cycloserine (Seromycin, Pulvules)
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Introduction
Tradenames: Seromycin, Pulvules.
Indications
- adjunctive treatment in pulmonary or extrapulmonary tuberculosis
- treatment of acute urinary tract infection caused by Escherichia coli or Enterobacter species when less toxic conventional therapy has failed or is contraindicated
Contraindications
- epilepsy
- depression
- severe anxiety
- psychosis
- severe renal insufficiency
- chronic alcoholism
Dosage
- tuberculosis
- adults:
- children: 10-20 mg/kg/day PO divided BID up to 1000 mg QD
- administer concurrently with pyridoxine 50 mg QD to minimize neurotoxic effects
Capsule: 250 mg.
Pharmacokinetics
- 70-90% absorption after oral administration
- time to peak serum concentration (oral): 3-4 hours
- tissue distribution
- crosses placenta
- appears in breast milk
- adequate CSF penetration
- 60-70% eliminated unchanged in the urine
- elimination 1/2life 10 hours with normal renal function
elimination via kidney
elimination by hemodialysis = +
Monitor
Adverse effects
- not common (1-10%)
- uncommon (< 1%)
- cardiac arrhythmias, dizziness, tremor, vertigo, confusion, seizures, psychosis, depression, coma, paresis, rash, abnormal liver function tests, vitamin B12 deficiency, folate deficiency
- may occur with ingestions > 1 g
- clinical manifestations:
- management:
- decontaminate with activated charcoal
- can be hemodialyzed
- administer 100-300 mg of pyridoxine
- management is largely supportive
Drug interactions
- increased toxicity with alcohol
- pyridoxine may increase CNS adverse effects[2]
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
More general terms
References
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Jump up to: 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ Department of Veterans Affairs, VA National Formulary