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Isoniazid Disease Interactions

There are 5 disease interactions with isoniazid:

Major

Inh (Includes Isoniazid) ↔ 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.
  4. Moulding TS, Redeker AG, Kanel GC "Twenty isoniazid-associated deaths in one state." Am Rev Respir Dis 140 (1989): 700-5
  5. U.S. Departmnet of Health and Human Services / Public Health Service "Severe isoniazid-associated hepatitis--New York, 1991-1993." MMWR Morb Mortal Wkly Rep 42 (1993): 545-7
  6. Mitchell JR, Zimmerman HJ, Ishak KG, et al "Isoniazid liver injury: clinical spectrum, pathology, and probable pathogenesis." Ann Intern Med 84 (1976): 181-92
  7. Bartelink AK, Lenders JW, van Herwaarden CL, et al "Fatal hepatitis after treatment with isoniazid and rifampicin in a patient on anticonvulsant therapy." Tubercle 64 (1983): 125-8
  8. Franks AL, Binkin NJ, Snider DE, et al "Isoniazid hepatitis among pregnant and postpartum Hispanic patients." Public Health Rep 104 (1989): 151-5
  9. Maddrey WC, Boitnott JK "Isoniazid hepatitis." Ann Intern Med 79 (1973): 1-12
  10. 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
  11. "Product Information. Nydrazid (isoniazid)" Apothecon Inc, Princeton, NJ.
  12. Israel HL, Gottlieb JE, Maddrey WC "Perspective: preventive isoniazid therapy and the liver." Chest 101 (1992): 1298-301
  13. Maddrey WC "Isoniazid-induced liver disease." Semin Liver Dis 1 (1981): 129-33
  14. Snider DE, Caras GJ "Isoniazid-associated hepatitis deaths: a review of available information." Am Rev Respir Dis 145 (1992): 494-7
  15. Yoshikawa TT, Nagami PH "Adverse drug reactions in TB therapy: risks and recommendations." Geriatrics 37 (1982): 61-8
View all 15 references
Major

Inh (Includes Isoniazid) ↔ 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
  4. Weber WW, Hein DW "Clinical pharmacokinetics of isoniazid." Clin Pharmacokinet 4 (1979): 401-22
  5. "Product Information. Nydrazid (isoniazid)" Apothecon Inc, Princeton, NJ.
  6. Ellard GA, Gammon PT "Pharmacokinetics of isoniazid metabolism in man." J Pharmacokinet Biopharm 4 (1976): 83-113
View all 6 references
Major

Inh (Includes Isoniazid) ↔ 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.
  4. "Product Information. Nydrazid (isoniazid)" Apothecon Inc, Princeton, NJ.
  5. 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):
  6. Jimenez-Lucho VE, del Busto R, Odel J "Isoniazid and ethambutol as a cause of optic neuropathy." Eur J Respir Dis 71 (1987): 42-5
  7. Gonzalez-Gay MA, Sanchez-Andrade A, Aguero JJ, Alonso MD, Rodriguez E, Criado JR "Optic neuritis following treatment with isoniazid in a hemodialyzed patient." Nephron 63 (1993): 360
View all 7 references
Moderate

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

isoniazid drug Interactions

There are 507 drug interactions with isoniazid

isoniazid alcohol/food Interactions

There are 2 alcohol/food interactions with isoniazid

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.
Unknown No information available.

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

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