ethionamide (Rx)

Brand and Other Names:Trecator
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 250mg

Tuberculosis, Active

15-20 mg/kg/day PO  

Initiate dose at 250 mg/day for 1-2 days; THEN increase to 250 mg twice daily for 1-2 days with gradual increases to highest tolerated dose; 750 mg/day average dose

Not to exceed 1000 mg/day in 3-4 divided doses

Renal Impairment

End-stage renal disease on hemodialysis: 250-500 mg/day

CrCl <30 mL/min: 250-500 mg/day

CrCl ≥ 30 mL/min: No dose adjustment necessary

Administration

Part of multi-drug regimen; not first-line treatment

Take with food

Dosing Considerations

If susceptibility tests indicate that the patient's organism is resistant to one of first-line antituberculosis drugs (i.e., isoniazid or rifampin) yet susceptible to ethionamide, ethionamide should be accompanied by at least one drug to which M. tuberculosis isolate is known to be susceptible;3 if tuberculosis is resistant to both isoniazid and rifampin, yet susceptible to ethionamide, ethionamide should be accompanied by at least two other drugs to which the M. tuberculosis isolate is known to be susceptible

Directly observed therapy is recommended for all patients receiving treatment for tuberculosis

Monitor: baseline & periodic LFTs, TFTs, glucose

Dosage Forms & Strengths

tablet

  • 250mg

Tuberculosis, Active

M. tuberculosis resistant to isoniazid or rifampin, or patient intolerant to drugs

10-20 mg/kg/day divided BID/TID PO OR  

15 mg/kg PO qDay

No more than 1000 mg/day in 3-4 divided doses

Administration

Part of multi-drug regimen; not first-line treatment

Take after meals

Dosing Considerations

If susceptibility tests indicate that the patient's organism is resistant to one of first-line antituberculosis drugs (i.e., isoniazid or rifampin) yet susceptible to ethionamide, ethionamide should be accompanied by at least one drug to which M. tuberculosis isolate is known to be susceptible; if tuberculosis is resistant to both isoniazid and rifampin, yet susceptible to ethionamide, ethionamide should be accompanied by at least two other drugs to which the M. tuberculosis isolate is known to be susceptible

Directly observed therapy is recommended for all patients receiving treatment for tuberculosis

Monitor: baseline & periodic LFTs, TFTs, glucose

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Interactions

Interaction Checker

and ethionamide

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (3)

                • cycloserine

                  ethionamide, cycloserine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced CNS toxicity; risk of seizure.

                • isoniazid

                  ethionamide increases levels of isoniazid by unspecified interaction mechanism. Use Caution/Monitor.

                • sodium picosulfate/magnesium oxide/anhydrous citric acid

                  ethionamide decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

                Minor (0)

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                  Adverse Effects

                  >10%

                  Disorder of gastrointestinal tract (50%)

                  Frequency Not Defined

                  Postural hypotension

                  Depression

                  Dizziness

                  Drowsiness

                  Headache

                  Peripheral neuropathy

                  Psychosis

                  Photosensitivity

                  Rash

                  Excessive salivation

                  Gynecomastia

                  Hypoglycemia

                  Impotence

                  Anorexia

                  Dyspepsia

                  Diarrhea

                  Nausea

                  Metallic taste

                  Vomiting

                  Thrombocytopenia

                  Elevated liver transaminases

                  Hepatitis

                  Optic neuritis

                  Visual changes

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                  Warnings

                  Contraindications

                  Hypersensitivity to ethionamide

                  Severe hepatic dysfunction

                  Cautions

                  Use caution in diabetes mellitus, thyroid disease, hepatic impairment

                  HIV patients may have malabsorption syndrome

                  Used as monotherapy in the treatment of tuberculosis results in rapid development of resistance; give suitable companion drug or drugs; base the choice on results of susceptibility testing; therapy may be initiated prior to receiving results of susceptibility tests as deemed appropriate by physician; administer with at least one, sometimes two, other drugs to which organism is known to be susceptible

                  Prescribing drug in the absence of a proven or strongly suspected bacterial infection indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria

                  Ethionamide may potentiate adverse effects of other antituberculous drugs administered concomitantly

                  Perform ophthalmologic examinations (including ophthalmoscopy) before and periodically during therapy

                  Excessive ethanol ingestion should be avoided; psychotic reaction reported

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                  Pregnancy & Lactation

                  Pregnancy Category: C

                  Lactation: excretion in milk unknown; use with caution

                  Pregnancy Categories

                  A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                  B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                  C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                  D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                  X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                  NA: Information not available.

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                  Pharmacology

                  Metabolism: liver

                  Excretion: kidney

                  Mechanism of Action

                  Bacteriostatic or bactericidal

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                  Images

                  No images available for this drug.
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                  Patient Handout

                  Patient Education
                  ethionamide oral

                  ETHIONAMIDE - ORAL

                  (e-thye-ON-a-mide)

                  COMMON BRAND NAME(S): Trecator

                  USES: Ethionamide is used with other medications to treat tuberculosis (TB). Ethionamide is an antibiotic and works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

                  HOW TO USE: Take this medication by mouth with or without food, usually once daily or as directed by your doctor. If this medication causes stomach upset or nausea/vomiting, take this medication with meals. Also, discuss with your doctor if it may be helpful to divide your daily dose into smaller doses to be taken several times a day. Follow your doctor's instructions carefully.The dosage is based on your age, weight, medical condition, and response to treatment.For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same time(s) every day.Continue to take this medication (and other TB medications) until the full prescribed amount is finished, even if symptoms disappear. Stopping the medication too early or skipping doses may allow the bacteria to continue to grow, which may result in a return of the infection and cause the infection to be more difficult to treat (resistant).Your doctor may also direct you to take vitamin B6 (pyridoxine) to help prevent certain side effects (such as nerve problems) from ethionamide. Follow your doctor's instructions carefully.Tell your doctor if your condition persists or worsens.

                  SIDE EFFECTS: Nausea, vomiting, diarrhea, abdominal/stomach pain, increased saliva, strange metallic taste in the mouth, loss of appetite, or sores in the mouth may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Many people using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.Tell your doctor right away if any of these unlikely but serious side effects occur: unusual hunger, unusual sweating, shakiness, persistent nausea/vomiting, unusual tiredness/weakness, yellowing eyes/skin, dark urine, joint pain/swelling, slow heartbeat, mental/mood changes (such as nervousness, restlessness, depression).Tell your doctor right away if any of these rare but serious side effects occur: vision changes (such as blurred/decreased/double vision, color blindness), eye pain, numbness/tingling of arms/legs.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                  PRECAUTIONS: Before taking ethionamide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, underactive thyroid (hypothyroidism), eye problems (such as optic neuritis, cataracts, diabetic retinopathy).Alcohol may increase the risk of liver disease or mental/mood changes. Avoid alcoholic beverages while using this medication.Ethionamide may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).If you have diabetes, this product may lower your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of low blood sugar, such as sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. Your doctor may need to adjust your diabetes medication, exercise program, or diet.This medication is not recommended for use during pregnancy. It may harm an unborn baby. Consult your doctor for more details.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

                  DRUG INTERACTIONS: The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.Keep a list of all the products you use. Share the list with your doctor and pharmacist to reduce your risk for serious medication problems.

                  OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                  NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as sputum test, eye/vision exams, liver/thyroid function, blood glucose, complete blood count) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

                  MISSED DOSE: It is important to take each dose of this medication as scheduled. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

                  STORAGE: Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

                  Information last revised July 2021. Copyright(c) 2021 First Databank, Inc.

                  IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                  Tier Description
                  1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                  2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
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                  Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.