Delamanid is a key drug for the treatment of multidrug-resistant tuberculosis, but it is not suitable for all patients. Severe hepatic impairment and QTc interval prolongation are contraindications and cautions that require high vigilance in its clinical use.

I. Contraindication in Patients with Severe Hepatic Impairment

1. Clearly contraindicated

Delamanid is mainly metabolized in the liver. For patients with severe hepatic impairment (such as Child-Pugh class C), drug metabolism capacity is significantly reduced, which may lead to drug accumulation in the body and increase the risk of toxicity. Its use should be prohibited.

2. Caution in moderate hepatic impairment

For patients with moderate hepatic impairment, there is currently a lack of sufficient pharmacokinetic data. The drug should be used cautiously under strict medical monitoring, with regular rechecks of liver function indicators. If abnormalities occur, immediately assess whether to discontinue the drug.

3. Be alert to symptoms of hepatotoxicity

During medication, patients should closely observe whether signs of liver injury appear, such as fatigue, decreased appetite, nausea, jaundice (yellowing of the skin or sclera), or dark urine. If any occur, seek medical attention immediately.

II. Risk Management in Patients with QTc Prolongation

1. Assessment required before medication

Delamanid may cause QTc interval prolongation on electrocardiogram and increase the risk of serious arrhythmias (such as torsades de pointes). An electrocardiogram must be performed before medication, and patients with significantly prolonged baseline QTc intervals should avoid using the drug.

2. Avoid concomitant use of drugs that prolong QTc

Patients should inform the physician of all medications they are taking. Delamanid is strictly prohibited from being used in combination with other drugs known to prolong the QTc interval (such as certain antiarrhythmic drugs, macrolide antibiotics, fluoroquinolones, etc.) to avoid additive risks.

3. Regular electrocardiogram monitoring

During treatment, regular electrocardiogram rechecks are required to closely monitor changes in the QTc interval. If significant QTc prolongation is found, the physician needs to assess whether to adjust the dose or discontinue the drug.

4. Pay attention to electrolyte balance

Electrolyte disturbances such as hypokalemia and hypomagnesemia can increase the risk of QTc prolongation. During medication, electrolyte balance should be monitored and maintained, and corrected if necessary.