Interacting drugs- summary

 + Cyclosporine

 Alcohol 

 Alcohol and cycloserine are incompatible, alcohol increases the possibility and risk of epileptic episodes.

Isoniazid

in combination with cycloserine may result in increased CNS side effects, mostly notably dizziness.

Treatment of active pulmonary and extrapulmonary tuberculosis..

CNS-convulsions, drowsiness, and somnolence,

Headache, tremor, Dysarthria, vertigo,

Confusion and disorientation with loss of memory.

Cardiovascular-Sudden development of congestive heart failure has been reported.

Allergic skin rash.

Hypersensitivity to cycoserine,

Epilepsy, depression,

Severe anxiety or psychosis,s Severe renal insufficiency,

Excessive concurrent use of alcohol.

Special precautions:

CNS toxicity- Discontinue the drug or reduce dosage if patient develops allergic dermatitis or symptoms of CNS toxicity such as convulsions, psychosis, somnolence, depression.

Monitor patients by hemotologic, renal excretion, blood level and liver function studies

Pregnancy- not known whether the drug can cause fetal harm. Administer only if needed.

Lactation- because of potential for serious adverse reactions,decide to discontinue or not taking into account the importance to the mother.

Indications:

Treatment of active pulmonary and extrapulmonary tuberculosis..

Dosage::

Administer 500mg to 1g in divided doses monitored by blood levels. Usual initial dose is 250mg twice daily at 12 hourly intervals for the first 2 weeks.

Do not exceed 1g/day..

1. May cause drowsiness. Observe caution when driving or performing tasks requiring alertness.

2. Avoid excessive alcohol consumption.

3. Notify physician if skin rash, mental confusion, dizziness, headache, or tremors occur.

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

5. Pregnancy- cycloserine has not been shown to cause birth defects or other problems in humans

6. Breast feeding- cycloserine has been reported to cause problems in nursing babies .

7. Children- not reported to cause different side effects or problems in children than adults

8. Elderly- cyclosporine in elderly is not expected to cause different side efects or problems inolder people than it does in younger adults.

9. Other medicines- tell your doctor if you are taking other medicines- Ethionamide - may increase the risk of nervous system side efects especially seizures.

10. Other medical problems- tell your doctor if you have any other medical problems- Alcohol abuse or Convulsive disorders such as seizures or epilepsy- cyclosporine may increase the risk of seizures in patients who drink alocohol or history of seizures

11. 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:

Inhibits cell wall synthesis in susceptible strains of gram positive and gram negative bacteria. Pharmacokinetics: When given orally, cyclosporine is rapidly absorbed, reaching peak plasma concentrations in 3 to 8 hours.

Approximately 30% of the drug is metabolised, 50% of parentral dose is excreted unchanged in the urine in the first 12 hours. Renal insufficiency will lead to toxic accumulation.

May be taken after meals if GI  upset occurs

Pregnancy:

Not known whether the drug can cause fetal harm. Use only if clearly needed.

Lactation:

Because of potential for serious adverse reactions in nursing infants, decide whether to discontinue the drug or discontinue nursing, based on the importance of the drug to the mother,.