Tadinisur: A Second-Line Medication for Drug-Resistant Tuberculosis
Tadinisur is a brand name for ethionamide, a second-line antituberculosis drug used primarily for treating drug-resistant tuberculosis in patients with organisms that have demonstrated or presumed susceptibility to the medication.
Mechanism and Role in Treatment
- Ethionamide (Tadinisur) is structurally similar to isoniazid (INH) and is used specifically for patients with drug-resistant tuberculosis 1
- It may be considered when first-line agents cannot be used due to resistance, toxicity, or contraindications 1
Dosing Information
- Adult dosing: 15-20 mg/kg per day (maximum 1.0 g/day), typically administered as 500-750 mg/day 1
- Can be given as a single daily dose or divided into two doses 1
- Single daily doses are often given at bedtime or with the main meal to improve tolerability 1
- Pediatric dosing: 15-20 mg/kg per day (maximum 1.0 g/day) 1
- No data supports intermittent dosing; daily administration is recommended 1
- Available as 250 mg tablets 1
Adverse Effects
Gastrointestinal Effects
- Commonly causes profound gastrointestinal side effects, including metallic taste, nausea, severe vomiting, loss of appetite, and abdominal pain 1
- Taking the medication with food or at bedtime may improve gastrointestinal symptoms 1
Hepatotoxicity
- Hepatotoxicity occurs in approximately 2% of patients taking ethionamide 1
- Similar hepatotoxic profile to INH due to structural similarities 1
Neurological Effects
- Neurotoxicity, including peripheral neuritis, optic neuritis, anxiety, depression, and psychosis 1
- Reported in 1-2% of patients on shorter courses, with higher rates during prolonged treatment 1
Endocrine Effects
- Can cause endocrine disturbances including gynecomastia, alopecia, hypothyroidism, and impotence 1
- May make diabetes more difficult to manage 1
Special Populations
Pregnancy
- Ethionamide (Tadinisur) should not be used during pregnancy 1
- Crosses the placenta and is teratogenic in laboratory animals 1
Renal Impairment
- For patients with creatinine clearance less than 30 ml/minute or those receiving hemodialysis, the dose should be reduced to 250-500 mg/day 1
Hepatic Disease
- Should be used with caution in patients with underlying liver disease 1
CNS Penetration
- CSF concentrations equal to those in serum, making it potentially useful for tuberculous meningitis 1
Monitoring Recommendations
- Liver function tests should be obtained at baseline and monthly if underlying liver disease is present 1
- Repeat liver function tests if symptoms of hepatotoxicity occur 1
- Thyroid-stimulating hormone should be measured at baseline and monthly during treatment 1