Interacting drugs- summary


Aluminium hydroxide                                                                                                                Absorption delayed or reduced by aluminium hydroxide.

 

Preliminary treatment of pulmonary or extrapulmonary tuberculosis

 

Retrobulbar neuritis with reduction in visual acuity,
 Constriction of visual field, central or peripheral scotoma and green-red colour blindness.

 Retinal haemorrhage (rare).
Reduced renal clearance of urates(gout).

GI disturbances,rash, headache, dizziness, anorexia.
False positive screening test for pheochromocytoma.

 

Optic neuritis, impaired renal function, susceptibility to epilepsy,neonates.Hypersens.

Special precautions::
Test visual functions before treatment.
Pregnancy and children.
Reduce dosage for patients with impaired kidney function.
Serum concentration of ethambutol should not exceed 5mcg per ml.
Elderly.
 

Preliminary treatment of pulmonary or extrapulmonary tuberculosis


Dosage:
Do not use ethambutol alone. Administer once in  24 hours only. Absorption not  significantly
altered with food.

Initial - administer  15mg/kg as a single dose every  24 hours. Concurrently  administer at least
one other anti-tubercular drug to which the organism is susceptible.

 

Classification:  Anti-tubercular
Patent position:
Major brands:
AKT-4                     LUPIN
COMBUNEX         LUPIN
COMBUTOL         LUPIN             MARKET LEADER
INABUTOL           THEMIS CHEM
LY-BUTOL              LYKA
MYAMBUTOL         CYANAMID
MYCOBUTOL         CADILA PHARMA
MYCONEX            CADILA PHARMA
RIFACOM             INDOCO
THEMIBUTOL         THEMIS CHEM
TIBITOL             PCI
WOKEX             TRIDOSS

Domestic production                      93/94    570.8T
Demand projection                         94/95    531T

Raw materials:
1.dl  2 aminobutanol
2.Mono sodium glutamate
3.Glutamic acid
4.Tartaric acid
5.d 2 aminobutanol
6.d 2 amino butanol tartarate
7.1,2 dichloro ethane
8.1,2 dibromo methane
9.Glyoxal
10.Lithium aluminium hydride

Manufacturers:
1.Cadila  Labs- 40T
2.Plasma  Labs,Mangalore- 70T- 7/92

 

1. May cause stomach upset; take with food.
2. Notify if changes in vision( eg blurring, red-green colour blindness) or skin rash occurs.

3. Allergies- Tell your doctor if you have ever had any unusual or allergic reactions to ethambutol or   other related medicines. Also tell your doctor  if your are allergic to any other substances such  as foods, preservatives or dyes.

4.Pregnancy-  pregnant women with tuberculosis should be treated with TB medicines,including  ethambutol. However, studies in animals have shown that ethambutol causes cleft palate, skull and  spine defects absence of one eye and hare lip.  
   
5. Breast feeding-  ethambutol has not been shown to cause problems in nursing babies  
       
6. Children-  not normally used in children younger than 6 years of age becau it may be  hard to tell if  they are having side effects affecting their eyes.    
   
7. Elderly- this medicine is not expected to cause different side effects or problems in older people  than it does  in younger adults.

8. Other medicines- tell your doctor if you are taking any of the following-
    
    if you are taking any other non prescription medicines or OTC medicines        

9. Other medical problems-

    Make sure if you have any other medical problems-

    Gouty arthiritis - ethambutol may cause or worsen attacks of gout

     Kidney disease-  patients with kidney disease may be more likely to have side effects

     Optic neuritits - ethambutol may cause or worsen eye disease

10.Missed dose-

    If you miss a dose of this medicine take it as soon as possible. However if it is almost time for your   next dose  go back to your regular dosing schedule.
    Do not double doses.

 

Pharmacology:
Ethambutol diffuse into actively growing mycobacterium cells such as tubercle bacilli. It
arrests synthesis of one or more metabolites, thus causing impairment of cell metabolism,
arrest of multiplication and cell death.

Pharmacokinetics:
Following a single oral dose of 15/25mg/kg, ethambutol attains a peak  of 2 to 5mcg/ml in
serum 2 to 4 hours after administration. During the 24 hours following oral administration, about 20% of ethambutol is metabolised by the liver.  About 50% of unchanged drug is excreted in the urine.

 

Absorption is not significantly altered by administration of food.

Pregnancy:
 The effects of combinations of ethambutol with other antituberculous drugs on the fetus
are not known. Use only when needed, when the potential benefits outweigh the potential
hazards.

Children:
 Not recommended for use in childrern below 13 years.