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Combutol 400 mg (Ethambutol)

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Quick Overview

Buy Combutol 400 mg (Ethambutol), Ethambutol is used in the prevention, treatment and recurrence (second time treatment) of tuberculosis (a serious infection caused by bacteria that affects the lungs and in certain cases other parts of the body). It is always given in combination with other antituberculosis drugs. 
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Combutol 400 mg (Ethambutol)

Uses

Ethambutol is used in the prevention, treatment and recurrence (second time treatment) of tuberculosis (a serious infection caused by bacteria that affects the lungs and in certain cases other parts of the body). It is always given in combination with other antituberculosis drugs. 

How it works

Ethambutol belongs to a class of anti-tuberculosis drugs. It suppresses the growth of tuberculosis causing bacteria (Mycobacterium tuberculosis). Ethambutol enters the growing bacteria and kills the bacteria by inhibiting an important enzyme arabinosyl tranferases involved in the formation of the outer protective covering of the bacteria called cell wall.
 

What is ethambutol?

Ethambutol is an antibiotic that prevents growth of the tuberculous bacteria in the body. Ethambutol is used to treat tuberculosis (TB), and is usually given together with at least one other tuberculosis medicine. Ethambutol may also be used for purposes not listed in this medication guide.

What is the most important information I should know about ethambutol?

Ethambutol can cause serious vision problems or irreversible vision loss. You may not be able to take this medicine if you have an eye problem or vision disorder.

What should I discuss with my healthcare provider before taking ethambutol?

You should not use ethambutol if you are allergic to it. You may not be able to take ethambutol if you have an eye condition called optic neuritis (inflammation of nerve fibers behind your eyes). Your doctor will decide if this treatment is right for if you have an eye disorder.

Ethambutol can cause vision problems that may be a sign that you should stop taking the medicine. You may not be able to take ethambutol if you cannot recognize or report any changes in your vision. Young children or debilitated patients may not be able to tell someone about vision problems.

To make sure ethambutol is safe for you, tell your doctor if you have:

  • inflammatory eye disorders such as uveitis or iritis;

  • eye problems caused by diabetes;

  • cataracts;

  • liver disease;

  • kidney disease; or

  • gout.

How should I take ethambutol?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Tell your doctor if you have ever used tuberculosis medicine before. Your dose may be different if you have been treated for tuberculosis in the past.

You may take ethambutol with or without food.

Ethambutol may be taken with food if it upsets your stomach.

Tell your doctor if you have any changes in weight. Ethambutol doses are based on weight and your dose may also need to be changed.

Your vision will need to be checked often while you are taking ethambutol. If you wear glasses, take them with you to your vision examination.

Your blood cells, kidney function, and liver function may also need to be checked.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Ethambutol will not treat a viral infection such as the flu or a common cold.

Tuberculosis is sometimes treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor's advice.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking ethambutol?

Avoid taking an antacid containing aluminum hydroxide (Alternagel, Maalox, Mi-Acid, Mylanta, Rulox) within 4 hours after you take ethambutol. Some antacids can make it harder for your body to absorb ethambutol.

Ethambutol side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Ethambutol can cause serious vision problems, including vision loss that may be permanent. Stop using ethambutol and call your doctor at once if you have any problems with one or both of your eyes, such as:

  • blurred vision or trouble focusing;

  • loss of vision in one eye that lasts an hour or longer;

  • increased sensitivity of your eyes to light;

  • loss of color vision; or

  • pain with eye movement, pain behind your eyes.

Call your doctor at once if you have:

  • new or worsening cough with fever, trouble breathing;

  • numbness of tingling in your hands or feet;

  • confusion, hallucinations;

  • fever, swollen glands, painful mouth sores, skin sores, cold or flu symptoms, general ill feeling;

  • easy bruising or bleeding (nosebleeds, bleeding gums);

  • chest pain or shortness of breath with mild exertion;

  • little or no urinating;

  • liver problems--upper stomach pain, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • itching or rash;

  • joint pain;

  • headache, dizziness; or

  • nausea, vomiting, stomach pain, indigestion, loss of appetite.

Ethambutol dosing information

Usual Adult Dose for Tuberculosis -- Active:

Initial treatment: 15 mg/kg orally once a day for 6 to 8 weeks with concurrent isoniazid therapy. 
Retreatment: 25 mg/kg orally once a day for 60 days concurrently with at least one other anti-TB drug. After 60 days, decrease dose to 15 mg/kg orally once a day. 
As an alternative to single daily dose, a dose of 40 mg/kg orally twice a week or 30 mg/kg orally 3 times a week can be administered. This generally follows 2 weeks of daily therapy. This regimen allows directly observed therapy (DOT).

Usual Adult Dose for Mycobacterium avium-intracellulare -- Treatment:

900 mg orally once a day. Pulmonary AVI treatment consists of clarithromycin and 2 to 4 other drugs such as ethambutol, rifampin, clofazimine, and/or other agents. The duration of treatment is 18 to 24 months.
Disseminated MAI treatment consists of clarithromycin or azithromycin and 1 to 3 other drugs such as ethambutol, clofazamine, ciprofloxacin, ofloxacin, rifampin, rifabutin, or amikacin. As long as clinical and microbiological response is documented, therapy should be continued for life.

Usual Adult Dose for Mycobacterium avium-intracellulare -- Prophylaxis:

15 mg/kg orally once a day. Used in combination therapy with clarithromycin or azithromycin. Therapy should be continued for life.

Usual Pediatric Dose for Tuberculosis -- Active:

Greater than 13 years:
Initial treatment: 15 mg/kg orally once a day for 6 to 8 weeks with concurrent isoniazid therapy. 
Retreatment: 25 mg/kg orally once a day for 60 days concurrently with at least one other anti-TB drug. After 60 days, decrease dose to 15 mg/kg orally once a day. 
As an alternative to single daily dose, a dose of 40 mg/kg orally twice a week or 30 mg/kg orally 3 times a week can be administered. This generally follows 2 weeks of daily therapy. This regimen allows directly observed therapy (DOT).

Usual Pediatric Dose for Mycobacterium avium-intracellulare -- Treatment:

Greater than 13 years:
900 mg orally once a day. Pulmonary AVI treatment consists of clarithromycin and 2 to 4 other drugs such as ethambutol, rifampin, clofazimine, and/or other agents. The duration of treatment is 18 to 24 months.
Disseminated MAI treatment consists of clarithromycin or azithromycin and 1 to 3 other drugs such as ethambutol, clofazamine, ciprofloxacin, ofloxacin, rifampin, rifabutin, or amikacin. As long as clinical and microbiological response is documented, therapy should be continued for life.

Usual Pediatric Dose for Mycobacterium avium-intracellulare -- Prophylaxis:

Greater than 13 years:
15 mg/kg orally once a day. Used in combination therapy with clarithromycin or azithromycin. Therapy should be continued for life.

What other drugs will affect ethambutol?

Other drugs may interact with ethambutol, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

 

Expert advice

 

Do consult your doctor before taking ethambutol if you have any eye problems such as cataracts (disturbed vision due to clouding of eye lenses) , recurrent inflammatory conditions of the eye, optic neuritis (inflammation of nerve fibers that transmit visual information from your eye to the brain), and diabetic retinopathy (a complication of eye due to diabetes). Ethambutol can cause serious eye damage. Regular eye checkups are recommended while on treatment with ethambutol.

 

Do consult your doctor before taking ethambutol:

 

  • If you have kidney problems.
  • If you have liver problems.
  • If you have gout (pain, swelling, redness and stiffness in joints due to accumulation of uric acid).

 

Ethambutol is not recommended for use in children aged below 3 years.

 

Do consult your doctor before taking ethambutol if you are pregnant or planning to become pregnant.

 

Do consult your doctor before taking ethambutol if you are breastfeeding.

 

Do not stop taking ethambutol without consulting your doctor. If you forget to take a dose of ethambutol, take it as soon as you remember. Do not double the dose to make up for the missed dose.

 

Frequently asked questions

 

Ethambutol

 

Q. Does ethambutol cause blindness?

 

Optic neuritis (inflammation of nerve fibers that transmit visual information from your eye to the brain) is one of the side effects of ethambutol which causes several forms of eye defect. Although these conditions are reversible upon discontinuation of the drug, rare cases of irreversible blindness have also been reported. Please contact your doctor immediately if you notice any of these symptoms: decreased clearness of vision, loss of vision, disturbed vision due to blind spots, color blindness, visual field defect and eye pain.

 

Q. Does ethambutol induce hyperuricemia/how does ethambutol induce hyperuricemia?

 

Yes. Increase in blood levels of uric acid is a side effect of ethambutol. It increases the retention of uric acid in the body by decreasing the excretion of urates (uric acid) by the kidneys. 

 

Q. How does ethambutol work in the body?

 

Ethambutol is an antibiotic effective against tuberculosis causing bacteria. It suppresses the growth of the bacteria by interfering with the formation of the outer protective covering (cell wall) of the bacteria, thereby weakening the bacteria.

 

Q. What is ethambutol toxicity/How does ethambutol cause optic neuritis/how does ethambutol affect vision?

 

Ethambutol toxicity involves toxic effects on the eyes (optic neuritis/optic neuropathy) which are related to the dose and duration of ethambutol treatment. It causes optic neuritis (inflammation of nerve fibers in the eye) by interfering with important cellular activities (mitochondrial toxicity) in the nerve cells and inducing nerve damage (neuropathy) thereby affecting the transmission of visual information from the eye to brain. The symptoms of ethambutol induced optic neuritis include: decreased clearness of vision, loss of vision, disturbed vision due to blind spots, color blindness, visual field defect and eye pain.

 

Q. What does ethambutol treat?

 

Ethambutol is an antibiotic effective against tuberculosis causing bacteria. It is used in the prevention, treatment and second time treatment of tuberculosis (a serious infection caused by bacteria that affects the lungs and in certain cases other parts of the body).

 

Q. Is ethambutol bacteriostatic or bactericidal?

 

Ethambutol is both a bacteriostatic and a bactericidal antibiotic. It suppresses the growth of bacteria (bacteriostatic) by interfering with the formation of the outer protective covering (cell wall) of the bacteria, thereby weakening it and causing cell death in certain cases (bactericidal).

 

Q. Is ethambutol safe in pregnancy?

 

There are no adequate studies on ethambutol in pregnant women. There are few reports of eye problems in infants born to mothers on multi drug therapy for tuberculosis during pregnancy. Ethambutol should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus. Please follow the advice of the doctor regarding its use.

 

Q. Is ethambutol hepatotoxic?

 

Liver toxicities are among the known side effects of ethambutol. Inflammation of liver (hepatitis), abnormal liver function causing yellowing of skin and eyes (jaundice), abnormal liver function tests (blood tests to assess health of liver) and very rarely liver failure have been noted in patients receiving multi drug  (including ethambutol) treatment for tuberculosis. Please contact your doctor before taking ethambutol if you have any liver problems.

 

Q. Is ethambutol toxicity reversible?

 

In most cases ethambutol toxicities are related to dose (depends upon the quantity of ethambutol you take) and duration of treatment and are reversible upon discontinuation. However, serious irreversible damage to eye and liver has been reported in rare cases.

 

Q. Is ethambutol chemotherapy?

 

Ethambutol is an antibiotic used in the treatment of tuberculosis. Do not confuse it with chemotherapy or chemo drugs used for the treatment of cancer.

 

Q. Ethambutol is effective against?

 

Ethambutol is effective against most tuberculosis causing bacteria belonging to Mycobacterium family (M. tuberculosis, M. avium complex, M. kansasii, M. marinum).


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