Bedaquiline: Tuberculosis Treatment, Dosage, and Side Effects Guide

Summary of Key Points

Bedaquiline is a prescription medication used to treat various forms of tuberculosis (TB), particularly drug-resistant strains. It works by targeting the bacteria responsible for TB, helping to halt their growth. Bedaquiline is typically prescribed for patients with multidrug-resistant tuberculosis (MDR-TB) and is used in combination with other TB medications. Always consult your healthcare provider before starting or adjusting your dose.

Names of Medication

US Brand Name: Sirturo (Bedaquiline)

The term “generic name” refers to the active ingredient in the medication, which remains the same regardless of the brand. In this case, Bedaquiline is the generic name.

Pharmacologic Category

Antitubercular Agents

Diarylquinolines

Bedaquiline Dosage Guidelines

Bedaquiline is used to treat several forms of tuberculosis. It is essential to follow your healthcare provider’s instructions carefully. Below are the typical dosing guidelines for adults:

Multidrug-resistant tuberculosis (MDR-TB): The recommended dose is 400 mg once daily for the first 2 weeks, followed by 200 mg three times per week for the next 22 weeks. Treatment duration is typically 24 weeks.

Tuberculosis (Drug-resistant, Pulmonary, Extrapulmonary, Chronic, Rifampicin-resistant, Isoniazid-resistant): The dosing is the same as for MDR-TB: 400 mg once daily for the first 2 weeks, then 200 mg three times per week for 22 weeks.

Latent tuberculosis infection: Bedaquiline is not typically used for latent TB infections. Consult your healthcare provider for alternative treatments.

Mycobacterium tuberculosis infection: The dosing regimen follows the same guidelines as MDR-TB: 400 mg once daily for 2 weeks, then 200 mg three times per week for 22 weeks.

Always consult your doctor before adjusting your dose. If you have questions about your treatment, you can schedule a telemedicine appointment with one of our providers today.

Dosage Forms and Strengths

Tablet: 100 mg

Administration Instructions for Bedaquiline

Bedaquiline should be taken with food to improve absorption. Swallow the tablet whole with water. It is crucial to take the medication exactly as prescribed by your doctor. Do not skip doses, as this could reduce the treatment’s effectiveness. If you miss a dose, take it as soon as you remember, unless it is close to your next dose. In that case, skip the missed dose and resume your regular schedule.

Bedaquiline Side Effects and Adverse Reactions

Like all medications, Bedaquiline can cause side effects. Some are more common than others, and it is important to be aware of them:

1. Nausea: Feeling nauseous is a common side effect.
2. Headache: Some patients report mild to moderate headaches.
3. Chest pain: Although rare, chest pain may occur. Contact your doctor if you experience this symptom.
4. Increased liver enzymes: This can indicate liver irritation or damage. Your doctor may monitor your liver function during treatment.
5. QT prolongation: A rare but serious heart rhythm condition. Your healthcare provider may monitor your heart function with an electrocardiogram (ECG).

If you experience any severe side effects or symptoms of an allergic reaction, such as difficulty breathing, swelling of the face, or hives, seek medical attention immediately. You can also reach out to one of our telemedicine providers for urgent care.

Contraindications for Bedaquiline

A contraindication is a specific condition where a medication should not be used because it may be harmful. For Bedaquiline, certain conditions make its use inadvisable due to the risk of serious side effects or complications.

1. Severe liver disease: Bedaquiline is processed by the liver. If you have severe liver disease, your body may not break down the medication properly, leading to a buildup of the drug, which can cause toxicity.
2. Prolonged QT interval: This heart condition causes the electrical activity of the heart to take longer than normal to recharge between beats. Bedaquiline can further prolong the QT interval, increasing the risk of life-threatening heart rhythm problems.
3. Allergy to Bedaquiline: If you have had an allergic reaction to Bedaquiline in the past, taking it again could cause a severe allergic reaction, which can be life-threatening.

If you have any of these conditions, discuss them with your healthcare provider. If you’re unsure, our telemedicine providers are available to help you review your medical history and determine if Bedaquiline is safe for you.

Drug Interactions with Bedaquiline

Bedaquiline can interact with other medications, increasing the risk of side effects or reducing the treatment’s effectiveness. Inform your healthcare provider about all the medications you are currently taking, including over-the-counter drugs and supplements. Below are some medications that may interact with Bedaquiline:

1. Rifampin (Rifadin): This antibiotic can reduce the effectiveness of Bedaquiline by speeding up its breakdown in the liver.
2. Ketoconazole (Nizoral): This antifungal medication can increase Bedaquiline levels in your blood, raising the risk of side effects.
3. Clarithromycin (Biaxin): This antibiotic can increase the risk of heart rhythm problems when taken with Bedaquiline.
4. Amiodarone (Pacerone): This heart medication can further prolong the QT interval, increasing the risk of dangerous heart rhythms.
5. Efavirenz (Sustiva): This HIV medication can reduce the effectiveness of Bedaquiline by speeding up its breakdown.

Always consult with your healthcare provider before starting or stopping any medication. If you need assistance, our telemedicine providers are available to review your medications and ensure there are no harmful interactions.

Bedaquiline in Pregnancy

Is it Safe to Take Bedaquiline During Pregnancy?

There is limited information on the safety of Bedaquiline during pregnancy. While animal studies suggest potential risks, there is not enough data from human studies to confirm its safety. If you are pregnant or planning to become pregnant, it’s important to carefully weigh the benefits and risks with your healthcare provider. In some cases, treating multidrug-resistant tuberculosis (MDR-TB) may be more critical than the potential risks to the fetus. Our telemedicine providers are available to help you make an informed decision based on your unique situation.

Bedaquiline While Breastfeeding

Is it Safe to Take Bedaquiline While Breastfeeding?

It is not yet clear whether Bedaquiline passes into breast milk or if it could affect a nursing infant. Due to the lack of sufficient data, breastfeeding while taking Bedaquiline is generally not recommended. If you are breastfeeding or planning to breastfeed, it’s essential to consult your healthcare provider. They may recommend alternative treatments or advise you to pause breastfeeding during your Bedaquiline treatment. Our telemedicine providers can guide you through these decisions and help you explore your options.

Estimated Cost of Bedaquiline

The cost of a 30-day supply of Bedaquiline without insurance can vary. With a GoodRx coupon, the price typically ranges from $25,000 to $30,000 for a 30-day supply. However, prices may differ depending on the pharmacy and location. If cost is a concern, speak with your healthcare provider or pharmacist about financial assistance programs or alternative treatment options that may be available to you.

Possible Alternatives to Bedaquiline

If Bedaquiline is not suitable for you, or if you are exploring other treatment options for tuberculosis, there are alternative medications and lifestyle changes that may be considered, depending on the type of tuberculosis you have. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers can assist you in exploring these alternatives.

1. Multidrug-resistant tuberculosis (MDR-TB): Alternatives such as Linezolid (Zyvox) or Delamanid (Deltyba) may be considered. In some cases, surgery may be an option to remove infected tissue.
2. Tuberculosis (TB): Standard treatment involves a combination of antibiotics, including Isoniazid, Rifampin, Pyrazinamide, and Ethambutol. Completing the full course of treatment is essential to prevent the development of drug resistance.
3. Pulmonary tuberculosis: In addition to medication, improving lung health through regular exercise, a balanced diet, and avoiding smoking can support recovery.
4. Extrapulmonary tuberculosis: Treatment typically involves the same antibiotics used for pulmonary TB, but the duration may be longer. In some cases, surgery may be necessary.
5. Latent tuberculosis infection: Preventive treatment with Isoniazid or Rifampin can help prevent the infection from becoming active. Regular monitoring is also important to ensure the infection remains under control.
6. Drug-resistant tuberculosis: Besides Bedaquiline, second-line drugs such as Levofloxacin (Levaquin) or Moxifloxacin (Avelox) may be used. Treatment is often longer and more complex in these cases.
7. Chronic tuberculosis: Long-term antibiotic therapy is typically required. In some cases, surgery may be necessary to remove damaged lung tissue.
8. Rifampicin-resistant tuberculosis: Alternative antibiotics, such as Fluoroquinolones or injectable agents like Amikacin, may be used.
9. Isoniazid-resistant tuberculosis: Rifampin, Pyrazinamide, and Ethambutol are often used as alternatives to Isoniazid.
10. Mycobacterium tuberculosis infection: Standard treatment involves a combination of antibiotics, but the regimen may vary depending on the strain and resistance patterns.

Recent Updates on Bedaquiline Research

Recent studies have focused on the long-term safety and effectiveness of Bedaquiline, particularly in treating multidrug-resistant tuberculosis (MDR-TB). A 2021 study published in the New England Journal of Medicine found that Bedaquiline, when combined with other TB medications, significantly improved treatment outcomes for patients with MDR-TB. Ongoing research is also exploring shorter treatment regimens, potentially reducing therapy duration from 18-24 months to as little as 6 months in some cases.

Additionally, new studies are investigating Bedaquiline’s potential in treating other forms of drug-resistant TB, including extensively drug-resistant tuberculosis (XDR-TB). Researchers are also examining the safety of Bedaquiline in special populations, such as children and pregnant women, to expand its use in these groups.

If you have questions about the latest research or how it may impact your treatment, our telemedicine providers are available to discuss the most up-to-date information and help you make informed decisions about your care.

James Kingsley

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