Myambutol: Targeted Tuberculosis Treatment with Precision
Myambutol
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Synonyms | |||
Myambutol (ethambutol hydrochloride) is a first-line antimycobacterial agent specifically formulated for the treatment of active tuberculosis. As an integral component of combination therapy, it works by inhibiting the synthesis of arabinogalactan—a critical cell wall component in Mycobacterium tuberculosis. This targeted mechanism allows for effective bacteriostatic action, reducing bacterial load and supporting sputum conversion. Administered orally, it is indicated for both pulmonary and extrapulmonary TB, and is essential in preventing the development of drug resistance when used according to standardized treatment guidelines.
Features
- Active ingredient: Ethambutol hydrochloride
- Available in 100 mg and 400 mg film-coated tablets
- Selective inhibition of mycobacterial arabinogalactan synthesis
- Oral administration with high bioavailability
- Heat-stable formulation suitable for various climates
- Compatible with most first-line anti-TB drugs including isoniazid, rifampicin, and pyrazinamide
Benefits
- Effectively reduces mycobacterial load in active tuberculosis infections
- Lowers risk of emergent drug resistance when used in combination regimens
- Supports faster sputum culture conversion compared to some monotherapies
- Enables shorter, more effective treatment courses when combined with other antitubercular drugs
- Well-tolerated profile with manageable side effects when properly monitored
- Contributes to higher cure rates in both drug-sensitive and multidrug-resistant TB cases
Common use
Myambutol is indicated for the treatment of all forms of tuberculosis, including pulmonary TB and extrapulmonary manifestations such as lymphatic, bone and joint, genitourinary, and military tuberculosis. It is always administered as part of a combination antituberculosis regimen, never as monotherapy, to prevent the development of drug-resistant strains. The medication is typically used during the initial two-month intensive phase of treatment, though it may be continued throughout the continuation phase in certain drug-resistant cases or when susceptibility testing supports its ongoing use.
Dosage and direction
Dosage is weight-based and must be calculated precisely according to patient body weight:
- 15-20 mg/kg body weight daily (maximum 2.5 g/day) for intensive phase treatment
- Alternatively, 25-30 mg/kg body weight three times weekly for directly observed therapy (DOT) programs
- For patients weighing 40-55 kg: 800 mg daily
- For patients weighing 56-75 kg: 1200 mg daily
- For patients weighing 76-90 kg: 1600 mg daily
Administration should be as a single daily dose, preferably on an empty stomach, though it may be taken with food if gastrointestinal upset occurs. Tablets should be swallowed whole with water and not crushed or chewed. Dosage must be adjusted in patients with renal impairment.
Precautions
Baseline ophthalmological examination is mandatory before initiation of therapy and should be repeated monthly during treatment. Visual acuity and color discrimination testing are essential as ethambutol can cause optic neuritis. Renal function should be assessed before treatment and monitored periodically, with dosage adjustments made for patients with creatinine clearance below 30 mL/min. Hepatic function should be monitored, particularly when used with other hepatotoxic anti-TB drugs. Use with caution in patients with pre-existing ocular conditions such as cataracts, diabetic retinopathy, or optic neuritis. Pediatric use requires careful visual monitoring as children may not reliably report visual symptoms.
Contraindications
Myambutol is contraindicated in patients with known hypersensitivity to ethambutol or any component of the formulation. It should not be used in patients with optic neuritis, unless no alternative treatment exists and benefits outweigh risks. Contraindicated in patients unable to report visual symptoms or cooperate with visual testing, including unconscious patients, young children, and those with significant cognitive impairment. Should not be used as monotherapy for any form of tuberculosis. Use during pregnancy requires careful risk-benefit assessment, though it is generally considered safe when needed for TB treatment.
Possible side effects
The most significant adverse effect is optic neuritis, which may present as blurred vision, scotomas, red-green color blindness, or constriction of visual fields. This is typically dose-related and often reversible upon discontinuation. Other reported side effects include:
- Peripheral neuropathy (tingling or numbness in extremities)
- Hyperuricemia (which may precipitate acute gout)
- Rash and dermatological reactions
- Gastrointestinal disturbances (nausea, abdominal pain, vomiting)
- Headache, dizziness, and malaise
- Hepatic enzyme elevations
- Arthralgia and joint pain
- Fever and chills (suggestive of hypersensitivity reaction)
Drug interaction
Myambutol may interact with several medication classes. Aluminum-containing antacids may decrease ethambutol absorption—administer at least 2 hours apart. May enhance neurotoxic effects when combined with other medications having neurotoxic potential. Can increase uric acid levels, potentially reducing effectiveness of uricosuric agents. When used with other antituberculosis drugs, monitoring for additive hepatic toxicity is essential. No significant interactions with antiretroviral drugs have been documented, making it suitable for HIV-TB co-infected patients.
Missed dose
If a dose is missed, it should be taken as soon as remembered on the same day. However, if it is almost time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never double the dose to make up for a missed one. Consistency in dosing is crucial for maintaining therapeutic drug levels and preventing resistance development. Patients on thrice-weekly DOT regimens should contact their healthcare provider immediately if a dose is missed to determine the appropriate course of action.
Overdose
Symptoms of overdose may include increased severity of known adverse effects, particularly visual disturbances, nausea, vomiting, dizziness, and mental confusion. There is no specific antidote for ethambutol overdose. Management is supportive and symptomatic, including gastric lavage if presentation is early after ingestion. Hemodialysis may enhance elimination as ethambutol is dialyzable. Patients should be hospitalized for observation and monitoring of visual acuity, renal function, and neurological status. Ophthalmological consultation is mandatory in suspected overdose cases.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) in a dry place protected from light and moisture. Keep in the original container with the lid tightly closed. Do not transfer tablets to other containers. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Proper storage is essential for maintaining drug stability and efficacy throughout the treatment course.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Myambutol is a prescription medication that should only be used under the supervision of a qualified healthcare professional experienced in tuberculosis management. Dosage and treatment duration must be individualized based on patient characteristics, disease status, and microbial susceptibility testing. Patients should not initiate, adjust, or discontinue therapy without medical supervision. Regular monitoring for ocular toxicity is essential throughout treatment.
Reviews
Clinical studies and decades of use have established Myambutol as a cornerstone of antituberculosis therapy. The WHO includes it in its essential medicines list, and treatment guidelines worldwide recommend its use in combination regimens. Studies demonstrate that ethambutol-containing regimens achieve sputum conversion rates of 85-95% in drug-sensitive tuberculosis when used according to guidelines. The reversible nature of its most significant side effect (optic neuritis) when detected early and managed appropriately makes it a valuable option in TB control programs. Its role in preventing resistance development has been particularly praised in clinical practice.