Before the start of therapy with cycloserine, it is necessary to isolate cultures of microorganisms and determine the sensitivity of strains to this preparation. In the case of tuberculosis infection, it is necessary to determine the sensitivity of the strain to other anti-tuberculosis drugs.
Treatment with cycloserine should be canceled or the dose should be reduced if the patient develops an allergic dermatitis or symptoms of the central nervous system, namely: headache, dizziness, drowsiness, confusion, tremor, peripheral paresis, dysarthria, convulsions and psychosis. In view of the low therapeutic index of cycloserine, the risk of seizures increases in patients with chronic alcoholism.
Poisoning is usually observed at drug concentrations in the blood of more than 30 mg / l, which may be the result of an overdose or impaired renal clearance. When taking the drug should monitor hematological indicators, kidney function (the concentration of creatinine and urea nitrogen in the blood), the concentration of the drug in the blood and the function of the liver.
In the treatment of patients with reduced renal function, taking a daily dose of more than 500 mg and who are suspected to have signs and symptoms of an overdose, the level of the drug in the blood should be monitored at least once a week. The dose needs to be adjusted in such a way as to maintain the level of the drug in the blood below 30 mg / l.To prevent symptoms of central nervous system damage, in particular, seizures, arousal or tremor, it is possible to use anticonvulsants or sedatives. Patients who receive more than 500 mg of cycloserine per day should be under the direct supervision of a doctor because of the possible development of such symptoms. It is possible to prevent or reduce the toxic effect of cycloserine by prescribing glutamic acid 500 mg 3 to 4 times daily (before meals) during the treatment period, and daily administration of the sodium salt of ATP (1 ml of a 1% solution), as well as pyridoxine in a dose 200-300 mg / day. For the prevention of adverse neurotoxic effects, psychotropic drugs of benzodiazepine diazepam (5 mg) or phenazepam (1 mg) overnight, as well as piracetam in a dose of 800 mg 2 times a day.
In some cases, the use of cycloserine can cause the development of vitamin deficiency AT12 and / or folic acid, megaloblastic and sideroblastic anemia. In case of anemia during treatment, it is necessary to conduct an appropriate examination and treatment of the patient.
It is necessary to limit mental tension of patients and to exclude possible factors of an overheat (stay on the sun with the uncovered head, hot douche).
In connection with the rapid development of resistance with monotherapy with cycloserine, it is recommended that it be combined with other anti-tuberculosis drugs.