The Name of God In The Name of God
Dec 14, 2015
In The Name of GodIn The Name of God
Common Adverse Reactions to Common Adverse Reactions to Anti-TB DrugsAnti-TB Drugs
Caused by: Any drugCaused by: Any drug
• Adverse reaction: Allergic reactionsAdverse reaction: Allergic reactions
• Signs/symptoms: Skin rashSigns/symptoms: Skin rash
Caused by: EthambutolCaused by: Ethambutol
Adverse reaction: Eye damage (optic neuritis)Adverse reaction: Eye damage (optic neuritis)
Signs/symptoms: Blurred or changed Signs/symptoms: Blurred or changed vision ; changed color vision .vision ; changed color vision .
Caused by: INH, PZA, RIFCaused by: INH, PZA, RIF
Adverse reaction: HepatitisAdverse reaction: Hepatitis
Signs/symptoms:Signs/symptoms:
Abdominal pain,Abnormal LFTs,Dark urineAbdominal pain,Abnormal LFTs,Dark urine
Lack of appetite,Nausea,Vomiting,YellowishLack of appetite,Nausea,Vomiting,Yellowish
skin or eyes.skin or eyes.
Caused by: IsoniazidCaused by: Isoniazid
Adverse reaction: Nervous system Adverse reaction: Nervous system damage damage
Signs/symptoms: Dizziness, Signs/symptoms: Dizziness, Tingling/numbness around mouthTingling/numbness around mouth
• Adverse reaction: Peripheral neuropathyAdverse reaction: Peripheral neuropathy
• Signs/symptoms: Tingling/numbness Signs/symptoms: Tingling/numbness in hands and feetin hands and feet
Caused by: PyrazinamideCaused by: Pyrazinamide
Adverse reaction: Stomach upsetAdverse reaction: Stomach upset
Signs/symptoms: Signs/symptoms:
Vomiting , Lack of appetiteVomiting , Lack of appetite
• Adverse reaction: Increased uric acidAdverse reaction: Increased uric acid
• Signs/symptoms: Abnormal UA level Signs/symptoms: Abnormal UA level Joint aches , Gout (rare)Joint aches , Gout (rare)
Caused by: RifampinCaused by: Rifampin
Adverse reaction: GI upsetAdverse reaction: GI upset
Signs/symptoms: Signs/symptoms: Anorexia,nausea,vomiting,diarrheaAnorexia,nausea,vomiting,diarrhea
• Adverse reaction: Discoloration of Adverse reaction: Discoloration of body fluidsbody fluids
• Signs/symptoms: Orange urine, sweat, or Signs/symptoms: Orange urine, sweat, or tears ,Stained soft contact lenses tears ,Stained soft contact lenses
• Adverse reaction: Drug interactionsAdverse reaction: Drug interactions
• Signs/symptoms: Interferes with some Signs/symptoms: Interferes with some medications: BC pills,Anticoagulants, medications: BC pills,Anticoagulants, Methadone,Anticonvulsants,Cardiac Methadone,Anticonvulsants,Cardiac glycosides,Oral hypoglycemics,…glycosides,Oral hypoglycemics,…
• Hemolytic anemia,Thrombocytopenia, Hemolytic anemia,Thrombocytopenia, Eosinophilia,LeukopeniaEosinophilia,Leukopenia
• Interstitial nephritis,Flushing,EdemaInterstitial nephritis,Flushing,Edema
• Pruritus,urticaria,pemphigoid reactionsPruritus,urticaria,pemphigoid reactions
• Myalgia,weakness,osteomalaciaMyalgia,weakness,osteomalacia
Caused by: StreptomycinCaused by: Streptomycin
• Adverse reaction: Ear damageAdverse reaction: Ear damage
• Signs/symptoms: Balance problems Signs/symptoms: Balance problems Hearing loss, Ringing in the earsHearing loss, Ringing in the ears
• Adverse reaction: Kidney damageAdverse reaction: Kidney damage
• Signs/symptoms: Abnormal kidney Signs/symptoms: Abnormal kidney function test resultsfunction test results
MANAGEMENTMANAGEMENT
MINOR SIDE EFFECTSMINOR SIDE EFFECTS
Minor side effects, such as gastrointestinal gastrointestinal intolerance, mild skin rash, pruritus or intolerance, mild skin rash, pruritus or flushingflushing are best managed by reassurance and symptomatic treatmentsymptomatic treatment and the patient should be encouraged to continue anti tuberculosis continue anti tuberculosis treatment.treatment.
Treatment with non steroidal anti inflammatory drugs (NSAID)(NSAID)provide symptomatic relief of pyrazinamide related arthralgiapyrazinamide related arthralgia. Skin rashesSkin rashes can usually be managed by withholding the withholding the causative drugcausative drug and if it is really necessary to reintroduce the drug, the patient should undergo desensitization.
MAJOR SIDE EFFECTSMAJOR SIDE EFFECTS
Hepatitis:Hepatitis:
Patients who develop jaundice or other signs of jaundice or other signs of liver dysfunctionliver dysfunction during therapy should have treatment stopped immediatelytreatment stopped immediately. Although many patients with drug-induced hepatotoxicity can be successfully rechallenged, this is best done in a where liver function can be carefully liver function can be carefully monitored.monitored.
Indications for stoping the hepatotoxic Indications for stoping the hepatotoxic anti-tuberculosis drugsanti-tuberculosis drugs
• 11- - Clinical signs and/or symptoms Clinical signs and/or symptoms of hepatitisof hepatitis
• 2- Abnormal liver enzymes2- Abnormal liver enzymes
• 3- Unexplained raised serum 3- Unexplained raised serum bilirubinbilirubin
If the period without drugs is likely to be prolongedlikely to be prolonged, and the patient requires treatmentrequires treatment, at least two other drugstwo other drugs should be given until it is determined whether the offending drug can be resumed.
The development of the following The development of the following conditons contraindicates further use conditons contraindicates further use
of the drugof the drug
**Thrombocytopenia ,hemolysis, shock and/or Thrombocytopenia ,hemolysis, shock and/or
renal failure due to rifampicin.renal failure due to rifampicin.
*Visual impairment due to ethambutol. *Visual impairment due to ethambutol.
*Eighth nerve damage from streptomycin. *Eighth nerve damage from streptomycin.
*Steven-Johnson syndrome. *Steven-Johnson syndrome.
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