Rifamate and Alcohol/Food Interactions

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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Isoniazid may cause liver problems, and taking it with alcohol can increase the risk. You should avoid or limit the use of alcohol while being treated with isoniazid. Call your doctor immediately if you have fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark urine, pale stools, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. 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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Consumer information for this interaction is not currently available.

ADJUST DOSING INTERVAL: Administration with food significantly reduces isoniazid absorption, increasing the risk of therapeutic failure or resistance. The mechanism is unknown.

GENERALLY AVOID: Concomitant administration of isoniazid with foods containing tyramine or histamine may decrease the metabolism of tyramine and histamine, increasing the risk of symptoms relating to tyramine- and/or histamine toxicity (e.g., headache, diaphoresis, flushing, diarrhea, nausea, vomiting, tachycardia, dyspnea, and hypotension). The proposed mechanism is isoniazid-mediated inhibition of monoamine oxidase (MAO) and diamine oxidase (DAO), enzymes responsible for the metabolism of tyramine and histamine, respectively.

MANAGEMENT: Isoniazid should be administered on an empty stomach, one hour before or two hours after meals. Patients should be advised to avoid foods containing tyramine (e.g., aged cheese, cured meats such as sausages and salami, fava beans, sauerkraut, soy sauce, beer, or red wine) or histamine (e.g., skipjack, tuna, mackerel, salmon) during treatment with isoniazid. Corticosteroids and antihistamines may be considered if histamine intoxication is suspected.