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All about: isoniazid/pyrazinamide/rifampin

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Generic Name: isoniazid/pyrazinamide/rifampin (eye so NYE a zid/peer a ZIN a mide/RIF am pin)
Brand Names: Rifater

What is isoniazid/pyrazinamide/rifampin?

Isoniazid, pyrazinamide, and rifampin are antibiotics. They prevent tuberculous bacteria from multiplying in your body.

Isoniazid, pyrazinamide, and rifampin are used together to treat tuberculosis (TB).

Isoniazid/pyrazinamide/rifampin may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about isoniazid/pyrazinamide/rifampin?

Take all of the isoniazid/pyrazinamide/rifampin that has been prescribed for you even if you begin to feel better. Your symptoms may begin to improve before the infection is completely treated. Avoid alcohol while taking isoniazid/pyrazinamide/rifampin. Alcohol will increase the risk of damage to your liver during treatment with this medication.

Call your doctor immediately if you experience a fever, chills, a sore throat, muscle and bone pain, painful or swollen joints, a headache, excessive tiredness or weakness, numbness or tingling in your hands or feet, loss of appetite, nausea and vomiting, yellowing of your skin or eyes, darkening of your urine, unusual bleeding or bruising, a rash, or itching.

Take isoniazid/pyrazinamide/rifampin on an empty stomach 1 hour before or 2 hours after meals. This medication may decrease the effectiveness of birth control pills. Talk to your doctor about using another form of birth control during treatment.

Who should not take isoniazid/pyrazinamide/rifampin?

Before taking this medication, tell your doctor if you have

  • ever had an allergic reaction;

  • kidney disease;

  • liver disease;

  • porphyria;

  • gout; or

  • diabetes mellitus.

You may not be able to take isoniazid/pyrazinamide/rifampin, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.

It is not known whether isoniazid/pyrazinamide/rifampin will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant. It is also not known whether isoniazid/pyrazinamide/rifampin will harm a nursing baby. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

How should I take isoniazid/pyrazinamide/rifampin?

Take isoniazid/pyrazinamide/rifampin exactly as directed by your doctor. However, if you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass (8 ounces) of water. Take isoniazid/pyrazinamide/rifampin on an empty stomach 1 hour before or 2 hours after a meal. Take all of the isoniazid/pyrazinamide/rifampin that has been prescribed for you even if you begin to feel better. Your symptoms may begin to improve before the infection is completely treated.

Your doctor may also want you to take a supplemental vitamin B6 (pyridoxine) tablet daily during treatment to prevent numbness and tingling caused by low levels of this vitamin.

Store this medication at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take a double dose of this medication.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of an isoniazid/pyrazinamide/rifampin overdose include nausea, vomiting, abdominal pain, tiredness, dizziness, slurring of speech, yellow skin or eyes, blurred vision, visual hallucinations, seizures, coma, and death.

What should I avoid while taking isoniazid/pyrazinamide/rifampin?

Do not wear contact lenses while taking isoniazid/pyrazinamide/rifampin. Rifampin may turn your tears, sweat, saliva, urine, feces, and contact lenses a red-orange color. This effect may be permanent on contact lenses.

This medicine may decrease the effectiveness of birth control pills. Talk to your doctor about using another form of birth control during treatment with isoniazid/pyrazinamide/rifampin to prevent pregnancy. Avoid alcohol while taking isoniazid/pyrazinamide/rifampin. Alcohol will increase the risk of damage to your liver during treatment with this medication.

Use caution with the foods listed below. They can interact with isoniazid/pyrazinamide/rifampin and cause a reaction that includes a severe headache, large pupils, neck stiffness, nausea, vomiting, diarrhea, flushing, sweating, itching, irregular heartbeats, and chest pain. A reaction will not necessarily occur, but eat these foods with caution until you know if you will react to them. Call your doctor immediately if you experience any of these symptoms.

Eat the following foods with caution:

  • cheeses, including american, blue, boursault, brick, brie, camembert, cheddar, emmenthaler, gruyere, mozzarella, parmesan, romano, roquefort, stilton, and swiss;

  • sour cream and yogurt;

  • beef or chicken liver, fish, meats prepared with tenderizer, bologna, pepperoni, salami, summer sausage, game meat, meat extracts, caviar, dried fish, herring, shrimp paste, and tuna;

  • avocados, bananas, figs, raisins, and sauerkraut;

  • soy sauce, miso soup, bean curd, and fava beans;

  • yeast extracts;

  • ginseng;

  • chocolate;

  • caffeine (coffee, tea, cola, etc.); and

  • beer (alcoholic and nonalcoholic), red wine (especially Chianti), sherry, vermouth, and other distilled spirits.

Isoniazid/pyrazinamide/rifampin side effects

If you experience any of the following serious side effects, stop taking isoniazid/pyrazinamide/rifampin and seek emergency medical attention or contact your doctor immediately:
  • an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

  • excessive tiredness or weakness;

  • nausea, vomiting, diarrhea, or loss of appetite;

  • yellow skin or eyes;

  • unusual bruising or bleeding;

  • dark urine;

  • little or no urine;

  • difficult or painful urination;

  • numbness or tingling in your hands or feet;

  • muscle or bone pain;

  • painful or swollen joints;

  • worsening gout;

  • seizures;

  • blurred vision;

  • fever, chills, or a sore throat;

  • a headache;

  • a rash or itching; or

  • confusion or abnormal behavior.

Other, less serious side effects may be more likely to occur. Continue to take isoniazid/pyrazinamide/rifampin and talk to your doctor if you experience

  • red-orange coloration of tears, sweat, saliva, urine, or feces; or

  • mild tiredness or weakness.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect isoniazid/pyrazinamide/rifampin?

Before taking isoniazid/pyrazinamide/rifampin, tell your doctor if you are taking any of the following drugs:

  • antacids. Aluminum salts will decrease the action of isoniazid. Do not take antacids that contain aluminum for 1 to 2 full hours before or after taking a dose of isoniazid.

  • allopurinol (Zyloprim). The effects of allopurinol may be decreased by pyrazinamide.

  • ketoconazole (Nizoral), itraconazole (Sporanox), or fluconazole (Diflucan). Isoniazid/pyrazinamide/rifampin may decrease the action of the antifungal medicines. Therefore, a fungal infection may not be adequately treated.

  • disulfiram (Antabuse). Unusual behavior and coordination difficulties may occur if these medicines are taken together.

Isoniazid may increase the effects of the following medicines:

  • warfarin (Coumadin);

  • carbamazepine (Tegretol);

  • theophylline (Theo-Dur, Theochron, Theolair, Slo-Phyllin, Elixophyllin);

  • ethionamide (Trecator-SC);

  • cycloserine (Seromycin);

  • phenytoin (Dilantin), ethotoin (Peganone), and mephenytoin (Mesantoin).

  • meperidine (Demerol); and

  • benzodiazepines such as alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), and temazepam (Restoril).

Before taking isoniazid/pyrazinamide/rifampin, tell your doctor if you are taking any of the medicines listed above.

Rifampin may decrease the effects of the following drugs:

  • acetaminophen (Tylenol, others);

  • blood thinners such as warfarin (Coumadin);

  • barbiturates such as phenobarbital (Luminal, Solfoton), amobarbital (Amytal), secobarbital (Seconal), and butabarbital (Butisol);

  • benzodiazepines such as alprazolam (Xanax), diazepam (Valium), and temazepam (Restoril);
  • beta-blockers such as atenolol (Tenormin), propranolol (Inderal), and metoprolol (Lopressor);
  • heart medicines such as digoxin (Lanoxin), disopyramide (Norpace), quinidine (Quinora, Quinidex, Cardioquin, others), mexiletine (Mexitil), tocainide (Tonocard), verapamil (Calan, Verelan, Isoptin), and enalapril (Vasotec);

  • corticosteroids such as prednisone (Deltasone, Orasone, Meticorten), prednisolone (Delta Cortef, Prelone, others), methylprednisolone (Medrol), and betamethasone (Celestone);

  • sulfonylureas such as glipizide (Glucotrol), glyburide (Micronase, Diabeta, Glynase), chlorpropamide (Diabinese), tolbutamide (Orinase), and tolazamide (Tolinase);

  • HIV and AIDS medicines such as zidovudine (Retrovir), delavirdine (Rescriptor), saquinavir (Invirase), ritonavir (Norvir), indinavir (Crixivan), and nelfinavir (Viracept);

  • sulfa medicines such as sulfamethoxazole (Bactrim, Septra, Gantanol, Azo-Gantanol), and sulfisoxazole (Gantrisin, Azo-Gantrisin);

  • estrogens such as Premarin, Ogen, Estrace, Menest, Estratab, Ortho-Est, and others;

  • oral birth control pills such as Triphasil, Ortho-Novum, Ortho-Cyclen, Ortho-Tri-Cyclen, Ovral, Lo/Ovral, Desogen, Nordette, Levora, Levlen, Tri-Levlen, Nelova, Norinyl, Brevicon, Ovcon, Loestrin, Demulen, and others;

  • phenytoin (Dilantin), ethotoin (Peganone), and mephenytoin (Mesantoin);

  • theophylline (Theolair, Theo-Dur, Theochron, Theo-Bid, others);

  • methadone (Dolophine);

  • clofibrate (Atromid-S); and

  • cyclosporine (Sandimmune, Neoral).

Pyrazinamide may affect the Acetest and Ketostix urine tests for ketones. This reaction can cause a pink-brown color to appear.

Drugs other than those listed here may also interact with isoniazid/pyrazinamide/rifampin. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

Where can I get more information?

  • Your pharmacist has additional information about isoniazid/pyrazinamide/rifampin written for health professionals that you may read.

What does my medication look like?

Isoniazid/pyrazinamide/rifampin is available with a prescription under the brand name Rifater. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

  • Rifater 50 mg isoniazid/300 mg pyrazinamide/120 mg rifampin--round, light-beige tablets

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2006 Cerner Multum, Inc. Version: 2.03. Revision Date: 2/13/04 4:05:12 PM.

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