Chlorpromazine in the Control of Side Effects of Para-Aminosalicylic Acid Administration

Abstract

Courses of antituberculous chemotherapy are more prolonged than ever, and the problem of the unpleasant side effects of the administration of para-aminosalicylic acid (PAS) harasses both patient and physician for longer periods of time. Clinicians who manage tuberculosis are quite familiar with the difficulties entailed in keeping an appreciable number of their patients on an uninterrupted, prolonged course of para-aminosalicylic acid. In my experience, at least 25 per cent of patients receiving this antituberculous drug develop anorexia, epigastric distress, nausea, vomiting, abdominal cramps, or diarrhea. Quite an appreciable number discontinue the medication on their own or have it discontinued by the physician because of these symptoms. Many others who continue the drug despite these unpleasant symptoms, have the extra burden of side effects added to the already heavy burden of tuberculosis, with its physical, social, economic and emotional difficulties. The physician is faced with the problem of finding either a form of the drug that will be tolerated or an adjuvant that will help control the unpleasant symptoms. Among the variations of the drug used are buffered tablets, granules, coated tablets, and salts of the acid. Recently, potassium para-aminosalicylate has been recommended for use in place of other para-aminosalicylic acid preparations, as carrying a high degree of patient tolerance and acceptance.’ Many different medicaments have been employed as adjuvants with varied degrees of success in an attempt to control the unpleasant side effects. Among them are the antacids, tincture of belladonna, other antispasmodics, camphorated tincture of opium, and dramamine.#{174}2 The effectiveness of chlorpromazine in the control of drug induced nausea and vomiting is well known.3’ � � It is the purpose of this paper to present the results of the use of this versatile drug in the control of side-effects of oral administration of para-aminosalicylic acid in the treatment of pulmonary tuberculosis. Material A total of 91 patients (87 males and four females) who experienced side effects attributable to para-aminosalicylic acid during courses of chemotherapy, and were treated with chlorpromazine are included in this study. They ranged from 21 to 63 years of age, with an average of 39. Both hospitalized and ambulatory patients are included. Those hospitalized were