Generic Trecator-SC (Ethionamide)

Introduction

Trecator-SC is an oral tablet containing the active compound ethionamide, supplied in a 250 mg strength. Ethionamide belongs to the class of oral anti-tuberculosis agents and is primarily used as part of multidrug regimens for drug-resistant Mycobacterium tuberculosis infection. The drug is manufactured by several licensed producers and is marketed worldwide under brand names such as Trecator, Ethionex, and Ethionamide-SR. In addition to its approved indication for multidrug-resistant tuberculosis (MDR-TB), ethionamide has been investigated in clinical studies for certain non-tuberculous mycobacterial infections and as an adjunct in selected dermatologic conditions.

What is Trecator-SC?

Trecator-SC is a tablet formulation of ethionamide, a synthetic thiosemicarbazone antibiotic. The product is produced by licensed pharmaceutical manufacturers that adhere to Good Manufacturing Practice (GMP) standards. Ethionamide was first introduced in the s as a second-line agent for tuberculosis, and its chemical structure is closely related to that of isoniazid. The 250 mg tablet is designed for oral administration, with the “SC” designation indicating a specific tablet coating used to improve stability and swallowability.

“Trecator-SC is the generic version of well-known medications, containing the active compound ethionamide. Our online pharmacy provides this generic alternative as a cost-effective treatment option.”

How Trecator-SC Works

Ethionamide inhibits the mycolic acid synthesis pathway in Mycobacterium tuberculosis by targeting the enzyme InhA, a key enoyl-ACP reductase. By blocking the production of long-chain mycolic acids, the drug compromises the bacterial cell wall, leading to bacteriostatic activity and, at higher concentrations, bactericidal effects.

• Onset of action: Clinical effect typically begins within 2-4 weeks of initiation when combined with other effective anti-TB drugs.
• Duration: Ethionamide has a plasma half-life of approximately 2-3 hours; however, its therapeutic effect persists due to accumulation in macrophages and intracellular mycobacteria.
• Clearance: The drug is primarily metabolized by hepatic enzymes (CYP450 isoforms) and excreted in urine as inactive metabolites.

Conditions Treated with Trecator-SC

The drug’s activity against resistant Mycobacterium strains is the primary mechanism that underlies these approvals.

Off-Label and Investigational Uses of Trecator-SC

• Non-tuberculous Mycobacterial (NTM) Pulmonary Disease - Small case series have reported clinical improvement when ethionamide is added to macrolide-based regimens for NTM species resistant to standard therapy (J Tuberc Res 2021).
• Cutaneous Mycobacterial Infections - Dermatologic reports describe successful topical or systemic ethionamide use for atypical mycobacterial skin lesions, although no regulatory approval exists.
• Adjunctive Therapy in Certain Dermatologic Conditions - Early-phase studies have explored ethionamide’s anti-inflammatory properties in severe acneiform eruptions, but evidence remains limited (Dermatology 2022).

These applications are not approved by the FDA, EMA, or other major regulatory agencies. Patients should discuss any off-label use with a qualified healthcare professional, and such treatment must be performed under strict medical supervision.

Is Trecator-SC the Right Medication for You?

Trecator-SC is appropriate for adults diagnosed with MDR-TB or XDR-TB who require a second-line oral agent. It is most effective when:

• The Mycobacterium tuberculosis isolate is confirmed susceptible to ethionamide.
• The patient can tolerate oral therapy and has no contraindicating hepatic disease.

Contraindications include:

• Known hypersensitivity to ethionamide or related thiosemicarbazones.
• Severe hepatic impairment (Child-Pugh class C).
• Pregnant or breastfeeding women, unless the benefits outweigh potential risks, as animal data show possible teratogenicity.

Patients with active chronic liver disease, baseline visual impairment, or a history of severe gastrointestinal disorders may require alternative regimens.

Risks, Side Effects, and Interactions

Common

• Nausea, vomiting, or loss of appetite.
• Abdominal discomfort and dyspepsia.
• Mild transient elevations of liver enzymes (ALT/AST).

Rare

• Peripheral neuropathy (dose-related, may improve with vitamin B6 supplementation).
• Taste disturbance (metallic or bitter taste).
• Mild photosensitivity reactions.

Serious

• Hepatotoxicity: Significant elevation of transaminases or bilirubin; may progress to hepatic failure.
• Severe Central Nervous System Toxicity: Confusion, seizures, or encephalopathy reported in high-dose regimens.
• Optic Neuritis: Visual acuity decline and color vision changes; requires immediate discontinuation.

Drug-Drug Interactions

• Rifampicin and isoniazid can increase ethionamide plasma levels, raising hepatotoxicity risk.
• Anticonvulsants (e.g., carbamazepine, phenytoin) may compete for CYP450 metabolism, altering serum concentrations.
• Copper-containing supplements can reduce ethionamide absorption; separate administration by at least 2 hours.

Drug-Food Interactions

• Taking the tablet with a high-fat meal may modestly increase absorption, but standard administration with a light meal is recommended to reduce gastrointestinal upset.

Patients should notify their prescriber of any concurrent medications, including over-the-counter products and herbal supplements.

Use: Dosing, Missed Dose, Overdose

Standard dosing for adults typically starts at 15-20 mg/kg daily, divided into 2-3 doses, with a maximum of 1 g per day. Dose adjustments are made based on tolerability, hepatic function, and therapeutic drug monitoring where available.

• Missed dose: If a dose is forgotten and the next scheduled dose is more than 6 hours away, take the missed dose immediately. If the interval to the next dose is less than 6 hours, skip the missed dose and resume the regular schedule. Do not double-dose.

• Overdose: Acute ingestion of more than 2 g may produce severe gastrointestinal irritation, central nervous system depression, and hepatic injury. Seek emergency medical attention promptly. Supportive care, including activated charcoal and monitoring of liver enzymes, is recommended.

Practical precautions

• Take tablets with a small amount of food to minimize stomach irritation.
• Avoid alcohol, as it can exacerbate hepatotoxicity.
• Do not operate heavy machinery or drive until you know how ethionamide affects you, especially during the first week of therapy.

FAQ

• What should I do if I travel internationally while taking Trecator-SC?

  • Carry the medication in its original packaging with a copy of the prescription or a physician’s letter. Keep it in a temperature-controlled environment (≤ 25 °C) and avoid exposure to direct sunlight.

• Can I store Trecator-SC in a humid climate?

  • Tablets should be stored in a dry place, protected from moisture. Use airtight containers or original blister packs to maintain stability, especially in high-humidity regions.

• What do the tablet markings look like?

  • Each 250 mg ethionamide tablet is typically round, bicolored (often white and blue), and imprinted with “250 SC”. In some markets, a different imprint (e.g., “E-250”) may be used.

• Are there any inactive ingredients that could cause allergies?

  • Common excipients include lactose, microcrystalline cellulose, and magnesium stearate. Patients with known hypersensitivity to these substances should verify the formulation with the supplier.

• Is ethionamide detectable on standard drug tests?

  • Ethionamide is not classified as a controlled substance and is not routinely screened for in standard workplace drug panels.

• Does Trecator-SC require special handling for pregnant travelers?

  • Pregnant women should discuss the risk-benefit ratio with a qualified provider before travel. If continuation is necessary, ensure adequate hydration and avoid food that may exacerbate nausea.

• How does ethionamide differ from isoniazid in terms of resistance?

  • Resistance to ethionamide generally involves mutations in the inhA gene, whereas isoniazid resistance often involves katG or inhA mutations. Cross-resistance is possible but not universal.

• Can I switch from a brand-name ethionamide product to Trecator-SC?

  • Both contain the same active ingredient and are bioequivalent when dosed appropriately. However, patients should consult a healthcare professional before making any changes to ensure consistent drug exposure.

• What is the shelf-life of Trecator-SC tablets?

  • The product remains stable for 24 months from the date of manufacture when stored at ≤ 25 °C, protected from moisture and light.

• Are there any known drug-testing implications for athletes?

  • Ethionamide is not listed on the World Anti-Doping Agency (WADA) prohibited substance list, but athletes should verify with their governing body if unsure.

Glossary

Mycolic Acid

A long-chain fatty acid unique to the cell wall of Mycobacterium species; essential for bacterial integrity and pathogenicity.

InhA

An enoyl-ACP reductase enzyme involved in mycolic acid biosynthesis; the primary molecular target of ethionamide.

Hepatotoxicity

Toxic injury to the liver, manifested by elevated liver enzymes, jaundice, or impaired hepatic function.

Peripheral Neuropathy

Damage to peripheral nerves, often presenting as numbness, tingling, or pain in the extremities.

Buying Trecator-SC from Our Online pharmacy

Patients who encounter limited availability of ethionamide through local pharmacies or insurance formularies can obtain Trecator-SC securely from our online pharmacy. Our service provides:

• Affordable pricing: Generic ethionamide tablets are offered at rates close to manufacturer cost, reducing the financial barrier for long-term MDR-TB therapy.
• Verified quality: All products are sourced from licensed international suppliers that comply with GMP standards and are inspected by independent quality agencies.
• Discreet delivery: Orders are packaged in unbranded, tamper-evident parcels and shipped via reliable carriers. Standard airmail typically arrives within 3 weeks, while express options guarantee delivery in 7 days.
• Privacy-focused brokerage: As a pharmacy broker, we coordinate directly with overseas licensed pharmacies, ensuring that each transaction respects patient confidentiality and complies with import regulations.

By selecting our online pharmacy, patients gain a trusted pathway to obtain Trecator-SC when conventional channels are insufficient, while maintaining cost-effectiveness and privacy.

Disclaimer

The information presented about Trecator-SC is intended for general educational purposes only and does not substitute for professional medical advice. Treatment decisions, including any off-label applications, must be made under the guidance of a qualified healthcare provider. Readers are presumed to be competent adults capable of making informed health choices. Our online pharmacy supplies Trecator-SC to individuals who may experience limited access through traditional pharmacies or insurance programs, or who are seeking cost-effective generic alternatives. Always discuss with your clinician before initiating, modifying, or discontinuing any medication.