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ANTIINFECTIVES FOR SYSTEMIC USE › ANTIMYCOBACTERIALS › DRUGS FOR TREATMENT OF TUBERCULOSIS › Thiocarbamide derivatives
ethionamide
J04AD03
Adult Dosing
- Initial: 250 mg orally once daily, increased by 250 mg every 1 to 3 weeks as tolerated to target dose of 15 to 20 mg/kg/day (max 1 g/day)
- Administer with food to minimize gastrointestinal intolerance
- Pyridoxine (vitamin B6) 50 to 100 mg daily should be co-administered to prevent peripheral neuropathy
Pediatric Dosing
- 15 to 20 mg/kg/day orally divided in 2 to 3 doses (max 1 g/day)
- Pyridoxine co-administration recommended for pediatric patients to prevent neurological adverse effects
Indications
- Treatment of active tuberculosis caused by Mycobacterium tuberculosis (typically multidrug-resistant strains) as part of a combination regimen
Mechanism of Action
- Bacteriostatic/bactericidal synthetic derivative of isonicotinic acid; inhibits peptide synthesis and mycolic acid production by blocking InhA (enoyl-ACP reductase)
Contraindications
- Hypersensitivity to ethionamide or any component of the formulation
- Severe hepatic impairment
Adverse Reactions
- Gastrointestinal intolerance: severe nausea, vomiting, diarrhea, abdominal pain, anorexia
- Neurological: peripheral neuropathy, headache, dizziness, depression, psychosis, drowsiness
- Hepatotoxicity: transient elevations in transaminases, clinical hepatitis
- Endocrine: hypothyroidism, gynecomastia, menstrual irregularities, impotence
- Other: metallic taste, postural hypotension, skin rash, photosensitivity
Drug Interactions
- Isoniazid: increased risk of neurotoxicity and hepatotoxicity
- Cycloserine: increased risk of central nervous system toxicity, including convulsions and psychotic episodes
- Alcohol: increases the risk of psychotic reactions and severe central nervous system depression
- Anticoagulants: may potentiate the anticoagulant effect
Curated Content: Needs Vetting Before Put to Clinical Use