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That sudden spike in nicotine can trigger nausea, vomiting, dizziness, and sometimes whats known as nicotine poisoning

Ethionamide requires activation by the mycobacterial enzyme flavin monooxygenase (EthA) and the transcriptional repressor EthR to form ethionamide sulfoxide, which binds to NAD + and inhibits the enoyl-acyl carrier protein reductase (InhA), thereby blocking mycolic acid synthesis, responsible for cell death (Dover et al., 2007)

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Over time, this can shift from a short-lived rise to a chronic problem, especially if other risk factors like stress or a high-sodium diet are in the mix