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Rifater (isoniazid / pyrazinamide / rifampin) Disease Interactions

There are 17 disease interactions with Rifater (isoniazid / pyrazinamide / rifampin):

Major

Inh (Includes Rifater) ↔ Hepatotoxicity

Severe Potential Hazard, High plausibility

Applies to: Liver Disease, Alcoholism

The use of isoniazid is contraindicated in patients with acute liver disease or a history of hepatic injury due to isoniazid. Caution is advised when using the drug in patients with chronic liver disease or a history of alcoholism. Isoniazid has been associated with severe and sometimes fatal hepatitis, which may occur even after many months of therapy. In a US Public Health Service Surveillance Study of nearly 14,000 isoniazid patients, the incidence of hepatitis was 1.25%, of which 4.6% was fatal. However, more recent studies have reported considerably lower rates when CDC guidelines for selection and monitoring of patients were followed. Epidemiologic studies indicate an increased incidence with increasing age, alcohol use, and female gender. As a precautionary measure, routine monitoring of serum transaminases (SGOT, SGPT) and bilirubin may be considered, although a transient and harmless increase in serum transaminase reportedly occurs in 10% to 20% of patients, usually in the first 3 months of therapy. Patients should be advised to promptly discontinue isoniazid therapy and seek medical attention if they experience signs or symptoms suggestive of liver damage such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice. Reinstitution of the drug should occur only after symptoms and laboratory abnormalities resolve, with low and gradually increasing dosages.

References

  1. Maddrey WC "Drug-related acute and chronic hepatitis." Clin Gastroenterol 9 (1980): 213-24
  2. Yamamoto T, Suou T, Hirayama C "Elevated serum aminotransferase induced by isoniazid in relation to isoniazid acetylator phenotype." Hepatology 6 (1986): 295-8
  3. "Product Information. INH (isoniazid)." Ciba Pharmaceuticals, Summit, NJ.
View all 15 references
Major

Inh (Includes Rifater) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Isoniazid is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from isoniazid due to decreased drug clearance. Dosage reductions are recommended in these patients.

References

  1. "Product Information. INH (isoniazid)." Ciba Pharmaceuticals, Summit, NJ.
  2. Acocella G, Bonollo L, Garimoldi M, et al "Kinetics of rifampicin and isoniazid administered alone and in combination to normal subjects and patients with liver disease." Gut 13 (1972): 47-53
  3. Reed MD, Blumer JL "Clinical pharmacology of antitubercular drugs." Pediatr Clin North Am 30 (1983): 177-93
View all 6 references
Major

Inh (Includes Rifater) ↔ Peripheral Neuropathy

Severe Potential Hazard, High plausibility

Applies to: Malnourished, Diabetes Mellitus, Alcoholism, Peripheral Neuropathy

Isoniazid commonly causes dose-related peripheral neuropathy, which results from the depletion of pyridoxine in the presence of the drug. The neuropathy is usually preceded by paresthesias of the feet and hands. Therapy with isoniazid should be administered cautiously in patients with preexisting peripheral neuropathy or risk factors for developing the condition, such as malnutrition, diabetes and alcoholism. Pyridoxine (vitamin B6) at a dosage of 10 to 50 mg/day may prevent or attenuate isoniazid-related peripheral neuropathy and is recommended for these patients.

References

  1. Dippenaar J, Jameson C, Dowse R "Side-effects of isoniazid." S Afr Med J 72 (1987): 89
  2. Siskind MS, Thienemann D, Kirlin L "Isoniazid-induced neurotoxicity in chronic dialysis patients: report of three cases and a review of the literature." Nephron 64 (1993): 303-6
  3. "Product Information. INH (isoniazid)." Ciba Pharmaceuticals, Summit, NJ.
View all 7 references
Major

Pza (Includes Rifater) ↔ Gout

Severe Potential Hazard, High plausibility

Applies to: Gout

The use of pyrazinamide is contraindicated in patients with acute gout. Pyrazinamide inhibits the renal excretion of uric acid, which may frequently result in precipitation or exacerbation of gout. Therapy with pyrazinamide should be administered cautiously in patients with hyperuricemia or a history of gout. Serum uric acid levels should be monitored regularly, and appropriate measures (e.g., administration of uricosuric agents) taken to prevent the development of gout. If gouty arthritis occurs, pyrazinamide should be discontinued.

References

  1. "Product Information. Pyrazinamide (pyrazinamide)." VersaPharm Inc, Marietta, GA.
  2. Amodio MI, Bengualid V, Lowy FD "Development of acute gout secondary to pyrazinamide in a patient without a prior history of gout." DICP 24 (1990): 1115-6
Major

Pza (Includes Rifater) ↔ Hepatotoxicity

Severe Potential Hazard, High plausibility

Applies to: Alcoholism, Liver Disease

The use of pyrazinamide is contraindicated in patients with severe liver damage. Pyrazinamide may cause hepatocellular injury, particularly in patients with underlying liver disease and during coadministration with other hepatotoxic agents including other antituberculous drugs such as isoniazid and rifampin. Therapy with pyrazinamide should be administered cautiously and under strict medical supervision in patients with liver disease or a history of alcoholism. Serum transaminases (ALT, AST) and bilirubin should be measured at baseline and monitored closely during therapy. Patients should be instructed to discontinue the drug promptly and seek medical attention if signs and symptoms of hepatic injury develop, including fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice. To lessen the risk of hepatotoxicity, the maximum dosage should not exceed 2 g/day when treatment is administered daily or 3 g/day when administered twice weekly.

References

  1. "Product Information. Pyrazinamide (pyrazinamide)." VersaPharm Inc, Marietta, GA.
  2. Mandell GL, Bennett JE, Dolin R, eds.. "Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 4th ed." New York, NY: Churchill Livingston 1 (1995):
  3. Cohen CD, Sayed AR, Kirsch RE "Hepatic complications of antituberculosis therapy revisited." S Afr Med J 63 (1983): 960-3
View all 5 references
Major

Pza (Includes Rifater) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Pyrazinamide is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from pyrazinamide due to decreased drug clearance. Dosage reductions are recommended in these patients if the drug is used.

References

  1. "Product Information. Pyrazinamide (pyrazinamide)." VersaPharm Inc, Marietta, GA.
  2. Lacroix C, Tranvouez JL, Hoang T, Duwoos H, LaFont O "Pharmacokinetics of pyrazinamide and its metabolites in patients with hepatic cirrhotic insufficiency." Arzneimittelforschung 40 (1990): 76-9
  3. Ellard GA "Absorption, metabolism and excretion of pyrazinamide in man." Tubercle 50 (1969): 144-58
Major

Pza (Includes Rifater) ↔ Renal Dysfunction

Severe Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

The half-life of pyrazinamide may be prolonged in patients with renal impairment. In addition, the drug's metabolites, at least one of which is pharmacologically active, may accumulate. Therapy with pyrazinamide should be administered cautiously in patients with renal dysfunction. Dosage adjustments may be necessary.

References

  1. Stamatakis G, Montes C, Trouvin JH, et al "Pyrazinamide and pyrazinoic acid pharmacokinetics in patients with chronic renal failure." Clin Nephrol 30 (1988): 230-4
  2. "Product Information. Pyrazinamide (pyrazinamide)." VersaPharm Inc, Marietta, GA.
  3. Ellard GA "Absorption, metabolism and excretion of pyrazinamide in man." Tubercle 50 (1969): 144-58
View all 4 references
Major

Rifampin (Includes Rifater) ↔ Hematopoietic Disturbances

Severe Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

Rifampin may infrequently cause hematopoietic abnormalities such as thrombocytopenia, leukopenia, decreased hemoglobin, and acute hemolytic anemia. Hemolysis has been described as part of an immune-mediated reaction which generally occurs after gaps in therapy. Thrombocytopenia is observed most frequently in patients receiving high-dose intermittent therapy or after a lapse in therapy, but very rarely during daily administration. It is reversible if rifampin is discontinued as soon as purpura appears. Patients with preexisting bone marrow depression or blood dyscrasias should be monitored closely during rifampin therapy for further decreases in blood counts. Although rifampin-related hematologic effects are often transient, cerebral hemorrhage and fatalities have been reported with the continued administration of rifampin after the appearance of purpura.

References

  1. "Product Information. Rifadin (rifampin)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  2. Lee M, Berger HW "Eosinophilia caused by rifampin." Chest 77 (1980): 579
  3. Dutt AK, Moers D, Stead WW "Undesirable side effects of isoniazid and rifampin in largely twice-weekly short-course chemotherapy for tuberculosis." Am Rev Respir Dis 128 (1983): 419-24
View all 15 references
Major

Rifampin (Includes Rifater) ↔ Hepatotoxicity

Severe Potential Hazard, High plausibility

Applies to: Liver Disease, Alcoholism

The use of rifampin has been associated with hepatocellular injury and liver dysfunction. Hepatitis and jaundice resulting in death have occurred, mostly in patients with underlying liver disease and during coadministration with other hepatotoxic agents including other antituberculous drugs such as isoniazid and pyrazinamide. Therapy with rifampin should be administered cautiously and under strict medical supervision in patients with liver disease or a history of alcoholism. Serum transaminases (ALT, AST) and bilirubin should be measured at baseline and every 2 to 4 weeks during therapy, but keeping in mind that elevated levels may occur transiently in 10% to 15% of patients, usually during the early days of treatment. Patients should be instructed to discontinue the drug promptly and seek medical attention if signs and symptoms of hepatic injury develop, including fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.

References

  1. Dutt AK, Moers D, Stead WW "Short-course chemotherapy for tuberculosis with mainly twice-weekly isoniazid and rifampin: community physicians' seven-year experience with mainly outpatients." Am J Med 77 (1984): 233-42
  2. Maddrey WC "Drug-related acute and chronic hepatitis." Clin Gastroenterol 9 (1980): 213-24
  3. Dutt AK, Moers D, Stead WW "Undesirable side effects of isoniazid and rifampin in largely twice-weekly short-course chemotherapy for tuberculosis." Am Rev Respir Dis 128 (1983): 419-24
View all 10 references
Major

Rifampin (Includes Rifater) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Rifampin is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from rifampin due to decreased drug clearance. In addition, the accumulation of rifampin may result in hyperbilirubinemia because rifampin competes with bilirubin for uptake by hepatocytes. Dosage adjustments are recommended in patients with liver disease. Withdrawal of rifampin therapy may be required if serum bilirubin is persistently high.

References

  1. Nitti V, Virgilio R, Patricolo MR, Iuliano A "Pharmacokinetic study of intravenous rifampicin." Chemotherapy 23 (1977): 1-6
  2. Acocella G "Clinical pharmacokinetics of rifampicin." Clin Pharmacokinet 3 (1978): 108-27
  3. "Product Information. Rifadin (rifampin)." Hoechst Marion-Roussel Inc, Kansas City, MO.
View all 4 references
Major

Rifampin (Includes Rifater) ↔ Porphyria

Severe Potential Hazard, Moderate plausibility

Applies to: Porphyria

Rifampin may induce the activity of delta amino levulinic acid synthetase, an enzyme involved in the biosynthesis of porphyrins. The use of rifampin has been associated with isolated cases of porphyria exacerbation. Therapy with rifampin should be administered cautiously in patients with a history of porphyria.

References

  1. "Product Information. Rifadin (rifampin)." Hoechst Marion-Roussel Inc, Kansas City, MO.
Moderate

Antibiotics (Includes Rifater) ↔ Colitis

Moderate Potential Hazard, Low plausibility

Applies to: Colitis/Enteritis (Noninfectious)

Pseudomembranous colitis has been reported with most antibacterial agents and may range in severity from mild to life-threatening, with an onset of up to two months following cessation of therapy. Antibiotic therapy can alter the normal flora of the colon and permit overgrowth of Clostridium difficile, whose toxin is believed to be a primary cause of antibiotic- associated colitis. The colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus. The most common culprits are clindamycin, lincomycin, the aminopenicillins (amoxicillin, ampicillin), and the cephalosporins. Therapy with broad-spectrum antibiotics and other agents with significant antibacterial activity should be administered cautiously in patients with a history of gastrointestinal diseases, particularly colitis. There is some evidence that pseudomembranous colitis, if it occurs, may run a more severe course in these patients and that it may be associated with flares in their underlying disease activity. The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically. A large bowel endoscopy may be considered to establish a definitive diagnosis in cases of severe diarrhea.

References

  1. Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
  2. Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
  3. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
View all 47 references
Moderate

Inh (Includes Rifater) ↔ Hemodialysis

Moderate Potential Hazard, High plausibility

Applies to: hemodialysis

Isoniazid is substantially removed by hemodialysis and should be administered after dialysis.

References

  1. Gold CH, Buchanan N, Tringham V, et al "Isoniazid pharmacokinetics in patients with chronic renal failure." Clin Nephrol 6 (1976): 365-9
  2. "Product Information. INH (isoniazid)." Ciba Pharmaceuticals, Summit, NJ.
  3. "Product Information. Nydrazid (isoniazid)" Apothecon Inc, Princeton, NJ.
Moderate

Inh (Includes Rifater) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Isoniazid is metabolized primarily by acetylation and dehydrazination in the liver. It is not significantly excreted by the kidney. Dosage adjustments in renal impairment are generally not necessary except in slow acetylators with a creatinine clearance below 10 mL/min. The rate of acetylation is genetically determined. Approximately 50% of blacks and caucasians are slow acetylators, and the majority of Eskimos and Asians are rapid acetylators.

References

  1. "Product Information. Nydrazid (isoniazid)" Apothecon Inc, Princeton, NJ.
  2. Gold CH, Buchanan N, Tringham V, et al "Isoniazid pharmacokinetics in patients with chronic renal failure." Clin Nephrol 6 (1976): 365-9
  3. "Product Information. INH (isoniazid)." Ciba Pharmaceuticals, Summit, NJ.
View all 9 references
Moderate

Pza (Includes Rifater) ↔ Diabetes Mellitus

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

The use of pyrazinamide may be associated with poor diabetic control. Patients with diabetes mellitus should be monitored more closely during therapy with pyrazinamide, and their antidiabetic regimen adjusted accordingly.

References

  1. "Product Information. Pyrazinamide (pyrazinamide)." VersaPharm Inc, Marietta, GA.
Moderate

Pza (Includes Rifater) ↔ Hemodialysis

Moderate Potential Hazard, High plausibility

Applies to: hemodialysis

Pyrazinamide is removed by hemodialysis and should be administered after dialysis.

References

  1. Woo J, Leung A, Chan K, Lai KN, Teoh R "Pyrazinamide and rifampicin regimens for patients on maintenance dialysis." Int J Artif Organs 11 (1988): 181-5
  2. "Product Information. Pyrazinamide (pyrazinamide)." VersaPharm Inc, Marietta, GA.
Moderate

Rifampin (Includes Rifater) ↔ Enzyme Induction

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperthyroidism, Hyperadrenocorticism, Hypoparathyroidism, Hypothyroidism, Panhypopituitarism, Hyperparathyroidism, Adrenal Insufficiency

Rifampin has enzyme-inducing effects that can enhance the metabolism of many endogenous substrates, including adrenal hormones, thyroid hormones, and vitamin D, the latter of which may affect serum calcium, phosphate and parathyroid hormone levels. Patients with preexisting imbalances of these hormones should be monitored more closely during long-term therapy with rifampin. In patients whose hormonal condition is stabilized on treatment, adjustments may be necessary in their treatment regimen to compensate for these effects.

References

  1. "Product Information. Rifadin (rifampin)." Hoechst Marion-Roussel Inc, Kansas City, MO.

Rifater (isoniazid / pyrazinamide / rifampin) drug Interactions

There are 830 drug interactions with Rifater (isoniazid / pyrazinamide / rifampin)

Rifater (isoniazid / pyrazinamide / rifampin) alcohol/food Interactions

There are 2 alcohol/food interactions with Rifater (isoniazid / pyrazinamide / rifampin)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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