Antituberculosis drugs may produce side effects varying from unimportant to life-threatening. The side effects of drugs prescribed for a patient must be known, as well as whether it is necessary to monitor for such effects. Table 1 lists the side effects and recommendations for monitoring of antituberculosis drugs used in the United States; only the most commonly used drugs, the so-called first-line drugs, will be reviewed in the text. Table 1Drug Side Effects Drug Side Effects Monitoring Remarks Isoniasid Peripheral neuritis Pyridoxine: 10 mg for prophylaxis; 50 to 100 mg. for treatment Hepatitis SGOT, SGPT (if symptomatic) Discontinue if symptomatic + /or liver ensymes more than twice normal Central nervous system convulsions optic neuritis with atrophy muscle twitching dissiness ataxia toxic encephalopathy Hypersensitivity: fever, rash Drug interactions: Diphenylhydantoin somnolence Observe for overdose Ethambutol Optic neuritis Visual acuity and red-green color discrimination Unreported at 15 mg/kg dose; occurs at 25 mg/kg. Use with caution in presence of renal insufficiency Skin rash Rifampin Orange urine, tears, saliva Reassure patient Flu-like syndrome Need not discontinue rifampin and may restart if do discontinue Hepatitis SGOT, SGPT (if symptomatic) Discontinue if jaundice +/or liver enzymes more than twice normal Thrombocytopenia Platelet count (if suspected) Anti-rifampin antibodies absorbed on platelets, fix complement, results in platelet damage; discontinue rifampin Hemolysis Drug related antibody fixes and activates complement; discontinue Renal failure Probably on immunologic basis Drug Interactions: Warfarin Prothrombin time Rifampin decreases the hypoprothrombinemic effect of warfarin; warfarin dose may need to be reduced when rifampin discontinued Oral contraceptives Pregnancy reported in women on rifampin and oral contraceptives which may have accelerated catabolism caused by ensyme induction Methadone Rifampin may be associated with withdrawal symptoms in patients on a methadone maintenance program; also probably related to accelerated catabolism caused by ensyme induction PAS Concomittant administration of PAS and rifampin may lead to decreased absorption of rifampin In vitro immunosuppression Apparently not clinically significant Streptomycin 8th cranial nerve damage Audiogram Vestibular function Use with caution in presence of renal insufficiency Nephrotoxicity BUN, creatinine Neuromuscular junction blockade Seen in patients also receiving muscle relaxants Hypersensitivity reactions—rash, dermatitis, analyphylasis Pyrasinamide Hyperuricemia—acute gout Uric acid Hyperuricemia common; acute gout rare Hepatotoxicity SGOT, SGPT (if symptomatic) More common with high dosage Gastrointestinal—anorexia, nausea Diabetes mellitis more difficult to manage PAS Gastrointestinal—anorexia, nausea Gastrointestinal intolerance extremely common in adult, less so in children Hypersensitivity reactions—fever, rash, arthritis Discontinue Hepatotoxicity SGOT, SGPT (if symptomatic) Sodium load Ethionamide Gastrointestinal—anorexia, nausea, vomiting Divided dose may help control gastrointestinal side-effects Postural hypotension, depression, asthenia, drowsiness Skin rash, purpura, gynecomastia, impotence Hepatotoxicity SGOT, SGPT Cycloserine Central nervous system somnolence headache tremor dysarthria vertigo abnormal behavior psychosis seizures More common with higher dosage and in presence of ethanol; serum levels may help; anticonvulsants have been used to control seizures Hypersensitivity—rash Kanamycin 8th cranial nerve damage Audiogram vestibular function Nephrotoxicity BUN, creatinine Vestibular toxicity Hypersensitivity reactions—rash, pruritus Neuromuscular junction blockade Should be given with care to patients receiving muscle relaxants Capreomycin 8th cranial nerve damage Audiogram Use with caution in older patients and in presence of renal insufficiency Nephrotoxicity BUN, creatinine, urinalysis Hypokalemia Serum potassium Hypersensitivity reactions—rash, urticaria, eosinophilia Neuromuscular junction blockade Use with caution in patients receiving muscle relaxants Open table in a new tab