assignment [1%:<30 mL/minute: 250 to 500 mg/day End-stage renal disease (ESRD) on hemodialysis: 250 to 500 mg/day Dosing: Hepatic Impairment Mild or moderate impairment: There are no dosage adjustments provided in the manufacturer s labeling; use with caution (Blumberg 2003) Severe impairment: Use is contraindicated. Administration Directly observed therapy (DOT) is recommended. Neurotoxic effects may be prevented or relieved by the coadministration of pyridoxine (see Pyridoxine monograph for dosing). Administer with or without meals. Gastrointestinal adverse effects may be decreased by administration at meals or bedtime, decreased dose, or giving with antiemetics. Dietary Considerations Healthcare provider may recommend an increase in dietary intake of pyridoxine to prevent neurotoxic effects of ethionamide. Avoid alcohol. Storage Store at 20 C to 25 C (68 F to 77 F). Drug Interactions Alcohol (Ethyl): May enhance the adverse/toxic effect of Ethionamide. Specifically, there may be a risk for a psychotic episode/reaction. Monitor therapy BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Avoid combination CycloSERINE: Ethionamide may enhance the adverse/toxic effect of CycloSERINE. Monitor therapy Isoniazid: Ethionamide may increase the serum concentration of Isoniazid. Monitor therapy Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents. Consider therapy modification Adverse Reactions Frequency not defined. Cardiovascular: Orthostatic hypotension Central nervous system: Altered sense of smell, depression, dizziness, drowsiness, headache, metallic taste, peripheral neuritis, psychiatric disturbance, restlessness, seizure Dermatologic: Acne vulgaris, alopecia, purpura, skin photosensitivity, skin rash Endocrine & metabolic: Goiter, gynecomastia, hypoglycemia, hypothyroidism, menstrual disease, pellagra (pellagra-like syndrome), weight loss Gastrointestinal: Abdominal pain, anorexia, diarrhea, sialorrhea, nausea, stomatitis, vomiting Genitourinary: Impotence Hematologic & oncologic: Leukopenia, thrombocytopenia Hepatic: Hepatitis, increased liver enzymes, increased serum bilirubin, jaundice Hypersensitivity: Hypersensitivity reaction Neuromuscular & skeletal: Arthralgia Ophthalmic: Blurred vision, diplopia, optic neuritis Warnings/Precautions Disease-related concerns: Diabetes: Use with caution in patients with diabetes mellitus; may cause hypoglycemia. Hepatotoxicity: May cause hepatotoxicity; monitor liver function tests at baseline and monthly. Porphyria: Use not recommended; porphyria-inducing in animal and in vitro studies (WHO 2008). Thyroid dysfunction: Use with caution in patients with thyroid dysfunction; hypothyroidism (reversible; with and without goiter) has been reported. Concurrent drug therapy issues: Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Other warnings/precautions: Appropriate use: Drug-resistant tuberculosis develops rapidly if ethionamide is used alone; must administer with other antituberculosis agents. Directly observed therapy (DOT) is recommended. Ethanol use: Avoid excessive ethanol intake; psychotic reaction may occur. Eye exams: Eye exams are recommended at baseline and periodically during therapy. Monitoring Parameters Baseline and monthly serum ALT and AST; baseline and periodic ophthalmic exams; periodic blood glucose and TSH Pregnancy Considerations Ethionamide crosses the placenta. Use during pregnancy is not recommended (Blumberg 2003). Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience abdominal pain, nausea, vomiting, diarrhea, headache, agitation, metallic taste, mouth irritation, mouth sores, fatigue, drooling, lack of appetite, or weight loss. Have patient report immediately to prescriber signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), signs of a low thyroid level (constipation; difficulty handling heat or cold; memory problems; mood changes; or burning, numbness, or tingling feeling), neck lump, severe dizziness, passing out, depression, vision changes, eye pain, severe eye irritation, blindness, mood changes, behavioral changes, or signs of low blood sugar (dizziness, headache, fatigue, feeling weak, shaking, tachycardia, confusion, increased hunger, or sweating) (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about ethionamide Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Interactions Support Group En Español 0 Reviews Add your own review/rating Drug class: nicotinic acid derivatives Consumer resources Ethionamide Ethionamide (Advanced Reading) Professional resources Ethionamide (AHFS Monograph) Other brands: Trecator Related treatment guides Tuberculosis, Active> ] Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Ethionamide Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Drug Class Nicotinic acid derivatives Related Drugs nicotinic acid derivatives n/a Tuberculosis, Active ciprofloxacin , Levaquin , levofloxacin , rifampin , moxifloxacin , Avelox , isoniazid , ethambutol , amikacin , gatifloxacin , streptomycin , pyrazinamide , Floxin , Rifadin , Amikin , Myambutol , cycloserine , Tequin , isoniazid / pyrazinamide / rifampin , rifapentine , kanamycin , Rifamate , More... to enclose
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