Antimycobacterial (MDR-TB)

Cycloserine

Brand names: Specialist UKHSA supply

Adult dose

Dose: 500mg–1g/day in divided doses (10–15mg/kg)

Route: Oral

Frequency: BD

Clinical pearls

Reserve drug for MDR/XDR-TB per WHO TB consolidated guideline
BTS/SIGN; UKHSA TB strategy
Pyridoxine 50–100mg/day prophylaxis for neuropathy

Contraindications

Epilepsy
Severe renal impairment
Depression / psychosis
Alcoholism
Severe anxiety
Hypersensitivity

Side effects

Neurotoxicity (psychosis, depression, suicidal ideation, seizures)
Peripheral neuropathy
Headache
Drowsiness
Hepatotoxicity
Megaloblastic anaemia

Interactions

Alcohol (seizures)
Isoniazid (additive neurotoxicity)
Ethionamide

Monitoring

Mental state
Seizure activity
Renal function
LFTs
Drug levels (target 25–35 mg/L)
Pyridoxine adherence

Reference: BNF; WHO MDR-TB guideline; BTS/SIGN; UKHSA; https://bnf.nice.org.uk/drugs/cycloserine/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways