How to manage side effects while taking HRZE drugs for TB?

Question

Hello doctor,

I am a 19-year-old male. I was diagnosed with pleural effusion, and my local doctor suspected tuberculosis. For a month, I have been taking HRZE anti-tuberculosis medicines (four tablets daily, in divided doses) as prescribed by the tuberculosis hospital.

My current routine of medicine is as below:

I take a gas capsule (for acidity) on an empty stomach.
After 30 minutes, I take two tuberculosis medicines with a 15-minute gap.
Then I eat light food.
After that, I take the remaining two tuberculosis medicines, followed by breakfast.

My symptoms are as below:

In the first week, I was fine and eating normally.
After that, I started facing nausea, vomiting after meals, loss of appetite, and weight loss (130 pounds to 115 pounds).
Sometimes I vomit the food I eat (not blood, but once the vomit looked red due to food color).
Urine and stool smell abnormal sometimes.
My tongue often turns white, and I feel a medicine-like taste in my mouth.
After skipping Montek (Montelukast) one day, I felt difficulty in breathing.
When I take a deep breath, my left chest feels like it is floating or vibrating.
I also feel weak and have low energy due to eating very little.
Yesterday, my semen looked slightly yellow.

Kindly answer my following questions:

Am I taking my tuberculosis medicines in the right way, or should I change the timing or sequence?
Are my vomiting and weight loss side effects of HRZE, or should I be worried about liver or kidney damage?
Should I repeat a chest X-ray or an ultrasound to check if the water is reducing? If yes, when?
How can I increase my appetite and gain weight while continuing tuberculosis treatment?
Can I eat foods like dosa (flat rice crepe), lassi (sweetened curd), milk, soup, chips, or momos (dumplings) in moderation, or should I avoid spicy or oily foods completely?
Is the floating or vibrating feeling in my chest normal during pleural effusion recovery?
What steps can I take to reduce acidity, nausea, and the medicine taste in my mouth?

I am worried because I am young and want to recover fast with proper nutrition. Please guide me on the medicine routine, diet, and whether I need new tests.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

You are doing the right thing by staying consistent with your tuberculosis medicines. Some of the symptoms you describe are common side effects of HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol), especially nausea, loss of appetite, vomiting, and a medicine-like taste.

The way you take the medicines can be adjusted. Ideally, tuberculosis drugs are taken together on an empty stomach with water, not in divided doses, because splitting them reduces their effectiveness and increases stomach upset. Taking them all at once, about 30 to 60 minutes before food, is usually advised, and you can continue your gas or antacid capsule beforehand if your doctor prescribed it.

Your vomiting, weight loss, and abnormal taste may still be from the medicines, but since these drugs can also affect the liver and sometimes the kidneys, it is very important to have regular liver function and kidney function blood tests during treatment. Please ask your doctor to arrange this soon. A repeat chest X-ray or ultrasound is usually done after two months of therapy to check if the pleural effusion is resolving, unless your symptoms worsen, in which case it should be done earlier.

The treatment plan is as below:

To improve appetite and nutrition, focus on soft, high-calorie, high-protein foods like milkshakes, lassi (sweetened curd), soup, boiled eggs, curd rice, khichdi (boiled rice with moong), and smoothies.
Small, frequent meals are easier to tolerate than large ones.
You may eat dosa (rice crepe), milk, lassi, soup, or momos (dumplings) occasionally, but avoid too much oily, fried, or spicy food since these worsen acidity.

The floating or vibrating feeling in your chest can happen during pleural effusion recovery and usually improves as the fluid decreases. To help with nausea and medicine taste, drink plenty of water, rinse your mouth after taking medicines, chew sugar-free gum or suck on lemon candies, and avoid taking the medicines with heavy meals.

Most importantly, do not stop or skip tuberculosis medicines, as this can lead to resistance. Please see your tuberculosis doctor soon for a liver and kidney blood test, weight monitoring, and guidance on whether your regimen needs adjustment.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.