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Drugs Used in the Management of Adverse Events
Learning ObjectivesDrugs Used in the Management of Adverse Events
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Adverse events may occur during anti-TB treatment and need to be managed using certain drugs.
The table below provides information on specific drugs suggested for managing Adverse Drug Reactions (ADRs) during anti-TB treatment.
| ADVERSE DRUG REACTIONS | SUGGESTED DRUGS TO MANAGE THE ADR |
|---|---|
| Nausea, vomiting, stomach upset | Metoclopramide, Dimenhydrinate, Prochlorperazine, Promethazine, Bismuth Subsalicylate, Domperidone |
| Heartburn, acid indigestion, sour stomach, ulcer |
H2-blockers (ranitidine, cimetidine, famotidine, etc.), Proton pump inhibitors (omeprazole, lansoprazole, etc.,) Avoid antacids because they can decrease absorption of fluoroquinolones, e.g., aluminium hydroxide |
| Oral candidiasis (non-AIDS patient) | Fluconazole, Clotrimazole lozenges, Nystatin suspension, Itraconazole liquid |
| Diarrhoea | Loperamide |
| Depression | Selective serotonin reuptake inhibitors (fluoxetine, sertraline), Tricyclic antidepressants (amitriptyline) (to be avoided with Bdq) |
| Severe anxiety | Lorazepam, Diazepam, Clonazepam |
| Psychosis | Haloperidol, Thorazine, Risperidone (consider benzotropine or biperiden to prevent extrapyramidal effects), Buromazine, Thioridazine |
| Seizures | Phenytoin, Carbamazepine, Valproic acid, Phenobarbital |
| Prophylaxis of neurological complications of Cycloserine | Pyridoxine (vitamin B6) |
| Peripheral neuropathy | Amitriptyline (to be avoided with Bdq) |
| Vestibular symptoms | Meclizine, Dimenhydrinate, Prochlorperazine, Promethazine |
| Musculoskeletal pain, arthralgia, headaches | Ibuprofen, Paracetamol, Codeine, Diclofenac |
| Cutaneous reactions, itching | Hydrocortisone cream, Calamine, Caladryl lotions |
| Systemic hypersensitivity reactions | Antihistamines (diphenhydramine, chlorpheniramine, dimenhydrinate), Corticosteroids (prednisone, dexamethasone) |
| Bronchospasm | Inhaled beta-agonists (albuterol, etc.), Inhaled corticosteroids (beclomethasone, etc.), Oral steroids (prednisone), Injectable steroids (dexamethasone, methylprednisolone) |
| Hypothyroidism | Levothyroxine |
| Electrolyte wasting | Potassium, magnesium and calcium replacement treatment (oral and intravenous formulations) |
Resources
- Guidelines for Programmatic Management of Drug Resistant Tuberculosis in India, March 2021.
- Ready Reckoner for Medical Officer - Adverse Drug Reactions Associated with Anti-TB Drugs Identification and Management, 2019.
- Technical and Operational Guidelines for TB in India, 2016.
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