Adult: Initially, 250 mg bid for 2 wk, followed by 500-1000 mg daily in divided doses. Max: 1000 mg daily. Adjust dose by monitoring plasma concentrations. Child: 10 mg/kg daily. Adjust doses according to blood concentrations and response.
Mild to moderate: Dose reduction may be needed. Severe: Contraindicated.
May be taken with or without food. May be taken after meals if GI discomfort occurs.
Hypersensitivity. Patient w/ epilepsy, depression, severe anxiety, psychosis, or in those who misuse alcohol. Severe renal impairment.
Patient w/ porphyria. Mild to moderate renal impairment. Pregnancy and lactation.
Drowsiness, somnolence, dizziness, headache, lethargy, depression, tremor, dysarthria, hyperreflexia, paraesthesia, nervousness, anxiety, vertigo, confusion, disorientation, loss of memory, paresis, major and minor clonic seizures, convulsions, coma; psychosis (possibly w/ suicidal tendencies), personality changes, hyperirritability, aggression; elevated serum aminotransferase levels, esp in patients w/ pre-existing liver disease. Rarely, hypersensitivity reactions including rash, and photosensitivity; cardiac arrhythmias and sudden CHF.
Monitor renal, hepatic, and hematological functions; plasma cycloserine concentrations.
Symptoms: Headache, vertigo, confusion, drowsiness, hyper-irritability, paraesthesias, dysarthria and psychosis; paresis, convulsions and coma often occur in larger doses. Management: Symptomatic and supportive treatment. Activated charcoal may be more effective than emesis or lavage in reducing absorption. May give 200-300 mg of pyridoxine HCl daily to treat and prevent neurotoxic events. Haemodialysis may remove the drug from the bloodstream but should only be used for life-threatening toxicity.
Concomitant use w/ other anti-TB drugs may lead to vit B12 and/or folic acid deficiency, megaloblastic and sideroblastic anaemia. Increased incidence of CNS effects w/ ethionamide and isoniazid. May inhibit hepatic metabolism of phenytoin.
Alcohol increases risk of epileptic episodes.
Description: Cycloserine inhibits bacterial cell wall synthesis by competing w/ amino acid (D-alanine) for incorporation into the bacterial cell wall. It may be bacteriostatic or bactericidal. Pharmacokinetics: Absorption: Readily and almost completely absorbed from the GI tract. Time to peak plasma concentration: 3-4 hr. Distribution: Widely distributed into body tissues and fluids, including the CSF, placenta, and breast milk. Metabolism: Hepatic. Excretion: Via urine by glomerular filtration (as unchanged drug). Plasma half-life: Approx 10 hr.
Anon. Cycloserine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 18/08/2014.Buckingham R (ed). Cycloserine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 18/08/2014.McEvoy GK, Snow EK, Miller J et al (eds). Cycloserine. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 18/08/2014.Seromycin Capsule (Purdue GMP Center LLC dba The Chao Center). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 18/08/2014.