Combutol (ethambutol) is most commonly used as an anti-tuberculosis medication, though it is sometimes used in treating certain bacterial infections of membranes, nerves, and skin.

It is effective if used as directed, which usually involves taking a dose every day over the long term---for 6 months to 2 years, sometimes longer. Combutol is also rarely used on its own; one or more other medications, such as isoniazid, rifampin, pyrazinamide, streptomycin, cycloserine, ethionamide, or viomycin are also often prescribed to be taken as well.

Effects of Combutol on patients under 13 years of age are unknown, so the medication is generally not used in this younger population.

First Treatment

Patients being treated for tuberculosis for the first time are usually relatively simple; Combutol and one to three other medications are prescribed, and typically taken once per day. Combutol can be taken with or without food, though other medications can influence that.

Dosage is determined by weight. Patients age 13 and up should take:

• 15 mg per kg of body weight (7 mg per lb of body weight) once per day.

Depending on the patient, a higher dosage may be advised but is typically taken every other day. Dosage may change throughout treatment, but it is unusual for dosage to drop lower than 15 mg per kg of body weight.

Treatment should last at least 6 months, and may expand to 2 years. It is important for patients to continue taking Combutol and any other medications prescribed for the full duration. Most patients will feel fine before treatment ends, but there will almost certainly still be lingering bacteria. Ending treatment early may allow the bacteria to resurge, as well as contribute to bacterial resistance.

Tuberculosis can be tricky to treat and there are numerous factors that can complicate treatment. Patients should follow doctor instructions carefully, even if they deviate significantly from the information given here.

If Previously Treated

Some patients need subsequent treatment; either the condition was not completely cured the first time or tuberculosis was reacquired. In this situation treatment can be more complicated, particularly in choosing medications. The doctor will most likely either:

• Verify in vitro that the bacteria are still susceptible to medications used previously, or
• Utilize all new medications.

Once medications have been decided, and assuming Combutol is one chosen, dosage is typically higher than in first-time treatment. More additional medications may also be used.

Patients age 13 and up are typically advised to take:

• 25 mg per kg of body weight (11 mg per lb of body weight) daily for the first 60 days.
• After the first 60 days, dosage may be reduced to 15 mg per kg of body weight (7 mg per lb of body weight) per day.

In treatments subsequent to the first, therapy often continues for 2 years, sometimes longer. Again patients often feel well before treatment ends, but it is important to continue until a doctor says it may end.

As with first treatments, doctor instructions may vary widely from those given above. Doctor instructions should always be followed.

Side Effects

Most commonly experienced side effects are mild, and many will stop occurring as the body adjusts to treatment, including:

• Stomach upset
• Appetite loss
• Dizziness
• Headache

The above are not cause for concern unless severe or persistant.

Serious side effects are rare, but do happen to some patients. About 3 percent of patients will experience blurred vision while taking Combutol. If addressed quickly the condition nearly always reverses; if unaddressed, it can lead to some level of permanent vision loss. Monthly eye exams are recommended for the duration of treatment, especially if Combutol is taken in higher doses.

Patients who have gout may find Combutol exacerbates the condition. A doctor can prescribe other medications to counter this.

Other warning signs that patients should seek medical attention for include:

• Moderate to severe confusion
• Numbness or tingling in extremities
• Pain in joints
• Disorientation
• Fever
• Hallucinations

Combutol and other medications prescribed with it may interact with other treatments, including over-the-counter varieties, as well as some supplements and vitamins. Always double-check with a doctor or pharmacist before adding, removing, or modifying dosage of any other medication throughout treatment.

Note the above side effects apply only to Combutol; other medications being taken will have their own side effects. Reading the inserts included with each product will give patients a good idea of potential adverse effects.