Trecator SC: Effective Second-Line Tuberculosis Treatment
| Product dosage: 250 mg | |||
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Synonyms | |||
Trecator SC (ethionamide) is an essential second-line antibacterial medication specifically indicated for the treatment of active tuberculosis when primary therapies have failed or are not tolerated. As a critical component of multidrug regimens, it targets Mycobacterium tuberculosis through a unique mechanism of action, disrupting cell wall synthesis. Its role is vital in managing drug-resistant strains, contributing to global efforts in TB control and helping prevent disease progression and transmission in complex clinical scenarios.
Features
- Contains ethionamide as the active ingredient
- Available in 250 mg film-coated tablets
- Functions as a bacteriostatic agent against Mycobacterium tuberculosis
- Requires prescription and professional medical supervision
- Typically used as part of a combination antituberculosis regimen
Benefits
- Provides a therapeutic option when first-line TB drugs are ineffective or contraindicated
- Helps combat multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB)
- Contributes to reduced bacterial load and decreased transmission risk
- Supports successful treatment outcomes when integrated into carefully managed regimens
- May help prevent relapse in complex TB cases when adherence to protocol is maintained
Common use
Trecator SC is primarily used in the treatment of active pulmonary and extrapulmonary tuberculosis infections caused by strains resistant to isoniazid or other first-line agents. It is never administered as monotherapy but is incorporated into individualized regimens based on drug susceptibility testing. Its use is common in cases where standard therapy with isoniazid, rifampin, pyrazinamide, and ethambutol has failed or cannot be tolerated due to adverse effects or confirmed resistance patterns.
Dosage and direction
The recommended adult dosage is 15-20 mg/kg/day, typically administered as 250-500 mg daily, divided into three or four doses. Dosing should be initiated at a lower amount (250 mg daily) and gradually increased to the full therapeutic dose over several days to improve gastrointestinal tolerance. The medication is best taken with food to minimize gastric irritation. Pediatric dosing is calculated as 15-20 mg/kg/day in divided doses, not to exceed 1 gram daily. Treatment duration varies but typically continues for 18-24 months or until sputum culture conversion is sustained, always as part of a combination regimen.
Precautions
Liver function tests should be monitored regularly throughout therapy due to potential hepatotoxicity. Patients should be advised that ethionamide may cause gastrointestinal disturbances, and dose titration can help manage these effects. Regular ophthalmological examinations are recommended as neuropathic effects, including optic neuritis, may occur. Diabetic patients require careful monitoring as ethionamide may interfere with diabetes management. Alcohol consumption should be avoided due to increased risk of hepatotoxicity and central nervous system effects.
Contraindications
Trecator SC is contraindicated in patients with severe hepatic impairment or active liver disease. It should not be used in patients with known hypersensitivity to ethionamide or any component of the formulation. The medication is contraindicated in cases of severe diabetes mellitus with complications. Use during pregnancy requires careful risk-benefit assessment due to potential teratogenic effects. Concomitant use with drugs that cause significant hepatotoxicity is generally contraindicated.
Possible side effects
Common side effects include gastrointestinal disturbances such as nausea, vomiting, abdominal pain, diarrhea, and metallic taste. Neurological effects may include dizziness, headache, drowsiness, asthenia, and peripheral neuropathy. Dermatological reactions including rash, photosensitivity, and acneiform eruptions may occur. Endocrine effects can include gynecomastia, hypothyroidism, and hypoglycemia. Hepatotoxicity, manifested by elevated transaminases, jaundice, or hepatitis, requires immediate medical attention. Psychiatric disturbances such as depression and emotional instability have been reported.
Drug interaction
Ethionamide may potentiate the effects of other hepatotoxic drugs including isoniazid, pyrazinamide, rifampin, and certain anticonvulsants. It may increase the metabolism of vitamin D, potentially leading to decreased levels. Concurrent use with cycloserine may increase neurotoxic effects. Ethionamide can enhance the effects of oral hypoglycemic agents and insulin, requiring adjustment of diabetes medication. It may decrease the effectiveness of oral contraceptives, necessitating alternative contraceptive methods. Interaction with alcohol significantly increases the risk of adverse effects.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never double the dose to make up for a missed one. Consistent adherence to the prescribed regimen is critical for treatment success and preventing development of further drug resistance. Healthcare providers should be notified of pattern non-adherence to assess potential need for regimen adjustment or additional support.
Overdose
Symptoms of overdose may include severe nausea, vomiting, neurological symptoms such as dizziness, confusion, and peripheral neuropathy, and potential hepatotoxicity. There is no specific antidote for ethionamide overdose. Management consists of immediate gastric lavage if ingestion was recent, followed by supportive care including monitoring of liver function, neurological status, and electrolyte balance. Hemodialysis is not effective for ethionamide removal. Patients should be monitored for several days due to the drug’s pharmacokinetic properties.
Storage
Store at controlled room temperature between 15-30°C (59-86°F). Protect from light and moisture. Keep in the original container with the lid tightly closed. Do not store in bathroom cabinets where humidity levels fluctuate. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Properly dispose of any unused medication according to local regulations or through medication take-back programs.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Trecator SC is a prescription medication that should only be used under the supervision of a qualified healthcare professional familiar with tuberculosis management. Treatment decisions must be based on individual patient characteristics, drug susceptibility testing, and current clinical guidelines. Patients should consult their healthcare provider for personalized medical advice and report any adverse effects promptly.
Reviews
“After developing resistance to first-line TB drugs, Trecator SC was incorporated into my regimen. While the gastrointestinal side effects were challenging initially, dose adjustment and supportive medications helped manage them. After 20 months of treatment, I achieved culture conversion and have remained TB-free for two years.” - Patient, 42
“As an infectious disease specialist, I find Trecator SC invaluable for managing complex MDR-TB cases. Its unique mechanism of action provides an important option when standard regimens fail. Careful monitoring and patient education are essential for successful outcomes, but it remains a cornerstone of second-line therapy.” - Physician, 15 years experience
“The neuropathic side effects were significant during my treatment with Trecator SC, requiring pyridoxine supplementation and dose modifications. However, the medication was crucial for overcoming my extensively drug-resistant TB infection. The trade-off was necessary for achieving cure.” - Patient, 31
“From a pharmacy perspective, Trecator SC requires careful patient counseling about administration with food, potential side effects, and the absolute necessity of adherence to prevent further resistance. It’s not an easy drug to take, but it serves a critical role in TB control programs.” - Pharmacist, 8 years experience