Trecator SC

Trecator SC (ethionamide) is a second-line antituberculosis agent specifically formulated for the treatment of drug-resistant tuberculosis (TB). As part of a comprehensive multidrug regimen, it plays a critical role in targeting mycobacterial populations that have developed resistance to first-line therapies. Its bacteriostatic action helps inhibit the growth of Mycobacterium tuberculosis, making it an essential component in managing complex TB cases under strict medical supervision.

Features

• Active ingredient: Ethionamide 250 mg per tablet
• Formulation: Film-coated tablets for oral administration
• Mechanism: Inhibits mycolic acid synthesis in the bacterial cell wall
• Compatibility: Designed for use within combination therapy protocols
• Packaging: Bottles of 100 tablets, with child-resistant cap
• Storage: Room temperature (15–30°C), protected from light and moisture

Benefits

• Effectively targets multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis strains
• Reduces bacterial load and helps prevent further transmission of resistant TB
• Supports treatment success when first-line agents are ineffective or intolerable
• Contributes to shorter, more manageable treatment durations in combination regimens
• Helps prevent relapse and development of further drug resistance
• Enables tailored therapeutic strategies for complex patient profiles

Common use

Trecator SC is indicated for the treatment of pulmonary and extrapulmonary tuberculosis in cases where resistance to isoniazid or other first-line agents has been confirmed. It is always administered as part of a combination regimen, never as monotherapy, to prevent further resistance development. Typical use involves culture-confirmed drug-resistant TB or cases where patients cannot tolerate standard first-line treatments due to adverse effects or contraindications.

Dosage and direction

The recommended adult dosage is 15–20 mg/kg body weight per day, typically administered as 500–1000 mg daily, divided into 3–4 doses. Dosing should be initiated at lower levels and gradually increased to minimize gastrointestinal intolerance. Administration with food may improve tolerance. Pediatric dosing is calculated as 15–20 mg/kg/day, not to exceed 1 g daily. Treatment duration typically ranges from 12–24 months, depending on disease severity and treatment response, and must always continue until microbiological cure is achieved.

Precautions

Regular liver function monitoring is essential due to potential hepatotoxicity. Baseline and periodic visual acuity testing is recommended as optic neuritis may occur. Patients should be monitored for signs of peripheral neuropathy, hypothyroidism, and psychiatric disturbances. Use with caution in patients with diabetes mellitus, as metabolic disturbances may occur. Alcohol consumption should be avoided due to increased risk of hepatotoxicity. Pregnancy requires careful risk-benefit assessment (Category C).

Contraindications

Trecator SC is contraindicated in patients with severe hepatic impairment, history of hypersensitivity to ethionamide or any component of the formulation, and in cases of severe gastrointestinal disorders that may impair absorption. It should not be used as monotherapy under any circumstances. Concomitant use with drugs that prolong QT interval requires extreme caution.

Possible side effect

Common adverse effects include gastrointestinal disturbances (nausea, vomiting, abdominal pain, metallic taste), hepatotoxicity (elevated transaminases, jaundice), neurological effects (peripheral neuropathy, optic neuritis, dizziness), endocrine effects (hypothyroidism, gynecomastia), and dermatological reactions (rash, photosensitivity). Less frequently, psychiatric symptoms (depression, psychosis) and metabolic disturbances (hypoglycemia) may occur.

Drug interaction

Significant interactions occur with cycloserine (increased neurotoxic risk), rifampin (may increase hepatotoxicity), and oral hypoglycemics (enhanced hypoglycemic effect). Concurrent use with other hepatotoxic drugs requires careful monitoring. Ethionamide may reduce the effectiveness of oral contraceptives, necessitating alternative contraception methods. Vitamin B6 supplementation is recommended to reduce neuropathic risk.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. Doubling doses to make up for missed administration is not recommended. Consistent adherence is critical to treatment success and resistance prevention. Patients should maintain a dosing schedule and contact their healthcare provider if multiple doses are missed.

Overdose

Symptoms of overdose may include severe nausea, vomiting, neurological symptoms (dizziness, confusion), and potential hepatotoxicity. There is no specific antidote; treatment involves supportive care and symptomatic management. Gastric lavage may be considered if ingestion was recent. Hospitalization for monitoring and supportive therapy is recommended for significant overdoses.

Storage

Store at controlled room temperature (15–30°C) in the original container, protected from light and moisture. Keep the bottle tightly closed with the child-resistant cap properly engaged. Do not transfer tablets to other containers. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes only and does not replace professional medical advice. Treatment with Trecator SC must be prescribed and monitored by a qualified healthcare professional experienced in tuberculosis management. Dosage and treatment duration should be individualized based on bacterial susceptibility testing, patient factors, and treatment response. Patients should report any adverse effects promptly to their healthcare provider.

Reviews

Clinical studies demonstrate Trecator SC’s efficacy in MDR-TB treatment regimens, with culture conversion rates of 70–85% when used appropriately in combination therapy. Specialist physicians note its critical role in managing resistant cases, though emphasize the importance of careful monitoring for adverse effects. Patient experiences vary, with many reporting significant gastrointestinal effects that often improve with dose adjustment and continued use. The drug remains a cornerstone of second-line TB treatment despite its side effect profile, particularly valuable in resource-limited settings where newer agents may be unavailable.