Skip to main content

Isoniazid Disease Interactions

There are 5 disease interactions with isoniazid.


INH (applies to isoniazid) hepatotoxicity

Major Potential Hazard, High plausibility. Applicable conditions: 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.


  1. Dutt AK, Moers D, Stead WW (1983) "Undesirable side effects of isoniazid and rifampin in largely twice-weekly short-course chemotherapy for tuberculosis." Am Rev Respir Dis, 128, p. 419-24
  2. Bartelink AK, Lenders JW, van Herwaarden CL, et al. (1983) "Fatal hepatitis after treatment with isoniazid and rifampicin in a patient on anticonvulsant therapy." Tubercle, 64, p. 125-8
  3. Maddrey WC, Boitnott JK (1973) "Isoniazid hepatitis." Ann Intern Med, 79, p. 1-12
  4. Mitchell JR, Zimmerman HJ, Ishak KG, et al. (1976) "Isoniazid liver injury: clinical spectrum, pathology, and probable pathogenesis." Ann Intern Med, 84, p. 181-92
  5. Maddrey WC (1980) "Drug-related acute and chronic hepatitis." Clin Gastroenterol, 9, p. 213-24
  6. Maddrey WC (1981) "Isoniazid-induced liver disease." Semin Liver Dis, 1, p. 129-33
  7. Yoshikawa TT, Nagami PH (1982) "Adverse drug reactions in TB therapy: risks and recommendations." Geriatrics, 37, p. 61-8
  8. Yamamoto T, Suou T, Hirayama C (1986) "Elevated serum aminotransferase induced by isoniazid in relation to isoniazid acetylator phenotype." Hepatology, 6, p. 295-8
  9. Franks AL, Binkin NJ, Snider DE, et al. (1989) "Isoniazid hepatitis among pregnant and postpartum Hispanic patients." Public Health Rep, 104, p. 151-5
  10. Moulding TS, Redeker AG, Kanel GC (1989) "Twenty isoniazid-associated deaths in one state." Am Rev Respir Dis, 140, p. 700-5
  11. Israel HL, Gottlieb JE, Maddrey WC (1992) "Perspective: preventive isoniazid therapy and the liver." Chest, 101, p. 1298-301
  12. Snider DE, Caras GJ (1992) "Isoniazid-associated hepatitis deaths: a review of available information." Am Rev Respir Dis, 145, p. 494-7
  13. "Product Information. INH (isoniazid)." Ciba Pharmaceuticals, Summit, NJ.
  14. U.S. Departmnet of Health and Human Services / Public Health Service (1993) "Severe isoniazid-associated hepatitis--New York, 1991-1993." MMWR Morb Mortal Wkly Rep, 42, p. 545-7
  15. (2001) "Product Information. Nydrazid (isoniazid)." Apothecon Inc
View all 15 references

INH (applies to isoniazid) liver disease

Major Potential Hazard, High plausibility.

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.


  1. Acocella G, Bonollo L, Garimoldi M, et al. (1972) "Kinetics of rifampicin and isoniazid administered alone and in combination to normal subjects and patients with liver disease." Gut, 13, p. 47-53
  2. Ellard GA, Gammon PT (1976) "Pharmacokinetics of isoniazid metabolism in man." J Pharmacokinet Biopharm, 4, p. 83-113
  3. Weber WW, Hein DW (1979) "Clinical pharmacokinetics of isoniazid." Clin Pharmacokinet, 4, p. 401-22
  4. Reed MD, Blumer JL (1983) "Clinical pharmacology of antitubercular drugs." Pediatr Clin North Am, 30, p. 177-93
  5. "Product Information. INH (isoniazid)." Ciba Pharmaceuticals, Summit, NJ.
  6. (2001) "Product Information. Nydrazid (isoniazid)." Apothecon Inc
View all 6 references

INH (applies to isoniazid) peripheral neuropathy

Major Potential Hazard, High plausibility. Applicable conditions: Malnourished, Diabetes Mellitus, Alcoholism

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.


  1. Jimenez-Lucho VE, del Busto R, Odel J (1987) "Isoniazid and ethambutol as a cause of optic neuropathy." Eur J Respir Dis, 71, p. 42-5
  2. Dippenaar J, Jameson C, Dowse R (1987) "Side-effects of isoniazid." S Afr Med J, 72, p. 89
  3. "Product Information. INH (isoniazid)." Ciba Pharmaceuticals, Summit, NJ.
  4. Siskind MS, Thienemann D, Kirlin L (1993) "Isoniazid-induced neurotoxicity in chronic dialysis patients: report of three cases and a review of the literature." Nephron, 64, p. 303-6
  5. Gonzalez-Gay MA, Sanchez-Andrade A, Aguero JJ, Alonso MD, Rodriguez E, Criado JR (1993) "Optic neuritis following treatment with isoniazid in a hemodialyzed patient." Nephron, 63, p. 360
  6. Bennett JE, Mandell GL, Dolin R, eds.. (1995) "Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases." New York, NY: Churchill Livingston, 1
  7. (2001) "Product Information. Nydrazid (isoniazid)." Apothecon Inc
View all 7 references

INH (applies to isoniazid) hemodialysis

Moderate Potential Hazard, High plausibility.

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


  1. Gold CH, Buchanan N, Tringham V, et al. (1976) "Isoniazid pharmacokinetics in patients with chronic renal failure." Clin Nephrol, 6, p. 365-9
  2. "Product Information. INH (isoniazid)." Ciba Pharmaceuticals, Summit, NJ.
  3. (2001) "Product Information. Nydrazid (isoniazid)." Apothecon Inc

INH (applies to isoniazid) renal dysfunction

Moderate Potential Hazard, Moderate plausibility.

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.


  1. Bowerson DW, Winterbauer RH, Stewart GL, et al. (1973) "Isoniazid dosage in patients with renal failure." N Engl J Med, 289, p. 84-7
  2. Reidenberg MM, Shear L, Cohen RV (1973) "Elimination of isoniazid in patients with impaired renal function." Am Rev Respir Dis, 108, p. 1426-8
  3. Gold CH, Buchanan N, Tringham V, et al. (1976) "Isoniazid pharmacokinetics in patients with chronic renal failure." Clin Nephrol, 6, p. 365-9
  4. Boxenbaum HG, Bekersky I, Mattaliano V, Kaplan SA (1975) "Plasma and salivary concentrations of isoniazid in man: preliminary findings in two slow acetylator subjects." J Pharmacokinet Biopharm, 3, p. 443-56
  5. Mitchison DA, Ellard GA (1980) "Tuberculosis in patients having dialysis." Br Med J, 280, p. 1533
  6. Andrew OT, Schoenfeld PY, Hopewell PC, Humphreys MH (1980) "Tuberculosis in patients with end-stage renal disease." Am J Med, 68, p. 59-65
  7. "Product Information. INH (isoniazid)." Ciba Pharmaceuticals, Summit, NJ.
  8. Kim YG, Shin JG, Shin SG, Jang IJ, Kim SG, Lee JS, Han JS, Cha YN (1993) "Decreased acetylation of isoniazid in chronic renal failure." Clin Pharmacol Ther, 54, p. 612-20
  9. (2001) "Product Information. Nydrazid (isoniazid)." Apothecon Inc
View all 9 references

Isoniazid drug interactions

There are 684 drug interactions with isoniazid.

Isoniazid alcohol/food interactions

There is 1 alcohol/food interaction with isoniazid.

Report options

QR code containing a link to this page

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.