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Drug Interactions between Adapin and IsonaRif

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

rifAMPin isoniazid

Applies to: IsonaRif (isoniazid / rifampin) and IsonaRif (isoniazid / rifampin)

Using isoniazid together with rifAMPin can cause serious side effects that may affect your liver. Call your doctor immediately if you experience a fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, or yellowing of the skin or the whites of your eyes. If your doctor does prescribe these medications together, you may need a dose adjustment or special tests to safely take both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

isoniazid doxepin

Applies to: IsonaRif (isoniazid / rifampin) and Adapin (doxepin)

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Coadministration of isoniazid (INH), with drugs that possess serotonergic activity (e.g., serotonin reuptake inhibitors, 5-HT1 receptor agonists, ergot alkaloids, etc.) may increase the risk of serotonin syndrome, a rare but serious and potentially fatal condition. The proposed mechanism is an increase in serotonin resulting from INH's weak inhibition of monoamine oxidase (the enzyme primarily responsible for breaking down norepinephrine, serotonin, and dopamine) combined with the increase in serotonin from the serotonergic drug(s). In one case report, a patient taking mirtazapine (15 mg nightly) for depression was started on INH (300 mg daily) and pyridoxine (25 mg daily) for tuberculosis prophylaxis following a liver transplant from a donor with latent tuberculosis. Six days following the initiation of INH, the patient developed symptoms consistent with serotonin syndrome (e.g., diarrhea, nausea, tremors, hypertension, and altered mental status) which resolved upon the cessation of INH and mirtazapine. However, consensus on the safety of concomitant use of isoniazid with drugs possessing serotonergic activity is lacking and most of the existing data are limited to case reports.

MANAGEMENT: Until more information is available, coadministration of isoniazid with drugs that possess serotonergic activity (e.g., serotonin reuptake inhibitors, 5-HT1 receptor agonists, ergot alkaloids, etc.) should generally be avoided. If coadministration with a serotonergic drug is required, patients should be advised to promptly seek medical attention if they experience signs and symptoms of serotonin syndrome (including but not limited to confusion, hallucinations, tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, neuromuscular abnormalities and/or unexplained gastrointestinal symptoms).

References

  1. "Product Information. Isoniazid/Rifapentine 300 mg/300 mg (Macleods) (isoniazid-rifapentine)." Imported (India) 2 (2021):
  2. "Product Information. Isoniazid (isoniazid)." Chartwell RX, LLC. (2023):
  3. "Product Information. Isoniazid (Arrotex) (isoniazid)." Arrotex Pharmaceuticals Pty Ltd (2023):
  4. Stockley IH "Lack of clinical evidence for potential interaction between isoniazid and selective serotonin reuptake inhibitors https://academic.oup.com/ajhp/article-abstract/53/18/2217/5094445?redirectedFrom=fulltext" (2024):
  5. Evans ME, kortas kj "Potential interaction between isoniazid and selective serotonin reuptake inhibitors https://academic.oup.com/ajhp/article-abstract/52/19/2135/5094220?redirectedFrom=fulltext&login=false" (2024):
  6. "Product Information. Isoniazid (isoniazid)." RPH Pharmaceuticals AB (2023):
  7. OBrien M, Gandhi RG, Kotton CN, Adamsick ML "Risk of serotonin syndrome with Isoniazid https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927797/" (2024):
  8. "Product Information. Isotamine (isoniazid)." Bausch Health, Canada Inc. (2021):
View all 8 references
Minor

rifAMPin doxepin

Applies to: IsonaRif (isoniazid / rifampin) and Adapin (doxepin)

Information for this minor interaction is available on the professional version.

Drug and food interactions

Moderate

rifAMPin food

Applies to: IsonaRif (isoniazid / rifampin)

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Concurrent use of rifampin in patients who ingest alcohol daily may result in an increased incidence of hepatotoxicity. The increase in hepatotoxicity may be due to an additive risk as both alcohol and rifampin are individually associated with this adverse reaction. However, the exact mechanism has not been established.

ADJUST DOSING INTERVAL: Administration with food may reduce oral rifampin absorption, increasing the risk of therapeutic failure or resistance. In a randomized, four-period crossover phase I study of 14 healthy male and female volunteers, the pharmacokinetics of single dose rifampin 600 mg were evaluated under fasting conditions and with a high-fat meal. Researchers observed that administration of rifampin with a high-fat meal reduced rifampin peak plasma concentration (Cmax) by 36%, nearly doubled the time to reach peak plasma concentration (Tmax) but reduced overall exposure (AUC) by only 6%.

MANAGEMENT: The manufacturer of oral forms of rifampin recommends administration on an empty stomach, 30 minutes before or 2 hours after meals. Patients should be encouraged to avoid alcohol or strictly limit their intake. Patients who use alcohol and rifampin concurrently or have a history of alcohol use disorder may require additional monitoring of their liver function during treatment with rifampin.

References

  1. "Product Information. Rifampin (rifAMPin)." Akorn Inc (2022):
  2. "Product Information. Rifampicin (rifampicin)." Mylan Pharmaceuticals Inc (2022):
  3. "Product Information. Rifadin (rifampicin)." Sanofi (2023):
  4. "Product Information. Rifadin (rifaMPICin)." Sanofi-Aventis Australia Pty Ltd (2024):
  5. Peloquin CA, Namdar R, Singleton MD, Nix DE "Pharmacokinetics of rifampin under fasting conditions, with food, and with antacids https://pubmed.ncbi.nlm.nih.gov/9925057/" (2024):
  6. "Product Information. Rofact (rifampin)." Bausch Health, Canada Inc. (2019):
View all 6 references
Moderate

isoniazid food

Applies to: IsonaRif (isoniazid / rifampin)

Food decreases the levels of isoniazid in your body. Take isoniazid on an empty stomach at least 1 hour before or 2 hours after a meal. This will make it easier for your body to absorb the medication. If nausea occurs, ask your doctor if you can take isoniazid with food. Avoid alcohol while taking isoniazid. Alcohol may increase the risk of damage to the liver during isoniazid treatment. Alcohol can also cause isoniazid side effects to get worse. Contact your doctor if you experience flushing, chills, headache, nausea, vomiting, and diarrhea.

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Moderate

doxepin food

Applies to: Adapin (doxepin)

Ask your doctor before using doxepin together with ethanol, this can alter the effects of doxepin and cause increased side effects. Call the doctor if you experience uneven heartbeats, extreme drowsiness, confusion, agitation, vomiting, blurred vision, sweating, muscle stiffness, feeling light-headed, and seizures. You should be warned not to exceed recommended dosages, to avoid alcohol, and to avoid activities requiring mental alertness. If your doctor prescribes these medications together, you may need a dose adjustment to safely take this combination. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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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.

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