Table 20.2.

First and second-line anti-tubercular agents and their adverse drug reactions (ADRs)

Drugs	Common ADRs	Uncommon ADRs	Rare ADRs
Isoniazid∗	Asymptomatic elevation of serum hepatic enzymes	Hepatitis, cutaneous hypersensitivity, peripheral neuropathy	Fever, giddiness, convulsions, optic neuritis, mental symptoms, haemolytic anaemia, aplastic anaemia, lupoid reactions, arthralgia, gynaecomastia
Rifampicin∗	Pruritus	Hepatitis, cutaneous hypersensitivity, gastrointestinal reactions, thrombocytopenia, febrile reaction, “flu syndrome”	Shortness of breath, shock, haemolytic anaemia, acute renal failure, thrombotic thrombocytopenic purpura
Pyrazinamide∗	Anorexia, nausea, flushing, photosensitization	Hepatitis, vomiting, arthralgia, cutaneous reactions	Sideroblastic anaemia, gout
Ethambutol∗		Retrobulbar neuritis, cutaneous reactions, arthralgia	Peripheral neuropathy
Streptomycin	Cutaneous hypersensitivity, giddiness, numbness, tinnitus	Vertigo, ataxia, deafness	Clinical renal failure, aplastic anaemia
Thioacetazone	Gastrointestinal reactions, cutaneous hypersensitivity, vertigo, conjunctivitis	Hepatitis, erythema multiforme, exfoliative dermatitis, haemolytic anaemia	Agranulocytosis
Amikacin/kanamycin/capreomycin	Hearing damage, vestibular disturbance, deranged renal function tests	Clinical renal failure
Ofloxacin/ciprofloxacin	Gastrointestinal reactions, insomnia	Anxiety, dizziness, headache, paresthesia, tremor	Convulsion, cutaneous hypersensitivity
Ethionamide/prothionamide	Gastrointestinal reactions	Hepatitis, peripheral neuropathy	Convulsion, depression, alopecia, hypothyroidism, impotence, gynaecomastia
Cycloserine	Dizziness, headache, depression, memory loss	Psychosis, convulsion	Sideroblastic anaemia
Para-aminosalicylic acid	Gastrointestinal reactions	Hepatitis, drug fever	Hypothyroidism, haematological reactions, generalized hypersensitivity, malabsorption

^∗First line anti-tubercular agents