As an anti tuberculosis drug, Delamanid's side effects mainly involve cardiac toxicity, neurological and digestive system reactions, and serious adverse reactions such as QT interval prolongation should be given special attention. At the same time, there are common side effects that can be self relieved.

1. Serious side effects that require immediate medical attention

(1) Cardiac toxicity: The incidence of QT interval prolongation is about 9.9%, which may progress to apical torsion ventricular tachycardia, requiring weekly electrocardiogram monitoring and correction of electrolyte imbalances.

(2) Psychological and neurological symptoms: including emotional disorders such as depression (2.1%) and anxiety (1.5%), and in severe cases, suicidal tendencies may occur requiring emergency intervention.

(3) Allergic reactions: manifested as angioedema (0.3%), bronchospasm, and isokinetic hypersensitivity reactions, requiring immediate discontinuation of medication and rescue with adrenaline.

2. Common self relieving side effects

(1) Digestive system: Nausea (12.4%) and vomiting (6.2%) often occur in the early stages of treatment, and tolerance usually improves within 2 weeks.

(2) Headache: The incidence rate is about 8.7%, mostly mild and temporary, which can be relieved by adjusting the medication time.

(3) Visual abnormalities, including blurred vision (3.5%), floaters, etc., usually do not affect continued treatment.

3. Risks for special populations

(1) Individuals with abnormal liver function: The incidence of elevated ALT is 13.6%, and monthly monitoring of liver function is required. It is contraindicated for Child Pugh C patients.

(2) HIV co infected individuals are more prone to abnormal blood drug concentrations caused by drug interactions, and antiviral regimens need to be adjusted.

(3) Elderly patients: The risk of QT interval prolongation increases by 2.3 times. It is recommended to halve the initial dose and strengthen electrocardiogram monitoring.

4. Suggestions for managing side effects

(1) Baseline examination is required before medication, including electrocardiogram, liver function, blood potassium and magnesium concentration, and assessment of mental status.

(2) Avoid combination therapy during treatment with QT prolongation risk drugs such as fluoroquinolones and tricyclic antidepressants.

(3) When grade 3 side effects occur, medication should be suspended and treatment should be restarted at 50% dose after recovery to grade 1.