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Seromycin (Cycloserine) - Drug Interactions, Contraindications, Overdosage, etc

 
 



DRUG INTERACTIONS

Concurrent administration of ethionamide has been reported to potentiate neurotoxic side effects.

Alcohol and Seromycin are incompatible, especially during a regimen calling for large doses of the latter. Alcohol increases the possibility and risk of epileptic episodes.

Concurrent administration of isoniazid may result in increased incidence of CNS effects, such as dizziness or drowsiness. Dosage adjustments may be necessary and patients should be monitored closely for signs of CNS toxicity.

OVERDOSAGE

Signs and Symptoms
Acute toxicity from cycloserine can occur if more than 1 g is ingested by an adult. Chronic toxicity from cycloserine is dose related and can occur if more than 500 mg is administered daily. Patients with renal impairment will accumulate cycloserine and may develop toxicity if the dosing regimen is not modified. Patients with severe renal impairment should not receive the drug. The central nervous system is the most common organ system involved with toxicity. Toxic effects may include headache, vertigo, confusion, drowsiness, hyperirritability, paresthesias, dysarthria, and psychosis. Following larger ingestions, paresis, convulsions, and coma often occur. Ethyl alcohol may increase the risk of seizures in patients receiving cycloserine.
The oral median lethal dose in mice is 5290 mg/kg.

Treatment
To obtain uptodate information about the treatment of overdose, a good resource is your certified Regional Poison Control Center. Telephone numbers of certified poison control centers are listed in the Physicians'Desk Reference (PDR). In managing overdosage, consider the possibility of multiple drug overdoses, interaction among drugs, and unusual drug kinetics in your patient.
Overdoses of cycloserine have been reported rarely. The following is provided to serve as a guide should such an overdose be encountered.
Protect the patient's airway and support ventilation and perfusion. Meticulously monitor and maintain, within acceptable limits, the patient's airway when employing gastric emptying or charcoal.
In adults, many of the neurotoxic effects of cycloserine can be both treated and prevented with the administration of 200 to 300 mg of pyridoxine daily.
The use of hemodialysis has been shown to remove cycloserine from the bloodstream. This procedure should be reserved for patients with life-threatening toxicity that is unresponsive to less invasive therapy.

CONTRAINDICATIONS

Administration is contraindicated in patients with any of the following:

Hypersensitivity to cycloserine

Epilepsy

Depression, severe anxiety, or psychosis

Severe renal insufficiency

Excessive concurrent use of alcohol

REFERENCES

1.Kubica GP, Dye WE: Laboratory methods for clinical and public healthmycobacteriology. US Department of Health, Education and Welfare, Public Health Service, 1967, pp 4755, 6670.
2. Jones LR: Colorimetric determination of cycloserine, a new antibiotic. Anal Chem 1956;28:39.
Literature revised April 28, 2005
Eli Lilly and Company
Indianapolis, IN 46285, USA

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