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(sigh-kloe-SER-een)
Seromycin Pulvules
Class: Anti-infective/Antitubercular

 Action Inhibits cell wall synthesis in susceptible strains of certain microorganisms.

 Indications Treatment of active pulmonary and extrapulmonary tuberculosis when organisms are susceptible (after failure of adequate treatment with primary medications); treatment of urinary tract infections caused by susceptible bacteria when conventional therapy has failed; treatment of Gaucher’s disease.

 Contraindications Epilepsy; depression; severe anxiety or psychosis; severe renal insufficiency; excessive concurrent use of alcohol.

 Route/Dosage

ADULTS: PO 250–500 mg q 12 hr; start with 250 mg q 12 hr for first 2 wk (maximum 1 g/day). CHILDREN: PO 10–20 mg/kg/day administered in 2 equally divided doses (maximum 1 g/day).

 Interactions

Alcohol: Increases possibility and risk of epileptic episodes. Do not use together. Isoniazid: May increase cycloserine CNS side effects (eg, dizziness).

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: CHF. CNS: Convulsions; drowsiness; somnolence; headache; tremor; dysarthria; vertigo; confusion; loss of memory; psychoses with suicidal tendencies, behavior changes, hyperirritability, aggression, paresis; hyperreflexia; paresthesias; major and minor clonic seizures; coma; dizziness. DERM: Skin rash. HEPA: Elevated hepatic transaminase.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and dosage not well established. CNS toxicity: Discontinue drug or decrease dosage if symptoms of CNS toxicity develop. May be increased with excessive alcohol consumption. Pyridoxine 200–300 mg/day may be given to prevent neurotoxic effects. Renal impairment: Weekly blood levels of drug should be determined and dosage adjusted to keep blood levels < 30 mcg/ml.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer with meals if GI irritation occurs.
  • Store in airtight, light-resistant container at room temperature.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Review history for epilepsy, depression, severe anxiety or psychosis, renal insufficiency or excessive alcohol use.
  • Review liver function, BUN, creatinine and CBC before beginning therapy.
  • Obtain culture before treatment and verify susceptibility when results are available.
  • Perform baseline assessment of signs and symptoms of infection.
  • If patient has active and infectious tuberculosis, institute infection control measures.
  • Monitor serum cycloserine levels at least weekly in patients receiving > 500 mg/day and in patients with reduced renal function or symptoms of toxicity. Blood levels should remain < 30 mcg/ml.
  • Monitor CBC, liver and renal function studies.
  • If allergic dermatitis or symptoms of CNS toxicity, convulsions, psychosis, depression, headache, tremor, vertigo, paresis or dysarthria develop, withhold medication and notify physician.
  • If CNS alterations occur, institute safety precautions.
  • In patients with tuberculosis, assess for therapeutic effectiveness by monitoring clinical signs and symptoms, sputum cultures or smears for acid-fast bacilli and chest x-rays.
  • In patients with urinary tract infections, assess for therapeutic effectiveness by monitoring clinical signs and symptoms and urine cultures.
OVERDOSAGE: SIGNS & SYMPTOMS
  CNS depression, drowsiness, mental confusion, headache, vertigo, hyperirritability, paresthesias, dysarthrias, psychosis, paresis, convulsions, coma

 Patient/Family Education

  • Instruct patient that if depression or suicidal thoughts occur, notify physician immediately.
  • Stress importance of regular follow-up visits to physician for ongoing assessment.
  • If patient does not have adequate family support system, refer patient to community health organization for monitoring and support.
  • Instruct patient to report these symptoms to physician: rash, anxiety, restlessness, confusion or tremor.
  • Caution patient to avoid intake of alcoholic beverages because of increased risk of seizures.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

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