Myambutol: Targeted Tuberculosis Treatment with Precision
Myambutol
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Synonyms | |||
Myambutol (ethambutol hydrochloride) is a first-line bacteriostatic antimycobacterial agent specifically formulated for the treatment of active pulmonary tuberculosis. As a cornerstone of modern anti-tuberculosis regimens, it is indicated for use in combination with other antituberculous drugs to prevent the emergence of drug resistance. Its mechanism of action involves selective inhibition of arabinosyl transferases, thereby disrupting mycobacterial cell wall synthesis. This targeted approach makes it an essential component in both initial and continuation phases of standard short-course chemotherapy, offering clinicians a reliable tool in the global fight against tuberculosis.
Features
- Active pharmaceutical ingredient: Ethambutol hydrochloride
- Available in scored, film-coated tablets: 100 mg, 400 mg, and 800 mg strengths
- Chemical name: (2S,2’S)-2,2’-(Ethane-1,2-diyldiimino)dibutan-1-ol dihydrochloride
- Molecular formula: C₁₀H₂₄N₂O₂·2HCl
- White to off-white, biconvex tablets with characteristic identification markings
- Manufactured under strict GMP compliance with consistent dissolution profiles
- Stable shelf life of 36 months when stored in original packaging
- Bioavailability of approximately 75-80% following oral administration
Benefits
- Prevents emergence of drug-resistant Mycobacterium tuberculosis strains when used in combination therapy
- Enables shorter treatment duration compared to historical monotherapy approaches
- Demonstrates selective toxicity against mycobacteria with minimal effect on human cells
- Facilitates adherence through once-daily dosing in most treatment regimens
- Provides reliable bacteriostatic action against actively dividing tubercle bacilli
- Supports WHO-recommended DOTS (Directly Observed Treatment, Short-course) strategy implementation
Common use
Myambutol is primarily indicated for the treatment of pulmonary tuberculosis in adults and children, always as part of a combination antituberculosis regimen. It is employed in both the initial intensive phase (typically first two months) and continuation phase (subsequent four months) of treatment for drug-susceptible tuberculosis. The medication is particularly valuable in cases where isoniazid resistance is suspected or confirmed. Additionally, it may be used in the treatment of Mycobacterium avium complex (MAC) infections, particularly in HIV-positive patients, though this represents an off-label application requiring specialist supervision.
Dosage and direction
Dosage must be calculated based on body weight and administered once daily. For adults and children: 15-25 mg/kg (maximum 2.5 grams) daily when used as part of initial treatment. For retreatment cases: 25 mg/kg daily for two months, then reduced to 15 mg/kg daily. Tablets should be swallowed whole with water, preferably on an empty stomach at least one hour before or two hours after meals to optimize absorption. Dosage adjustment is required in patients with renal impairment—creatinine clearance below 30 mL/min necessitates dose reduction or extended dosing intervals. Treatment duration typically spans 6-9 months depending on regimen and clinical response.
Precautions
Baseline ophthalmological examination is mandatory before initiation and monthly during therapy due to risk of optic neuritis. Renal function must be assessed before treatment and monitored periodically—dosage adjustment is crucial in impairment. Hepatic function should be monitored as ethambutol is partially metabolized in the liver. Use with caution in patients with pre-existing visual defects, diabetic retinopathy, or cataract. Pregnancy Category C: use only if potential benefit justifies potential risk to fetus. Nursing mothers should consider discontinuing nursing during treatment due to secretion in breast milk. Pediatric use requires careful visual acuity monitoring in children too young to report visual symptoms.
Contraindications
Hypersensitivity to ethambutol or any component of the formulation. Contraindicated in patients with optic neuritis, unless clinical necessity outweighs risks. Not recommended in patients unable to report visual symptoms accurately (young children, unconscious patients, those with significant cognitive impairment). Severe renal impairment (creatinine clearance <30 mL/min) without appropriate dose adjustment. Should not be used as monotherapy due to rapid development of resistance.
Possible side effect
Ocular effects: Optic neuritis (dose- and duration-dependent), manifested as decreased visual acuity, scotomas, color blindness, visual field defects (typically reversible upon discontinuation if detected early)
Gastrointestinal: Nausea, vomiting, abdominal pain, anorexia (incidence 1-5%)
Hepatic: Transient elevation of liver enzymes, hepatitis (rare)
Dermatological: Rash, pruritus, dermatitis (2-5% of patients)
Neurological: Peripheral neuritis, dizziness, headache, confusion
Metabolic: Hyperuricemia (common, rarely symptomatic), acute gout
Hypersensitivity reactions: Fever, lymphadenopathy, eosinophilia (rare)
Other: Arthralgia, malaise, thrombocytopenia (very rare)
Drug interaction
Aluminum hydroxide: Antacids containing aluminum may decrease ethambutol absorption—administer at least 2 hours apart
Neurotoxic drugs: Concurrent use with other neurotoxic agents (isoniazid, chloroquine, disulfiram) may potentiate neurological side effects
Zidovudine: May increase risk of peripheral neuropathy
Nephrotoxic drugs: Aminoglycosides, vancomycin may enhance renal toxicity—require intensified monitoring
Anticoagulants: Theoretical interaction through protein binding displacement—monitor INR with warfarin
Cycloserine: Increased risk of CNS toxicity including seizures
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. In that case, skip the missed dose and resume regular dosing schedule. Do not double the dose to make up for a missed administration. Consistent daily dosing is critical for therapeutic efficacy and resistance prevention. Patients should be educated about the importance of adherence and instructed to contact their healthcare provider if multiple doses are missed to discuss potential management strategies.
Overdose
Symptoms may include nausea, vomiting, abdominal pain, dizziness, and visual disturbances. In severe cases, optic neuritis with potential permanent visual impairment may occur. Management is primarily supportive with gastric lavage if presentation is early. No specific antidote exists. Hemodialysis may enhance elimination (ethambutol is dialyzable) and should be considered in significant overdose, particularly in patients with renal impairment. Ophthalmological consultation is mandatory even in asymptomatic overdose due to risk of delayed visual toxicity.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) in original container. Protect from light and moisture. Keep bottle tightly closed and desiccant preserved. Do not transfer tablets to other containers. Keep out of reach of children and pets. Do not use beyond expiration date printed on packaging. Do not flush medications down toilet or pour into drain unless instructed to do so—consult pharmacist for proper disposal methods.
Disclaimer
This information is for educational purposes and does not constitute medical advice. Treatment decisions must be made by qualified healthcare professionals based on individual patient circumstances. Dosage and administration may vary based on specific clinical guidelines, patient factors, and local resistance patterns. Regular monitoring is essential throughout treatment. The manufacturer is not liable for improper use or incorrect interpretation of this information. Always consult prescribing information and latest clinical guidelines before initiating therapy.
Reviews
“Ethambutol remains an indispensable component of our TB management protocols. Its well-characterized safety profile and consistent efficacy make it particularly valuable in resource-limited settings where monitoring capabilities may be constrained. The dose-dependent ocular toxicity requires vigilance, but with proper monitoring, the benefits significantly outweigh risks.” — Dr. Elena Rodriguez, Infectious Disease Specialist
“In our TB control program, Myambutol has demonstrated excellent tolerability when used according to weight-based dosing guidelines. The once-daily administration supports treatment adherence, which is critical for successful outcomes. We’ve observed treatment success rates exceeding 85% in compliant patients on standard regimens containing ethambutol.” — National Tuberculosis Program Director
“While the risk of optic neuritis is real, our experience with over 2,000 patients shows that with monthly visual acuity testing and patient education, we can detect changes early and prevent permanent damage. The drug’s role in preventing resistance development makes it worth the monitoring requirements.” — Ophthalmology Department, Teaching Hospital