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Ethambutol
Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
03-30-2008
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Available formulation in Zambia: Tablet: 100-400 mg (hydrochloride). Isoniazid + ethambutol tablet: 150 mg + 400 mg. Rifampicin + isoniazid + ethambutol tablet: 150 mg + 75 mg + 275 mg. Rifampicin + isoniazid + pyrazinamide + ethambutol tablet: 150 mg + 75 mg + 400 mg + 275 mg.
- All new TB cases (smear positive, smear negative, extra-pulmonary TB, and smear negative relapse): INH, RIF, PZA, and EMB x 2 months, then INH plus EMB x 6 months.
- TB smear positive re-treatment cases (e.g treatment failure, treatment after default, smear positive relapse): INH, RIF, PZA, EMB, and SM x 2 months, then INH, RIF, PZA, and EMB x 6 months.
- MAC: Ethambutol 15-20 mg/kg/day plus clarithromycin. Rifabutin not available or recommended.
- MDRTB standardized regimen: ethambutol 800mg/d (<50kg); 1200 mg (>50kg) plus ethionamide, kanamycin, ofloxacin, and pyrazinamide x 4 month, then based on culture conversion and sensitivity, continue with ethionamide, ofloxacin, and ethambutol for 12-18 months.
Zambia Information Author: Paul A. Pham, Pharm. D.
- Treatment of all forms of TB in combination with other antituberculous drugs.
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
|
Myambutol
| Ethambutol (EMB) | Elan | oral
tablet
100 mg | $0.68 |
|
|
|
| oral
tablet
400 mg | $1.78 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- TB: 15-20 mg/kg (max 2gm) qd (plus INH, PZA, Rifamycin)
- Intermittent directly-observed treatment regimens: 50 mg/kg 2x/wk (max 4g) or 25-30 mg/kg 3x/wk (max 2.4 g).
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MAC: 15mg/kg/d (plus macrolide)
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M. kansasii: 25 mg/kg/d x 2 mos then 15 mg/kg/d (max 2.5 gm/d) (plus INH and Rifamycin)
15 mg/kg/ q24h (consider dose reduction with clearance <70 mL/min).
15 mg/kg/ q24-36h.
15 mg/kg/ q48h.
15-20 mg/kg/day post-HD 3x/wk.
15 mg/kg/48 hrs.
No data. Consider dose reduction.
- Optic neuritis: decreased acuity, reduced color discrimination, constricted fields, and scotomata (infrequent with 15 mg/kg/d; inc risk w/ 25 mg/kg/d). Pts receiving 25 mg/kg/d should have baseline visual and color perception screening; repeated visual screening monthly. Ocular manifestation reversible with discontinuation, but irreversible blindness has been described.
- GI intolerance: anorexia, nausea, vomiting, and abdominal pain.
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Peripheral neuropathy.
- Hypersensitivity reaction.
- Confusion and dizziness.
- Acute gout.
- Hematologic: leukopenia, thrombocytopenia, eosinophilia, neutropenia, and lymphadenopathy.
- Dermatologic: rash, pruritus, dermatitis, and exfoliative dermatitis.
- Interstitial nephritis.
First line agent in combination for TB and MAC. Monitor visual acuity in pts receiving higher doses (25 mg/kg/d).
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