A comprehensive introduction to the possible side effects and risks of cycloserine during long-term use

Cycloserine (Cycloserine) is a classic second-line anti-tuberculosis drug, mainly used for patients with multi-drug-resistant tuberculosis or poor response to first-line anti-tuberculosis drugs. Due to its unique mechanism of action - inhibiting a key step in bacterial cell wall synthesis, cycloserine has irreplaceable value in the treatment of refractory tuberculosis. However, precisely because its target is related to the central neurotransmitter system, adverse reactions and safety risks are relatively prominent during long-term use, which requires patients and doctors to attach great importance to it.

Central nervous system side effects are one of the greatest concerns during long-term use of cycloserine. The more common symptoms include dizziness, headache, drowsiness, decreased concentration, memory loss, and sleep disorders. Such symptoms are particularly obvious in the initial stage of medication or during the dose adjustment stage. Some patients can gradually adapt after continued medication, but there are also patients whose symptoms persist, affecting daily life and treatment compliance.

Psychiatric and emotional adverse effects are another major risk of long-term use of cycloserine. Some patients may experience anxiety, irritability, low mood, depression and even behavioral changes. In a few cases, patients with long-term high doses or high blood concentrations may develop severe mental symptoms such as hallucinations, delusions, and insanity. Patients with a history of mental illness, alcohol dependence or basic neurological diseases have a relatively higher probability of developing such risks and require special evaluation before taking the drug.

Epileptiform seizures are also one of the serious adverse reactions clearly indicated in the instructions for cycloserine. Long-term use, especially if the dose is too high or the drug accumulates due to decreased renal function, may induce convulsions or epileptic seizures. Once such a situation occurs, it usually requires immediate discontinuation of the drug and neurological evaluation. Therefore, it is very important to strictly adhere to the recommended dosage during treatment and avoid increasing the dosage on your own.

In addition to neurological-related risks, long-term use of cycloserine may also cause a certain degree of gastrointestinal reactions, such as nausea, vomiting, decreased appetite, bloating, etc. These symptoms are usually not life-threatening, but if long-term, they may affect nutritional intake and overall treatment effectiveness. Some patients can find relief by taking it in divided doses, taking it with meals, or adjusting the dosage method under the guidance of a doctor.

In terms of metabolism and nutrition, long-term use of cycloserine may interfere with the metabolism of vitamin B6 (pyridoxine), thereby increasing the risk of neurotoxicity. Therefore, clinically it is usually recommended that patients simultaneously supplement vitamin B6 during the use of cycloserine to reduce the incidence of peripheral neuritis, paresthesia and central nervous side effects. This measure is considered to be one of the important means to improve the safety of long-term medication.

Patients with renal impairment should use extreme caution during long-term use of cycloserine. Since the drug is primarily excreted by the kidneys, reduced renal function can lead to accumulation of the drug in the body, significantly increasing the risk of neurological toxicity. Therefore, renal function should be monitored regularly during long-term treatment, and the dose or dosing interval should be adjusted in a timely manner based on the test results to avoid aggravation of adverse reactions.

Taken together, cycloserine does have many side effects and potential risks during long-term use, especially abnormalities in the central nervous system and mental behavior. However, in special cases such as multidrug-resistant tuberculosis, the benefits of treatment are still very clear. By strictly controlling dosage and combining vitaminsB6, regular monitoring of neurological and renal function status, and individualized adjustment of the plan under the guidance of a doctor, most patients can still complete treatment within a controllable risk range, thereby obtaining ideal anti-tuberculosis efficacy.

Keyword tags: cycloserine, long-term side effects, central nervous system, psychiatric reactions, epilepsy, anti-tuberculosis drugs, vitaminsB6, renal function.

Reference:https://en.wikipedia.org/wiki/Cycloserine