A complete analysis of the indications, usage and precautions in the instructions for Cycloserine to improve medication safety

Cycloserine (Cycloserine) is a broad-spectrum anti-tuberculosis drug that is a second-line anti-tuberculosis drug and is used to treat patients with pulmonary tuberculosis or tuberculosis that is resistant to first-line drugs (such as isoniazid and rifampicin). Its main mechanism of action is to inhibit the synthesis of the cell wall of Mycobacterium tuberculosis, specifically by competitively inhibiting D-alanine and D-alanine ligase, preventing the formation of cell wall peptidoglycan, thereby inhibiting bacterial growth and reproduction. Since cycloserine is often used as a supplementary drug for drug-resistant or relapse cases in anti-tuberculosis treatment, its clinical use must be carried out in strict accordance with the instructions to ensure efficacy and safety.

In terms of indications, cycloserine is mainly used for combination therapy in patients with resistance to first-line anti-tuberculosis drugs (multidrug resistance or recurrent tuberculosis). Clinically, cycloserine is often used in combination with rifampicin, isoniazid, pyrazinamide and aminoglycosides to enhance the efficacy of drug-resistant tuberculosis. Its single-agent anti-tuberculosis activity is limited, so it is not recommended to be used alone to prevent further development of drug-resistant strains. For children or patients with abnormal renal function, the dosage needs to be adjusted carefully under the guidance of a professional physician to reduce the risk of adverse events.

In terms of usage and dosage, adults usually take it orally, 250 mg per time to 500 mg, 2 times a day, the dose can be adjusted according to body weight and tolerance if necessary; the dosage for children needs to be calculated based on body weight, usually 10 to 15 mg per kilogram of body weight, taken orally 2 times a day. If renal function impairment occurs, the dosing interval can be appropriately extended or the dosage reduced to avoid toxic reactions caused by excessive blood concentration. The medicine can be taken orally with food or on an empty stomach, but it is necessary to take the medicine regularly and do not increase or decrease the dose or stop the medicine on your own to ensure the continuity and effectiveness of anti-tuberculosis treatment.

The adverse reactions of cycloserine are more significant, especially those related to the central nervous system. Common reactions include headache, insomnia, irritability, anxiety, depression, and even hallucinations or confusion, and in severe cases, seizures. Abnormal renal function or high-dose use may increase the risk of central nervous system toxicity, so liver and kidney function, blood pressure, and neuropsychiatric status need to be regularly assessed during treatment. Other adverse reactions include gastrointestinal discomfort, rash, allergic reactions and hematological abnormalities. To reduce the risk, vitamin B6 (pyridoxine) can be supplemented, daily 10 to 50 mg, to reduce the occurrence of neurological side effects.

The key points of safe management of cycloserine use include: first, strictly follow the doctor's instructions and take it according to the dosage, especially in drug-resistant tuberculosis combination regimens, to ensure drug synergy rather than single drug abuse; second, regularly monitor blood drug concentration, kidney and liver function and mental status, detect adverse reactions early and adjust the dose; third, patients with a history of mental illness or epilepsy should be used with caution, and maintain psychological assessment and necessary intervention during treatment; fourth, inform patients to avoid alcohol and central nervous system depressant drugs during medication to reduce the risk of drug interactions.

Overall, cycloserine has an irreplaceable role in the treatment of multidrug-resistant or recurrent tuberculosis, and its effectiveness depends on standardized use and combination regimens. By strictly following the indications, usage, dosage and precautions in the instructions, combined with individualized monitoring and risk management, treatment safety can be maximized, adverse reactions in the central nervous system and other systems can be reduced, and effective control of drug-resistant tuberculosis and long-term health management of patients can be achieved.

Keyword tags: cycloserine, anti-tuberculosis drugs, drug-resistant tuberculosis, central nervous system toxicity, drug safety

Reference materials:https://www.drugs.com/mtm/cycloserine.html