Cycloserine (Cs) or terizidone (Trd)

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    Update: January 2022

     

    Forms and strengths

    • 250 mg and 125 mg capsules

    Dosage

    • Child under 30 kg: 7.5 to 10 mg/kg 2 times daily (or 15 to 20 mg/kg once daily if tolerated)
    • Child 30 kg and over and adult: 5 to 7.5 mg/kg 2 times daily (or 10 to 15 mg/kg once daily if tolerated)
    • Maximum dose: 1000 mg daily
    • Renal insufficiency: 250 mg once daily or 500 mg 3 times a week

     

    Weight
    (kg)

    Daily dose
    (mg)

    250 mg
    capsule

    125 mg
    capsule

    5

    75-100

    1 caps

    6

    90-120

    1 caps

    7

    105-140

    1 caps

    8

    120-160

    1 caps

    9

    135-180

    1 caps

    10

    150-200

    1 caps x 2

    11

    165-220

    1 caps x 2

    12

    180-240

    1 caps x 2

    13

    195-260

    1 caps x 2

    14

    210-280

    1 caps x 2

    15

    225-300

    1 caps x 2

    16

    240-320

    1 caps (morning) + 2 caps (evening)

    17

    255-340

    1 caps (morning) + 2 caps (evening)

    18

    270-360

    1 caps (morning) + 2 caps (evening)

    19

    285-380

    1 caps (morning) + 2 caps (evening)

    20

    300-400

    1 caps (morning) + 2 caps (evening)

    21

    315-420

    1 caps (morning) + 2 caps (evening)

    22

    330-440

    1 caps (morning) + 2 caps (evening)

    23

    345-460

    1 caps (morning) + 2 caps (evening)

    24

    360-480

    1 caps x 2

    25

    375-500

    1 caps x 2

    26

    390-520

    1 caps x 2

    27

    405-540

    1 caps x 2

    28

    420-560

    1 caps x 2

    29

    435-580

    1 caps x 2

     

    30-35

    500

    1 caps x 2

    36-45

    500

    1 caps x 2

    46-55

    750

    1 caps (morning) + 2 caps (evening)

    56-70

    750

    1 caps (morning) + 2 caps (evening)

    > 70

    750

    1 caps (morning) + 2 caps (evening)

     

    Contra-indications, adverse effects, precautions

    • Avoid in patients with epilepsy, depression, psychosis, severe anxiety, history of neurological or psychiatric disorders, chronic alcohol use. However, if essential to the regimen, it can be administered under close monitoring.
    • May cause:
      • neurotoxicity: seizure, headache, lethargy, confusion, mood change, drowsiness, anxiety, psychosis, depression, suicidal ideation, peripheral neuropathy; rarely, vestibular toxicity;
      • hypersensitivity reactions.
    • For the management of adverse effects, see Appendix 17.
    • Avoid or monitor combination with isoniazid and thionamides (increased risk of neurotoxicity).
    • Administer concomitantly pyridoxine (vitamin B6); child: 1 to 2 mg/kg (usual range: 10 to 50 mg) once daily; adult: 100 mg once daily.
    • Pregnancy: use if the benefits outweigh the risks. Administer pyridoxine to the mother (as above).
    • Breastfeeding: no contra-indication. Administer pyridoxine to the mother (as above) and the breast-fed neonate or infant (1 to 2 mg/kg once daily).

    Monitoring

    • Symptomatic monitoring.

    Patient instructions

    • Take capsules with water before or after meals.
    • Avoid alcohol during treatment.

    Remarks

    • To increase tolerance, start with a low dose (e.g. 250 mg daily in adults), then increase over 1 to 2 weeks to achieve the requested dose.

    Storage

     
    –  Below 25 °C