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How To Overcome The Side Effects Of R-Cinex?

Posted on Thu, 27 Aug 2015

Question: Hi , My sister is diagnosed with TB in food pipe . She is 13 yrs old . Currently following below prescription advised by doctor :
1) R cinex
2) Combutel 600mg
3) Benedon 1/2 r=tablet
4) Pyzimic 1000 mg
She has side effect in liver because of R cinex (Stomach pain , not feeling hungry, Vomiting) . Please suggest if above prescription is good for 13 yrs old girl and how we can overcome these side effects.

Answered by Dr. Dr. Pradeep Kumar Jain (2 hours later)

Brief Answer:
The prescribed medication is appropriate

Detailed Answer:
Hello

Thanks for the query

If the diagnosis of tuberculosis of food pipe has been confirmed by investigations it should be treated with combination of 5 medications;Isoniazid and Rifampicin(Rcinex),Ethumbutol(Combutol) and Pyrazinamide(Pyzimic).
Vitamin B(Benedon) should be supplemented as Isoniazid can decrease the concentration of this vitamin in the body.
Assuming weight of your sister as about 35-40 kg, the dose is appropriate.
Symptoms of gastrointestinal upset like decrease appetite,nausea,vomiting and pain abdomen are very common side effects of Rifampicin and the medication should not be stopped unless the liver is affected.
Isoniazid can also cause liver problem.
I would suggest you to get serum bilirubin and SGPT/SGOT(liver enzymes) test done to see whether these symptoms are due to abnormal liver function.
If the report comes abnormal Rcinex will need to be stopped and if it is normal
I wont get overly worried.
I would like to give pantoprazole(acid reducing agent) and ondensetron(for vomiting)for symptomatic improvement.

I hope this helps.
Please do ask if you have any more query.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Pradeep Kumar Jain (23 hours later)

SGOT : 95
SGPT : 54

bilirubin total : .40 (Normal)

please suggest if rcinex should be stopped after these results.

Answered by Dr. Dr. Pradeep Kumar Jain (4 hours later)

Brief Answer:
I would like to monitor her closely

Detailed Answer:
Thanks for follow up

SGPT-54 and SGOT-95 both these values are more than the normal limit.
But increase in serum value at least 4 times the normal limit is considered to be significant and then isoniazid and rifampicin need to be stopped.
In the present scenario I would like to continue the medication with some acid reducing agents like pantoprazole.
I suggest you to get the test repeated after one week so that if there is significant rise in enzymes the medication need to be modified.

Please feel free to ask if you have any more doubts.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Pradeep Kumar Jain (17 minutes later)

yes for now doctor has advised to continue rcinex for 5 days and repeat lft test .

Answered by Dr. Dr. Pradeep Kumar Jain (2 minutes later)

Brief Answer:
Please let me know about the further proceedings

Detailed Answer:
Please let me know about the reports or any new symptoms so that I better able to help you out.

Wishing your sister's good health.
Regards

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar