Pharmacokinetic concerns in the management of drug induced vomiting in co-morbid tuberculosis patient: A case report from Malaysia.

ABSTRACT

A 46 years old patient with history of type II diabetes mellitus (DM) approached chest clinic with complaints of productive cough, low grade fever and night sweating. Positive sputum smear and cavities in upper lobe of left lung confirmed him as a pulmonary tuberculosis patient (PTB). He was prescribed World Health Organization recommended six months therapy for tuberculosis (TB). During treatment, patient suffered from persistent vomiting for which he was prescribed metoclopramide tablet (10mg). Total duration of TB treatment was prolonged up to 10 months which was attributed to frequent vomiting and uncontrolled blood sugar level throughout therapy. Appropriate glycaemic control is cornerstone in management of PTB patients with type II DM. According to United State Pharmacopoeia, dissolution time specification for rifampicin in fixed dose combination (FDC) is 45 minutes. This indicates that anti TB drugs must remain in gastrointestinal tract for at least 45 minutes. Administration of metoclopramide at least one hour before taking anti TB drugs can trim down episodes of vomiting.