Prothionamide is a thioamide that forms an important component in multidrug-resistant tuberculosis treatment regimens in adults and children.
Prothionamide is prescribed to treat multidrug-resistant tuberculosis (MDR TB) and given as part of a treatment regime, usually involving 5 medicines.
It is also used to treat tuberculous meningitis in adults and children.
Prothionamide is a thioamide, structurally similar to ethionamide and clinically interchangeable with it.
• Prothionamide is contraindicated in patients with known allergy to the drug.
• Prothionamide is also contraindicated in pregnant and lactating women and in patients who have severe renal disease and porphyria.
The recommended dose for prothionamide is
Adults: 15-20 mg/kg/day that amounts to around 500-750 mg per day; maximum dose per day should not exceed 1000 mg or 1 gram
Children: 15-20 mg/kg/day with a maximum daily dose of 1000 mg
• Prothionamide should be taken orally.
• Adults and children can take it as one dose to maximize peak levels (particularly for daily doses less than 750 mg) if they can tolerate it.
• The dose can be split into two if once a day dose is not tolerated.
• Dose may have to be gradually escalated for adults. Increase dose by 250 mg every 3 to 5 days.
• Take with or after meals to reduce gastrointestinal adverse effects.
• Complete the entire dose of the drug.
• Pyridoxine should be prescribed along with prothionamide (adult doses from 50 to 100 mg daily, up to 50 mg per 250 mg of prothionamide).
• Gastrointestinal:Excessive salivation, metallic taste, nausea, vomiting, abdominal pain, anorexia, diarrhea and inflammation of the mouth
• Central nervous system: Depression, drowsiness, encephalopathy, peripheral neuropathy, headache, restlessness, anxiety, psychotic disturbances
• Liver: Transient increases in Liver Function Test parameters, acute hepatitis (rare)
• Metabolic: Hypothyroidism, gynecomastia, hypoglycemia
• Thyroid function tests have to be taken once in 3 months when taking prothionamide.
• Blood sugar levels must be monitored in diabetic patients.
Prothionamide could cause adverse effects when given along with
• Cycloserine (increased risk of neurotoxicity).
• Isoniazid (increased serum concentrations).
• P-aminosalicylic acid (increased risk of hypothyroidism).
• Rifampicin and thiacetazone (increased risk of hepatotoxicity).
Prothionamide should be stored at room temperature.
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