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Drug Interactions between isoniazid / rifampin and Marpres

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: isoniazid / rifampin and 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 hydrALAZINE

Applies to: isoniazid / rifampin and Marpres (hydralazine / hydrochlorothiazide / reserpine)

Using isoniazid together with hydrALAZINE may increase the risk of nerve damage, which is a potential side effect of both medications. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Let your doctor know if you develop weakness, numbness, pain, burning, or tingling in your hands, feet, or limbs. 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

hydrALAZINE hydroCHLOROthiazide

Applies to: Marpres (hydralazine / hydrochlorothiazide / reserpine) and Marpres (hydralazine / hydrochlorothiazide / reserpine)

HydroCHLOROthiazide may add to the blood pressure lowering effects of hydrALAZINE. You may need a dose adjustment or more frequent monitoring of your blood pressure to safely use both medications. Contact your doctor if you experience dizziness, weakness, fatigue, lightheadedness, headache, flushing, fainting, or a rapid pulse or heart rate. Avoid driving or operating hazardous machinery until you know how these medications affect you, and use caution when getting up from a sitting or lying position. 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 reserpine

Applies to: isoniazid / rifampin and Marpres (hydralazine / hydrochlorothiazide / reserpine)

Consumer information for this interaction is not currently available.

GENERALLY AVOID: The addition of a rauwolfia alkaloid to existing monoamine oxidase inhibitor (MAOI) therapy may result in profound excitation and/or a hypertensive reaction. The proposed mechanism is increased norepinephrine levels at adrenergic receptors due to both the inhibition of catecholamine metabolism by MAOIs and the release of catecholamines induced by rauwolfia alkaloids. Theoretically, this interaction should not occur if rauwolfia alkaloid therapy is initiated several days before the start of MAOI therapy. However, clinical data are limited.

MANAGEMENT: In general, rauwolfia alkaloids should not be administered to patients treated with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, methylene blue, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with rauwolfia alkaloids.

References

  1. Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7
  2. Schulz R, Antonin KH, Hoffmann E, et al. "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther 46 (1989): 528-36
  3. Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62
  4. Sherman GP, Walton CA "Adrenergic transmission and drug interaction." J Am Pharm Assoc 15 (1975): 86-90
  5. De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5
View all 5 references
Moderate

hydrALAZINE reserpine

Applies to: Marpres (hydralazine / hydrochlorothiazide / reserpine) and Marpres (hydralazine / hydrochlorothiazide / reserpine)

Reserpine may add to the blood pressure lowering effects of hydrALAZINE. You may need a dose adjustment or more frequent monitoring of your blood pressure to safely use both medications. Contact your doctor if you experience dizziness, weakness, fatigue, lightheadedness, headache, flushing, fainting, or a rapid pulse or heart rate. Avoid driving or operating hazardous machinery until you know how these medications affect you, and use caution when getting up from a sitting or lying position. 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

hydroCHLOROthiazide reserpine

Applies to: Marpres (hydralazine / hydrochlorothiazide / reserpine) and Marpres (hydralazine / hydrochlorothiazide / reserpine)

Before taking hydroCHLOROthiazide, tell your doctor if you also use reserpine. You may need dose adjustments or special tests in order to safely take both medications together. The blood pressure lowering effects of this combination may be additive. You should take reserpine at bedtime and to notify your doctor if have dizziness or feel faint. 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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Drug and food interactions

Moderate

rifAMPin food

Applies to: 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: 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

hydrALAZINE food

Applies to: Marpres (hydralazine / hydrochlorothiazide / reserpine)

HydrALAZINE and ethanol may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. 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

hydroCHLOROthiazide food

Applies to: Marpres (hydralazine / hydrochlorothiazide / reserpine)

HydroCHLOROthiazide and ethanol may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. 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

reserpine food

Applies to: Marpres (hydralazine / hydrochlorothiazide / reserpine)

Reserpine and ethanol may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. 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.


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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.