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rifampin, isoniazid, and pyrazinamide (Oral route)

rif-AM-pin, eye-soe-NYE-a-zid, pir-a-ZIN-a-mide

Oral route(Tablet)

Severe and sometimes fatal hepatitis has been reported with isoniazid therapy and may occur even after many months of treatment. The risk for hepatitis increases with advancing age and alcohol use. Monthly clinical evaluation and liver function tests should be performed .

Commonly used brand name(s)

In the U.S.

  • Rifater

Available Dosage Forms:

  • Tablet

Therapeutic Class: Antitubercular Combination

Chemical Class: Rifamycin

Uses For rifampin, isoniazid, and pyrazinamide

Rifampin, isoniazid, and pyrazinamide is a combination anti-infective medicine. This combination medicine is used to treat tuberculosis (TB). It may be taken alone or with one or more of other medicines for TB.

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rifampin, isoniazid, and pyrazinamide is available only with your doctor's prescription.

Before Using rifampin, isoniazid, and pyrazinamide

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For rifampin, isoniazid, and pyrazinamide, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to rifampin, isoniazid, and pyrazinamide or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Rifampin, isoniazid, and pyrazinamide combination may not be appropriate for use in children and teenagers younger than 15 years of age. Higher doses of isoniazid are usually required in this age group.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of rifampin, isoniazid, and pyrazinamide combination in the elderly.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking rifampin, isoniazid, and pyrazinamide, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using rifampin, isoniazid, and pyrazinamide with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Artemether
  • Atazanavir
  • Boceprevir
  • Cobicistat
  • Darunavir
  • Delamanid
  • Elvitegravir
  • Fosamprenavir
  • Lopinavir
  • Lurasidone
  • Maraviroc
  • Nelfinavir
  • Praziquantel
  • Ranolazine
  • Rilpivirine
  • Saquinavir
  • Telaprevir
  • Tipranavir
  • Voriconazole

Using rifampin, isoniazid, and pyrazinamide with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abiraterone Acetate
  • Afatinib
  • Amiodarone
  • Amprenavir
  • Apixaban
  • Apremilast
  • Atovaquone
  • Axitinib
  • Bedaquiline
  • Bosutinib
  • Cabazitaxel
  • Cabozantinib
  • Canagliflozin
  • Carbamazepine
  • Ceritinib
  • Clozapine
  • Crizotinib
  • Cyclosporine
  • Dabigatran Etexilate
  • Dabrafenib
  • Dasatinib
  • Delavirdine
  • Dolutegravir
  • Domperidone
  • Doxorubicin
  • Doxorubicin Hydrochloride Liposome
  • Dronedarone
  • Efavirenz
  • Enzalutamide
  • Erlotinib
  • Ethionamide
  • Etravirine
  • Everolimus
  • Exemestane
  • Fentanyl
  • Fosphenytoin
  • Hydrocodone
  • Ibrutinib
  • Ifosfamide
  • Imatinib
  • Indinavir
  • Irinotecan
  • Isoniazid
  • Itraconazole
  • Ivabradine
  • Ivacaftor
  • Ixabepilone
  • Ketoconazole
  • Lapatinib
  • Levodopa
  • Linagliptin
  • Lorcainide
  • Macitentan
  • Mifepristone
  • Mycophenolate Mofetil
  • Nevirapine
  • Nifedipine
  • Nilotinib
  • Nimodipine
  • Pazopanib
  • Perampanel
  • Phenytoin
  • Piperaquine
  • Pitavastatin
  • Pixantrone
  • Pomalidomide
  • Ponatinib
  • Posaconazole
  • Pyrazinamide
  • Quetiapine
  • Quinine
  • Regorafenib
  • Rifampin
  • Ritonavir
  • Rivaroxaban
  • Roflumilast
  • Romidepsin
  • Simeprevir
  • Sirolimus
  • Sofosbuvir
  • Sorafenib
  • Sunitinib
  • Tacrolimus
  • Tasimelteon
  • Tegafur
  • Telithromycin
  • Temsirolimus
  • Ticagrelor
  • Tofacitinib
  • Tolvaptan
  • Trabectedin
  • Vandetanib
  • Vemurafenib
  • Vilazodone
  • Vincristine Sulfate
  • Vincristine Sulfate Liposome
  • Vinflunine
  • Vorapaxar
  • Vortioxetine
  • Zidovudine

Using rifampin, isoniazid, and pyrazinamide with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acetaminophen
  • Acetyldigoxin
  • Aliskiren
  • Aminosalicylic Acid
  • Anisindione
  • Aprepitant
  • Atorvastatin
  • Betamethasone
  • Bexarotene
  • Bosentan
  • Buspirone
  • Carbamazepine
  • Carvedilol
  • Caspofungin
  • Chloramphenicol
  • Chlorpropamide
  • Citalopram
  • Clarithromycin
  • Clofibrate
  • Cortisone
  • Deferasirox
  • Desogestrel
  • Dexamethasone
  • Diazepam
  • Dicumarol
  • Dienogest
  • Digoxin
  • Diltiazem
  • Disopyramide
  • Disulfiram
  • Doxycycline
  • Drospirenone
  • Eltrombopag
  • Enalaprilat
  • Enalapril Maleate
  • Enflurane
  • Estradiol Cypionate
  • Estradiol Valerate
  • Ethinyl Estradiol
  • Ethionamide
  • Ethynodiol Diacetate
  • Etonogestrel
  • Etoricoxib
  • Fesoterodine
  • Fluconazole
  • Fludrocortisone
  • Fosaprepitant
  • Fosphenytoin
  • Gefitinib
  • Gliclazide
  • Glyburide
  • Haloperidol
  • Isradipine
  • Lamotrigine
  • Leflunomide
  • Levomethadyl
  • Levonorgestrel
  • Levothyroxine
  • Linezolid
  • Losartan
  • Medroxyprogesterone Acetate
  • Mefloquine
  • Meperidine
  • Mestranol
  • Metformin
  • Methadone
  • Methylprednisolone
  • Metoprolol
  • Morphine
  • Morphine Sulfate Liposome
  • Moxifloxacin
  • Nisoldipine
  • Norelgestromin
  • Norethindrone
  • Norgestimate
  • Norgestrel
  • Ospemifene
  • Oxycodone
  • Phenprocoumon
  • Phenytoin
  • Pioglitazone
  • Pirmenol
  • Prednisolone
  • Prednisone
  • Propafenone
  • Raltegravir
  • Repaglinide
  • Rofecoxib
  • Rosiglitazone
  • Ruxolitinib
  • Sertraline
  • Simvastatin
  • Tadalafil
  • Tamoxifen
  • Theophylline
  • Tocainide
  • Triazolam
  • Trimetrexate
  • Valproic Acid
  • Warfarin
  • Zaleplon
  • Zidovudine
  • Zolpidem

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using rifampin, isoniazid, and pyrazinamide with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use rifampin, isoniazid, and pyrazinamide, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

Using rifampin, isoniazid, and pyrazinamide with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use rifampin, isoniazid, and pyrazinamide, or give you special instructions about the use of food, alcohol, or tobacco.

  • food
  • Tyramine Containing Food

Other Medical Problems

The presence of other medical problems may affect the use of rifampin, isoniazid, and pyrazinamide. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse, or history of—Use with caution. There may be an increased chance of getting hepatitis if you take rifampin, isoniazid, and pyrazinamide and drink alcohol daily.
  • Diabetes, history of or
  • Porphyria (an enzyme problem)—Use with caution. May make these conditions worse.
  • Gout, acute or
  • Liver disease, acute or severe—Should not be used in patients with these conditions.

Proper Use of rifampin, isoniazid, and pyrazinamide

Take rifampin, isoniazid, and pyrazinamide exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

rifampin, isoniazid, and pyrazinamide should be taken on an empty stomach, 1 hour before or 2 hours after a meal with a full of glass of water. It is important to take rifampin, isoniazid, and pyrazinamide on a regular schedule.

If rifampin, isoniazid, and pyrazinamide upsets your stomach, take it with food. Antacids may also help. However, do not take aluminum-containing antacids (e.g., Maalox®, Mylanta®) within 1 hour of the time you take rifampin, isoniazid, and pyrazinamide combination. They may keep rifampin, isoniazid, and pyrazinamide from working properly.

To help clear up your tuberculosis (TB) completely, it is very important that you keep taking rifampin, isoniazid, and pyrazinamide for the full time of treatment, even if you begin to feel better after a few weeks. It is important that you do not miss any doses.

Your doctor may also want you to take pyridoxine (e.g., Hexa-Betalin, vitamin B6) everyday to help prevent or lessen some of the side effects of isoniazid. If it is needed, it is very important to take pyridoxine everyday along with rifampin, isoniazid, and pyrazinamide. Do not miss any doses.

Dosing

The dose of rifampin, isoniazid, and pyrazinamide will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of rifampin, isoniazid, and pyrazinamide. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For the treatment of tuberculosis:
      • Adults and teenagers over 15 years of age weighing 55 kilograms (kg) (121 pounds) or more—6 tablets per day.
      • Adults and teenagers over 15 years of age weighing between 45 and 54 kg (99 and 119 pounds)—5 tablets per day.
      • Adults and teenagers over 15 years of age weighing 44 kg (97 pounds) or less—4 tablets per day.
      • Teenagers and children younger than 15 years of age—rifampin, isoniazid, and pyrazinamide is not recommended for this age group.

Missed Dose

If you miss a dose of rifampin, isoniazid, and pyrazinamide, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If rifampin, isoniazid, and pyrazinamide combination is taken on an irregular schedule, side effects may occur more often and may be more serious than usual. If you have any questions about this, check with your doctor.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using rifampin, isoniazid, and pyrazinamide

It is very important that your doctor check your progress at regular visits. Blood tests may be needed to check for unwanted effects.

If your symptoms do not improve within 2 to 3 weeks, or if they become worse, check with your doctor.

You should not use rifampin, isoniazid, and pyrazinamide if you are also receiving certain medicines to treat HIV infection (such as atazanavir, darunavir, fosamprenavir, ritonavir, saquinavir, tipranavir, Aptivus®, Fortovase®, Invirase®, Lexiva®, Norvir®, Prezista®, or Reyataz®).

Liver problems may be more likely to occur if you drink alcoholic beverages regularly while you are taking rifampin, isoniazid, and pyrazinamide. Also, the regular use of alcohol may keep rifampin, isoniazid, and pyrazinamide from working properly. Therefore, you should strictly limit the amount of alcoholic beverages you drink while you are taking rifampin, isoniazid, and pyrazinamide.

Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

Stop using rifampin, isoniazid, and pyrazinamide and check with your doctor right away if you have joint pain, stiffness, or swelling; lower back, side, or stomach pain; or swelling of the feet or lower legs.

rifampin, isoniazid, and pyrazinamide will cause urine, stool, saliva, sputum, sweat, and tears to turn reddish-orange to reddish-brown. This is to be expected while you are taking rifampin, isoniazid, and pyrazinamide. This effect may cause soft contact lenses to become permanently discolored. Standard cleaning solutions may not take out all the discoloration. Therefore, it is best not to wear soft contact lenses while taking rifampin, isoniazid, and pyrazinamide. Hard contact lenses are not discolored by rifampin, isoniazid, and pyrazinamide. This condition will return to normal once you stop taking rifampin, isoniazid, and pyrazinamide. If you have any questions about this, check with your doctor.

If rifampin, isoniazid, and pyrazinamide causes you to feel very tired or very weak; or causes clumsiness; unsteadiness; a loss of appetite; nausea; numbness, tingling, burning, or pain in the hands and feet; or vomiting, stop taking it and check with your doctor immediately. These may be early warning symptoms of more serious liver or nerve problems that could develop later.

Rifampin, isoniazid, and pyrazinamide combination may cause blood problems. These problems may result in a greater chance of certain infections, slow healing, and bleeding of the gums. Therefore, you should be careful when using regular toothbrushes, dental floss, and toothpicks. Dental work should be delayed until your blood counts have returned to normal. Check with your medical doctor or dentist if you have any questions about proper oral hygiene (mouth care) during treatment.

If you develop a skin rash, hives, or any allergic reaction to rifampin, isoniazid, and pyrazinamide, stop taking the medicine and check with your doctor as soon as possible.

Before you have any medical tests, tell the medical doctor in charge that you are taking rifampin, isoniazid, and pyrazinamide. The results of some tests may be affected by rifampin, isoniazid, and pyrazinamide.

Eating certain foods (such as cheese [Swiss or Cheshire] or fish [e.g., skipjack, tuna, or Sardinella]) or drinking red wine may cause reactions in some patients taking isoniazid-containing medicines. Check with your doctor if flushing, fast or pounding heartbeat, headache, redness or itching of the skin, sweating, dizziness, or lightheadedness occurs while you are taking rifampin, isoniazid, and pyrazinamide.

Birth control pills may not work properly while you are taking rifampin, isoniazid, and pyrazinamide. To keep from getting pregnant, use another form of birth control along with your birth control pills. Other forms include condoms, diaphragms, or contraceptive foams or jellies.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

rifampin, isoniazid, and pyrazinamide Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Clumsiness or unsteadiness
  • dark urine
  • loss of appetite
  • nausea and vomiting
  • numbness, tingling, burning, or pain in the hands and feet
  • pain in large and small joints
  • unusual tiredness or weakness
  • yellow eyes or skin
Less common
  • Chills
  • difficulty with breathing
  • dizziness
  • fever
  • headache
  • itching
  • muscle and bone pain
  • redness of the skin
  • shivering
  • skin rash
Rare
  • Bloody or cloudy urine
  • blurred vision or loss of vision, with or without eye pain
  • convulsions (seizures)
  • greatly decreased frequency of urination or amount of urine
  • mental depression
  • mood or mental changes
  • sore throat
  • unusual bleeding or bruising

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Diarrhea
  • stomach pain
Less common
  • Sore mouth or tongue

rifampin, isoniazid, and pyrazinamide commonly causes urine, stool, saliva, sputum, sweat, and tears to turn reddish-orange to reddish-brown. This side effect does not usually require medical attention.

Dark urine and yellowing of the eyes or skin (signs of liver problems) caused by isoniazid are more likely to occur in patients 50 years of age and older.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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