Serious reactions,
May require treatment and/or
Requires changes in dose or stopping
May be life threatening:
Kidney Failure,
Serious allergic reactions,
Vision changes, eye pain,
Neurological problems,

Unpleasant reactions,
Not damaging to health,
Do not usually require changes in
Discoloration of body fluids,
Sleeping problems,

Consultation to healthcare providers at 1-800-TEX-LUNG
2303 S.E. Military Drive, San Antonio, TX 78223

HEMATOLOGICAL (all of these are rare)
Low platelet count which impairs ability to clot and may cause bleeding – stop drug. Rifampin, Rifabutin, rarely INH,
Linezolid, EMB, Ethion, FQN, PAS, PZA, Capreo, Strep.
Low white blood cell count which limits ability to fight infections, especially bacterial infections. Rifabutin especially in high
doses, INH, Linezolid, Rifampin, PAS, EMB
Anemia. Linezolid, rarely INH, rifampin, Ethion, FQN, PZA, Cycloserine.
Early signs: fatigue, rash, poor appetite, nausea, bloating.
Later signs: vomiting, abdominal pain, jaundice, dark urine, light stools, neurological problems.
Laboratory evaluation: liver enzymes (AST/ALT) and bilirubin, clotting studies (evaluate extent of inflammation and liver function).
Medication must be stopped while LFT's done if signs of hepatitis present.
1.) Hold TB meds if LFT's greather than 3 times the normal and symptomatic.
2.) Hold TB meds if LFT's greater than 5 times normal even if no symptoms.
3.) Hold TB meds if T. bili is increased greater than 2 times the normal and no other explanation
Rash: may be mild and medications continued with or without benedryl.
Hives: medication should be stopped and restarted only after desensitization, preferably in hospital.
Swelling of lips: stop drug; do not restart.
Breathing difficulty or wheezing: stop drug; do not restart.
Drug fever: patient well except for fever; resolves with stopping drug.
Rifampin reaction: low platelets, renal failure, flu-like symptoms. Stop Rifamycins
Drug induced lupus due to INH, rarely Rifampin. Drugs usually must be stopped.
NEUROLOGICAL TOXICITY: Peripheral neuropathy: tingling, pain and/or numbness of hands or feet. More common in those
with diabetes, alcoholics, HIV infected. Usually can be treated with change in dose or addition of Vitamin B6. INH, Ethionamide,

Linezolid, rarely fluroquinolones, EMB.
Central neuropathy: headaches, sleep difficulty, loss of concentration, seizures, personality changes, memory loss. INH,
Ethionamide, Cycloserine, Levofloxin, Linezolid.
SEROTONIN SYNDROME: Linezolid is a monoamine oxidase inhibitor (MAO) and interacts with other drugs that promote
release of serotonin or block its re-uptake. Causes excessive CNS and peripheral serotonergic activity. May be fatal. Manifests
as altered mental status, neuromuscular activity and autonomic dysfunction.
Visual toxicity: Change in color vision. Change in visual acuity. Ethambutol, Rifabutin, Linezolid, Clofazamine
Inflammation of eye (uveitis): pain, redness, blurring of vision. Rifabutin
Athralgias: Common with PZA, INH, fluroquinalones, Rifabutin especially with high dose. Can be due to electrolyte abnormality.
May occur with Amikacin, Streptomycin, Capreomycin.
Gout: High uric acid in persons on PZA (with kidney disease).
Tendonitis: stop exercise. Evaluate risk versus benefit of drug. Consider non-steroidal antiinflammatory. May need to stop
medication. Fluroquinolones.
Tendon rupture: Usually Achilles tendon in ankle. Fluroquinalones: stop medication; stop exercise.
Kidney failure: patient will feel ill and may have decreased urine output or swelling: Streptomycin, Amikacin, Capreomycin,
Rifampin, Rifabutin.
Consultation to healthcare providers at 1-800-TEX-LUNG, Produced by
Heartland National TB Center with funds awarded by the Centers for Disease Control & Prevention (CDC).
Adverse effects of treating LTBI serious enough to entail hospital admission or death also should be reported
to the CDC through local public health authorities or by calling (404)639-8401.

Hepatitis, INH, Rifampin, PZA, Ethionamide, PAS, Levofloxin (rare), Ethambutol (rare).

Neurological, Peripheral Neurotoxicity, INH, Ethionamide, Linezolid, Central Neurotoxicity, INH, Ethionomide, Fluroquinolones, Cycloserine, Amikacin, Linezolid.

Renal, Streptomycin, Amikacin, Capreomycin, Rifampin, Rifabutin.

Opthalomologic, Vision Changes: Ethambutol, Rifabutin, Linezolid. Uvetis: Rifabutin. Orange tears: Rifampin.

Hematological (rare), Rifampin, rifabutin, ethambutol, INH, PZA, Linezolid, Cycloserin (rare), Capreomycin (rare), Levofloxacin (rare), Moxifloxacin (rare), Steptomycin (rare), PAS(rare).