DRUGS SIDE EFFECTS MANAGEMENT

Rash Observe patient/stop drug if significant

Liver dysfunction Monitor AST/limit alcohol consumption/monitor for hepatitis symptoms
Flulike syndrome Administer at least twice weekly/limit dose to 10 mg/kg (adults)
Red-orange urine Reassure patient
Drug interactions (induce P450 - ↑ elimination
RIFAMPIN
anticoagulant & contraceptive; ↑ urinary excretion of Consider monitoring levels of other drugs affected by rifampin, especially with
methadone – precipitate methadone withdrawal; contraceptives, anticoagulants, and digoxin / avoid use with protease inhibitors
pseudomembranous colitis)
Fever, chills Stop drug
Light-chain protenuria
Monitor AST/limit alcohol consumption/monitor for hepatitis symptoms /
Hepatitis educate patient / stop drug at first symptoms of hepatitis (nausea, vomiting,
ISONIAZID anorexia, flulike syndrome)
(cause pyridoxine Peripheral neuritis Administer vitamin B6
deficiency due to Optic neuritis Administer vitamin B6/stop drug
competition with Seizures; insomnia; restlessness; urinary retention;
Administer vitamin B6
pyridoxal phosphate psychoses
for enzyme Allergy – fever; skin rash
apotryptophanase) Hemolysis in G6PD deficiency
Inhibit metabolism of Phenytoin
SLE-like syndrome
Monitor AST/limit daily dosage to 15–30 mg/kg/discontinue with signs or
Hepatitis symptoms of
PYRAZINAMIDE
hepatitis
Hyperuricemia
Monitor uric acid level only in cases of gout or renal failure
(inhibit uric acid excretion by kidney)
Use 25 mg/kg daily only for first 2 months (except in drug-resistant
Optic neuritis tuberculosis), then use lower daily dose (15 mg/kg) when possible / monitor
ETHAMBUTOL
(+ red-green colour blindness; reduce visual acuity; visual acuity (eye chart) and red-green color vision (Ishihara Color Book) at
retinal damage) baseline and with any visual complaint / educate patient / stop drug at first
change in vision, get ophthalmologic evaluation
Limit dose and duration of therapy as much as possible/avoid daily therapy in
patients >50 years old/monitor BUN and serum creatinine levels and possibly
STREPTOMYCIN,
conduct audiometry before and as needed during therapy/question patient
AMIKACIN, Ototoxicity, renal toxicity
regularly about tinnitus, dizziness, vertigo, and decreased hearing/measure
CAPREOMYCIN
serum drug levels if possible/educate patient/stop drug at first development of
adverse effect (usually tinnitus)