A typical clinical and pharmacological article
This information is a reference and it is not enough that the drug has been prescribed by a doctor ..
PHARMACHOLOGIC EFFECT
Combined anti-tuberculosis drug.
Isoniazid has a bactericidal effect on the actively dividing cells of Mycobacterium tuberculosis, inhibits the synthesis of mycolic acids, which are a component of the cell wall, has a moderate effect on slow and fast-growing atypical mycobacteria. For mycobacteria tuberculosis, the MIC is 0.025-0.05 mg / L.
Rifampicin has a bactericidal effect on intra- and extracellularly located microorganisms, inhibits the DNA-dependent RNA polymerase of microorganisms. For mycobacteria tuberculosis MPK - 2 mg / l.
Pyrazinamide has bactericidal activity, previously converted into an active form - pyrazinic acid. The pyrazinamide target is the synthetase I gene of mycobacterial fatty acid, which is involved in the biosynthesis of mycolic acid. It acts on intracellularly located mycobacteria, it penetrates well into the tuberculosis foci. In an acidic environment, the MPC is 20 mg / l.
Etambutol is a bacteriostatic drug that is effective against typical and atypical mycobacteria tuberculosis. Suppresses the synthesis of the cell wall, blocking the inclusion of mycolic acids in it. The MPC is 0.78-2 mg / l.
Pyridoxine is a vitamin remedy; participates in the metabolism. It is necessary for the normal functioning of the central nervous system and the peripheral nervous system. Anti-tuberculosis drugs can reduce the concentration of pyridoxine, in connection with this, the daily requirement for vitamin increases to 60 mg.
INDICATIONS
- tuberculosis (newly diagnosed, any forms).
DOSING MODE
Inside, in the morning, on an empty stomach for 30-40 minutes before eating. Dosing is performed according to rifampicin - 10 mg / kg body weight, but not more than 5 tab. The course of treatment is 2-4 months.
At a body weight of more than 80 kg, isoniazid is additionally prescribed in the evening (the total daily dose of isoniazid is 10 mg / kg).
If necessary, it can be combined with a / m injection of streptomycin in a dose of 15 mg / kg 1 time / day.
SIDE EFFECT
Isoniazid
From the central nervous system and peripheral nervous system: headache, dizziness, rarely fatigue, weakness, irritability, euphoria, insomnia, paresthesia, numbness of limbs, peripheral neuropathy, optic neuritis, polyneuritis, psychosis, emotional lability, depression, frequent seizures in patients epilepsy.
From the cardiovascular system: palpitation, angina pectoris, increased blood pressure.
On the part of the digestive system: nausea, vomiting, gastralgia, toxic hepatitis.
Allergic reactions: skin rash, itching, hyperthermia, arthralgia.
Other: very rarely - gynecomastia, menorrhagia, tendency to bleeding and hemorrhage.
Rifampicin
On the part of the digestive system: nausea, vomiting, diarrhea, decreased appetite, erosive gastritis, pseudomembranous enterocolitis, increased activity of hepatic transaminases in blood serum, hyperbilirubinemia, hepatitis.
Allergic reactions: urticaria, eosinophilia, angioedema, bronchospasm, arthralgia, fever.
From the nervous system: headache, reduced visual acuity, ataxia, disorientation.
From the urinary system: nephronecrosis, interstitial nephritis, acute renal failure.
Other: leukopenia, dysmenorrhea, induction of porphyria, myasthenia gravis, hyperuricemia, exacerbation of gout, influenza-like syndrome, skin reactions, hemolytic anemia, thrombocytopenic purpura.
Pyrazinamide
On the part of the digestive system: nausea, vomiting, diarrhea, metallic taste in the mouth, impaired liver function (decreased appetite, liver tenderness, hepatomegaly, jaundice, yellow atrophy of the liver), exacerbation of peptic ulcer.
From the nervous system: dizziness, headache, sleep disorders, increased excitability, depression, in some cases - hallucinations, convulsions, confusion.
From the hematopoiesis: thrombocytopenia, sideroblastic anemia, erythrocyte vacuolization, porphyria, hypercoagulation, splenomegaly.
From the musculoskeletal system : arthralgia, myalgia.
From the side of the urinary system: dysuria, interstitial nephritis.
Allergic reactions: skin rash, hives.
Other: hyperthermia, acne, hyperuricemia, exacerbation of gout, photosensitivity, increased serum iron concentration.
Ethambutol
From the nervous system: weakness, headache, dizziness, impaired consciousness, disorientation, hallucinations, depression, peripheral neuritis (paresthesia in the extremities, numbness, paresis, itching).
From the sense organs: optic neuritis (reduced visual acuity, violation of color perception, mainly - green and red colors, color blindness, scotoma).
On the part of the digestive system: decreased appetite, nausea, vomiting, gastralgia, increased activity of hepatic transaminases.
Allergic reactions: dermatitis, skin rash, itching, arthralgia, fever, anaphylaxis.
Other: hyperuricemia, exacerbation of gout.
Pyridoxine
Allergic reactions, hypersecretion of hydrochloric acid, numbness, the appearance of a sense of compression of the limbs - a symptom of "stocking" and "gloves", rarely - a rash, itching of the skin.
CONTRAINDICATIONS
hypersensitivity;
- liver and GI diseases in acute stage;
- diseases of the central nervous system (including epilepsy, other diseases with a tendency to convulsive seizures);
- Diseases of the organs of vision (optic neuritis, cataracts, diabetic retinopathy, inflammatory diseases of the eyes);
- Children's age (up to 13 years);
- Pregnancy;
lactation period.
With caution: hypothyroidism, hyperuricemia, gout.
PREGNANCY AND LACTATION
Contraindications: pregnancy; lactation period.
APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
Contraindication - acute liver disease.
APPLICATION FOR CHILDREN
Contraindication - children's age (up to 13 years).
DRUG INTERACTION
The intake of isoniazid, rifampicin, ethambutol and, especially, pyrazinamide in a combined dosage form significantly increases antimicrobial activity against mycobacterium tuberculosis.
Rifampicin induces certain enzymes of the cytochrome P450 system, accelerating the metabolism of prednisolone, phenytoin, quinidine, oral anticoagulants, hormonal contraceptives, antifungals, cimetidine, cyclosporine.
Isoniazid reduces the association of rifampicin with plasma proteins, pyrazinamide slows the excretion of rifampicin.
PASK impairs the absorption of rifampicin.
The administration of rifampicin with lomefloxacin and ofloxacin results in a decrease in the antimicrobial activity of these combinations against mycobacteria tuberculosis.
Antacids, opioid analgesics reduce the bioavailability of rifampicin.
Isoniazid: MAO inhibitors increase the risk of side effects from the central nervous system, cardiovascular system.
Pyridoxine, glutamic acid reduces the risk of developing side effects of isoniazid.
The combined use of isoniazid and cycloserine increases the risk of developing neurotoxic side effects.
Pyrazinamide increases the concentration of isoniazid and rifampicin in the serum, slowing their excretion. When taking rifampicin together with pyrazinamide, hepatotoxicity increases.
Aluminum hydroxide reduces the absorption of ethambutol.
The use of ethambutol with aminoglycosides, ciprofloxacin, imipenem, carbamazepine, lithium salts, quinine increases the risk of neurotoxic action of drugs.
Etambutol enhances the antimicrobial activity of other anti-tuberculosis drugs.
Pyridoxine weakens the action of levodopa when administered together, reduces the risk of toxic effects of antituberculosis drugs on the central nervous system and peripheral nervous system.
TERMS OF RELEASE FROM PHARMACY
The drug is released by prescription.
TERMS AND CONDITIONS OF STORAGE
Store in a dry place, protected from light, out of reach of children, at a temperature not exceeding 25 В° C.
