In The Name of GodIn The Name of God

Common Adverse Reactions to Common Adverse Reactions to Anti-TB DrugsAnti-TB Drugs

Caused by: Any drugCaused by: Any drug

• Adverse reaction: Allergic reactionsAdverse reaction: Allergic reactions

• Signs/symptoms: Skin rashSigns/symptoms: Skin rash

Caused by: EthambutolCaused by: Ethambutol

Adverse reaction: Eye damage (optic neuritis)Adverse reaction: Eye damage (optic neuritis)

Signs/symptoms: Blurred or changed Signs/symptoms: Blurred or changed vision ; changed color vision .vision ; changed color vision .

Caused by: INH, PZA, RIFCaused by: INH, PZA, RIF

Adverse reaction: HepatitisAdverse reaction: Hepatitis

Signs/symptoms:Signs/symptoms:

Abdominal pain,Abnormal LFTs,Dark urineAbdominal pain,Abnormal LFTs,Dark urine

Lack of appetite,Nausea,Vomiting,YellowishLack of appetite,Nausea,Vomiting,Yellowish

skin or eyes.skin or eyes.

Caused by: IsoniazidCaused by: Isoniazid

Adverse reaction: Nervous system Adverse reaction: Nervous system damage damage

Signs/symptoms: Dizziness, Signs/symptoms: Dizziness, Tingling/numbness around mouthTingling/numbness around mouth

• Adverse reaction: Peripheral neuropathyAdverse reaction: Peripheral neuropathy

• Signs/symptoms: Tingling/numbness Signs/symptoms: Tingling/numbness in hands and feetin hands and feet

Caused by: PyrazinamideCaused by: Pyrazinamide

Adverse reaction: Stomach upsetAdverse reaction: Stomach upset

Signs/symptoms: Signs/symptoms:

Vomiting , Lack of appetiteVomiting , Lack of appetite

• Adverse reaction: Increased uric acidAdverse reaction: Increased uric acid

• Signs/symptoms: Abnormal UA level Signs/symptoms: Abnormal UA level Joint aches , Gout (rare)Joint aches , Gout (rare)

Caused by: RifampinCaused by: Rifampin

Adverse reaction: GI upsetAdverse reaction: GI upset

Signs/symptoms: Signs/symptoms: Anorexia,nausea,vomiting,diarrheaAnorexia,nausea,vomiting,diarrhea

• Adverse reaction: Discoloration of Adverse reaction: Discoloration of body fluidsbody fluids

• Signs/symptoms: Orange urine, sweat, or Signs/symptoms: Orange urine, sweat, or tears ,Stained soft contact lenses tears ,Stained soft contact lenses

• Adverse reaction: Drug interactionsAdverse reaction: Drug interactions

• Signs/symptoms: Interferes with some Signs/symptoms: Interferes with some medications: BC pills,Anticoagulants, medications: BC pills,Anticoagulants, Methadone,Anticonvulsants,Cardiac Methadone,Anticonvulsants,Cardiac glycosides,Oral hypoglycemics,…glycosides,Oral hypoglycemics,…

• Hemolytic anemia,Thrombocytopenia, Hemolytic anemia,Thrombocytopenia, Eosinophilia,LeukopeniaEosinophilia,Leukopenia

• Interstitial nephritis,Flushing,EdemaInterstitial nephritis,Flushing,Edema

• Pruritus,urticaria,pemphigoid reactionsPruritus,urticaria,pemphigoid reactions

• Myalgia,weakness,osteomalaciaMyalgia,weakness,osteomalacia

Caused by: StreptomycinCaused by: Streptomycin

• Adverse reaction: Ear damageAdverse reaction: Ear damage

• Signs/symptoms: Balance problems Signs/symptoms: Balance problems Hearing loss, Ringing in the earsHearing loss, Ringing in the ears

• Adverse reaction: Kidney damageAdverse reaction: Kidney damage

• Signs/symptoms: Abnormal kidney Signs/symptoms: Abnormal kidney function test resultsfunction test results

MANAGEMENTMANAGEMENT

MINOR SIDE EFFECTSMINOR SIDE EFFECTS

Minor side effects, such as gastrointestinal gastrointestinal intolerance, mild skin rash, pruritus or intolerance, mild skin rash, pruritus or flushingflushing are best managed by reassurance and symptomatic treatmentsymptomatic treatment and the patient should be encouraged to continue anti tuberculosis continue anti tuberculosis treatment.treatment.

Treatment with non steroidal anti inflammatory drugs (NSAID)(NSAID)provide symptomatic relief of pyrazinamide related arthralgiapyrazinamide related arthralgia. Skin rashesSkin rashes can usually be managed by withholding the withholding the causative drugcausative drug and if it is really necessary to reintroduce the drug, the patient should undergo desensitization.

MAJOR SIDE EFFECTSMAJOR SIDE EFFECTS

Hepatitis:Hepatitis:

Patients who develop jaundice or other signs of jaundice or other signs of liver dysfunctionliver dysfunction during therapy should have treatment stopped immediatelytreatment stopped immediately. Although many patients with drug-induced hepatotoxicity can be successfully rechallenged, this is best done in a where liver function can be carefully liver function can be carefully monitored.monitored.

Indications for stoping the hepatotoxic Indications for stoping the hepatotoxic anti-tuberculosis drugsanti-tuberculosis drugs

• 11- - Clinical signs and/or symptoms Clinical signs and/or symptoms of hepatitisof hepatitis

• 2- Abnormal liver enzymes2- Abnormal liver enzymes

• 3- Unexplained raised serum 3- Unexplained raised serum bilirubinbilirubin

If the period without drugs is likely to be prolongedlikely to be prolonged, and the patient requires treatmentrequires treatment, at least two other drugstwo other drugs should be given until it is determined whether the offending drug can be resumed.

The development of the following The development of the following conditons contraindicates further use conditons contraindicates further use

of the drugof the drug

**Thrombocytopenia ,hemolysis, shock and/or Thrombocytopenia ,hemolysis, shock and/or

renal failure due to rifampicin.renal failure due to rifampicin.

*Visual impairment due to ethambutol. *Visual impairment due to ethambutol.

*Eighth nerve damage from streptomycin. *Eighth nerve damage from streptomycin.

*Steven-Johnson syndrome. *Steven-Johnson syndrome.

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