Bedaquiline, as an anti tuberculosis drug, has specific contraindications, dietary restrictions, and medication conditions that need to be strictly followed to reduce the risk of QT interval prolongation. The following provides a detailed explanation from three aspects: taboo groups, taboo foods, and restrictive conditions.

1. Taboo population

(1) Pregnant women: Based on animal studies showing embryotoxicity, it is contraindicated during pregnancy. Women of childbearing age should confirm their pregnancy status and take effective contraceptive measures before taking medication.

(2) Breastfeeding period: Medications may be secreted through breast milk. Breastfeeding is prohibited during treatment and for several months after discontinuation to avoid exposure risks to the infant.

(3) Children: The safety of patients under 18 years old has not been established and is not recommended for use.

(4) Liver dysfunction: Not recommended for patients with moderate to severe damage (Child Pugh B/C), as drug metabolism obstruction can lead to toxic accumulation.

2. Forbidden foods

(1) Grapefruit/grapefruit juice: Inhibiting CYP3A4 enzyme can increase the blood concentration of bedaquiline by three times, increasing the risk of cardiac toxicity.

(2) High fat diet: It should be taken on an empty stomach or with a low-fat meal. Fat intake>30g can reduce drug absorption by 40%.

(3) Alcohol: aggravates the metabolic burden on the liver and may increase the risk of liver function damage.

3. Restrictive conditions

(1) Contraindications for combination therapy

Strong CYP3A4 inducers (such as rifampicin): Combination use is prohibited as it can reduce the efficacy of bedaquiline by up to 75%.

QT prolonging drugs (such as fluoroquinolones): should be avoided in combination, otherwise the risk of tip twisting and ventricular tachycardia increases fivefold.

(2) Monitoring requirements

Electrocardiogram monitoring: QTc should be tested weekly, and if it is prolonged by more than 500ms, medication should be stopped immediately.

Liver function test: ALT should be tested before treatment and monthly, and treatment should be interrupted when the elevation exceeds 3 times ULN.

(3) Course control

Up to 24 weeks: Exceeding the course of treatment may increase mortality rates, and strict adherence to WHO recommended protocols is necessary.