Rifampin, Isoniazid, and Pyrazinamide (Oral)

Rifampin, isoniazid, and pyrazinamide is a combined anti-infective medicine, that is used in the treatment of tuberculosis (TB).

Overview

Rifampin, isoniazid, and pyrazinamide are a combination of three anti-infective medications. These medicines are used in conjunction for the treatment of tuberculosis or TB. This medication may be taken either as a sole medical treatment for TB or in combination with other drugs for effective treatment.

The US brand name of Rifampin, isoniazid, and pyrazinamide is Rifater and is likely to be prescribed under this brand. This medication is only available from a suitable medical professional via prescription and should only be used as directed by a doctor.

Conditions Treated

Type of Medicine

  • Tablet (oral)

Side Effects

As well as the required effects that Rifampin, isoniazid, and pyrazinamide causes, this medication can also cause other, unwanted consequences as a result of taking it. It is likely that not all of these side effects will occur, if any, but should any of the listed complications, conditions or effects arise as a result of taking this drug, medical attention may be required.

If any of the below listed side effects occur while undergoing treatment with Rifampin, isoniazid, and pyrazinamide, check with a medical professional or doctor immediately, as the results may be life-threatening or cause further complications:

  • Black, tarry stools
  • Bleeding gums
  • Blistering, peeling, loosening of skin
  • Bloody/cloudy urine
  • Blurred vision/loss of vision, with or without eye pain
  • Chills
  • Clumsiness or unsteadiness
  • Coughing or spitting up blood
  • Dark urine
  • Difficulty in breathing
  • Dizziness
  • Fast, irregular, pounding, or racing heartbeat or pulse
  • Fever
  • Greatly decreased frequency of urination or amount of urine
  • Headache
  • Hearing loss
  • Loss of appetite
  • Mental depression
  • Mood or psychological changes
  • Muscle and bone pain
  • Nausea and vomiting
  • Numbness, tingling or pain in the hands and feet
  • Pain in large and small joints
  • Pinpoint red spots on skin
  • Ringing or buzzing or other unexplained noise in ears
  • Seizures
  • Shivering
  • Skin rash, itching, or redness
  • Sore throat
  • Tightness in the chest
  • Unusual bleeding or bruising
  • Unusual tiredness or weakness
  • Yellow eyes or skin

Other side effects that may be experienced during a course of Rifampin, isoniazid, and pyrazinamide may not need medical support or attention if they occur. The side effects listed below may go away over time or during your treatment as a result of your body adjusting to the drug. Should any of the side effects become uncomfortable or continue to escalate, check with your doctor to discuss ways to prevent or reduce these effects.

If any of the following become bothersome or worry you during your treatment on Rifampin, isoniazid, and pyrazinamide, contact your doctor to discuss preventative methods:

  • Diarrhea
  • Sore mouth or tongue
  • Stomach pain

Additional or varying side effects not listed above may also occur during your course of Rifampin, isoniazid, and pyrazinamide. Should any other effects become present during this time, notify your doctor as soon as possible.

Call a medical professional for medical advice about any worrying side effects. You can also report side effects directly to the FDA on 1-800-FDA-1088.

Dosage

The dosage of Rifampin, isoniazid, and pyrazinamide varies per-patient, and as such your prescription will be customized to the exact requirements for your illness. The information regarding dosage below only states the standard, or universal, dosage prescribed of this medication. Always follow the orders of your doctor or the printed directions on your prescription if in doubt. If your dosage varies from what is listed, do not alter your dose unless otherwise stated by your doctor.

The dosage of Rifampin, isoniazid, and pyrazinamide that you take is in part dependent on the strength of the medication prescribed. Other factors that determine prescribed dosage includes the time allowed between each dose, the length of time your course of medication is specified for or the number of treatments taken per day. All of these can vary based on your doctor's recommendation and the medical condition for which you are prescribed Rifampin, isoniazid, and pyrazinamide.

For dosage form orally (tablets):

For the treatment of tuberculosis:

  • Adults/children aged 15 years and older that weigh 55 kilograms (kg) (121 pounds) or more: 6 tablets per day.
  • Adults/children aged 15 years and older that weigh between 45-54 kg (99-119 pounds): 5 tablets per day.
  • Adults/ children aged 15 years and older that weigh 44 kg (97 pounds) or below: 4 tablets per day.
  • Children aged younger than 15 years: Usage and dosage to be determined and prescribed by your doctor.

Should you forget or miss a dose of Rifampin, isoniazid, and pyrazinamide, ensure that you take your tablet as soon as possible after you remember. In the case that it's almost time for your next tablet, skip the dose that has been missed and return to your prescribed dosing schedule with no alteration. Never take an extra dose if you are unsure if you have already taken a tablet.

If a rifampin, isoniazid, and pyrazinamide combination dosage is taken on a less regular schedule, additional and varying side effects may occur an increased amount, and can also be more severe than usual. If you have any queries about this, check with a medical professional and try to work out the best way to take your medication on a more regular schedule.

Interactions

Many forms of medication are not recommended to be used together. However, in some cases two otherwise incompatible drugs may be prescribed in tandem, regardless of the fact that interactions may occur. When this happens, your doctor can choose to alter your dose or take other precautions to reduce the effects. When taking Rifampin, isoniazid, and pyrazinamide, it is critical that everyone involved in your medical case has a full history and up-to-date list of any and all medications you are currently taking or have taken in the past. This is especially important for the listed drugs below.

The interactions listed have been chosen because of their level of significance, as well as their likeliness to cause potential negative effects when taken with Rifampin, isoniazid, and pyrazinamide. Your doctor may opt not to treat you with these medications or alter other medications that you are prescribed:

  • Voriconazole
  • Tipranavir
  • Telaprevir
  • Saquinavir
  • Ritonavir
  • Rilpivirine
  • Ranolazine
  • Praziquantel
  • Paritaprevir
  • Ombitasvir
  • Nelfinavir
  • Maraviroc
  • Lurasidone
  • Lopinavir
  • Isavuconazonium
  • Grazoprevir
  • Fosamprenavir
  • Elvitegravir
  • Elbasvir
  • Delamanid
  • Dasabuvir
  • Darunavir
  • Daclatasvir
  • Cobicistat
  • Boceprevir
  • Atazanavir
  • Artemether

Taking rifampin, isoniazid, and pyrazinamide with any of the listed medications below is usually not a recommended method of medicating, but may be unavoidable or required in certain individual cases. If both drugs are prescribed at the same time, your doctor may wish to change the dosage of your medication to reduce potential side effects, or how often you take one or either of the medicines.

  • Zidovudine
  • Vortioxetine
  • Vorapaxar
  • Vinflunine
  • Vincristine Sulfate Liposome
  • Vincristine
  • Vilazodone
  • Venetoclax
  • Vemurafenib
  • Velpatasvir
  • Vandetanib
  • Valbenazine
  • Ulipristal
  • Trabectedin
  • Tolvaptan
  • Tofacitinib
  • Ticagrelor
  • Thiotepa
  • Tenofovir Alafenamide
  • Temsirolimus
  • Telithromycin
  • Tegafur
  • Tasimelteon
  • Tacrolimus
  • Sunitinib
  • Sorafenib
  • Sonidegib
  • Sofosbuvir
  • Sirolimus
  • Simeprevir
  • Romidepsin
  • Rolapitant
  • Roflumilast
  • Rivaroxaban
  • Rifampin
  • Ribociclib
  • Regorafenib
  • Quinine
  • Quetiapine
  • Pyrazinamide
  • Posaconazole
  • Ponatinib
  • Pixantrone
  • Pitavastatin
  • Piperaquine
  • Phenytoin
  • Perampanel
  • Pazopanib
  • Panobinostat
  • Palbociclib
  • Osimertinib
  • Olaparib
  • Norgestrel
  • Norgestimate
  • Norethindrone
  • Nintedanib
  • Nimodipine
  • Nilotinib
  • Nifedipine
  • Nevirapine
  • Netupitant
  • Naloxegol
  • Mycophenolic Acid
  • Mycophenolate Mofetil
  • Mifepristone
  • Midostaurin
  • Methadone
  • Mestranol
  • Manidipine
  • Macitentan
  • Lorcainide
  • Linagliptin
  • Levonorgestrel
  • Levodopa
  • Ledipasvir
  • Lapatinib
  • Lamotrigine
  • Ketoconazole
  • Ixazomib
  • Ixabepilone
  • Ivacaftor
  • Ivabradine
  • Itraconazole
  • Isoniazid
  • Irinotecan Liposome
  • Irinotecan
  • Indinavir
  • Imatinib
  • Ifosfamide
  • Idelalisib
  • Ibrutinib
  • Glimepiride
  • Gestodene
  • Gefitinib
  • Fosphenytoin
  • Fosaprepitant
  • Fentanyl
  • Exemestane
  • Everolimus
  • Etravirine
  • Etonogestrel
  • Ethynodiol
  • Ethionamide
  • Ethinyl Estradiol
  • Estradiol
  • Erlotinib
  • Enzalutamide
  • Eluxadoline
  • Eliglustat
  • Efavirenz
  • Edoxaban
  • Drospirenone
  • Dronedarone
  • Doxorubicin Hydrochloride Liposome
  • Doxorubicin
  • Donepezil
  • Domperidone
  • Dolutegravir
  • Digoxin
  • Dienogest
  • Desogestrel
  • Delavirdine
  • Deflazacort
  • Deferasirox
  • Dasatinib
  • Dabigatran Etexilate
  • Cyclosporine
  • Crizotinib
  • Cobimetinib
  • Clozapine
  • Cholera Vaccine, Live
  • Ceritinib
  • Cariprazine
  • Carbamazepine
  • Cabozantinib
  • Bupropion
  • Brivaracetam
  • Brigatinib
  • Brexpiprazole
  • Bosutinib
  • Bedaquiline
  • Axitinib
  • Atovaquone
  • Aripiprazole
  • Aprepitant
  • Apremilast
  • Apixaban
  • Amprenavir
  • Amiodarone
  • Afatinib
  • Acetaminophen
  • Abiraterone

Some medications may cause minor side effects and interactions when taken with Rifampin, isoniazid, and pyrazinamide. This increased risk of side effects is often outweighed by the benefits of each form of medication, as both drugs at the same time can be the best course of treatment for you. Discuss with your doctor if a change in dosage or usage is required for any of the below medications.

  • Zolpidem
  • Zidovudine
  • Zaleplon
  • Warfarin
  • Valproic Acid
  • Trimetrexate
  • Triazolam
  • Tocainide
  • Theophylline
  • Tamoxifen
  • Tadalafil
  • Simvastatin
  • Sertraline
  • Rosiglitazone
  • Rofecoxib
  • Repaglinide
  • Raltegravir
  • Propafenone
  • Prednisone
  • Prednisolone
  • Pirmenol
  • Pioglitazone
  • Phenytoin
  • Phenprocoumon
  • Oxycodone
  • Oxcarbazepine
  • Ospemifene
  • Nisoldipine
  • Moxifloxacin
  • Morphine Sulfate Liposome
  • Morphine
  • Metoprolol
  • Methylprednisolone
  • Metformin
  • Meperidine
  • Mefloquine
  • Losartan
  • Linezolid
  • Levothyroxine
  • Levomethadyl
  • Isradipine
  • Haloperidol
  • Glyburide
  • Gliclazide
  • Fosphenytoin
  • Fludrocortisone
  • Fluconazole
  • Fesoterodine
  • Etoricoxib
  • Enflurane
  • Enalaprilat
  • Enalapril Maleate
  • Eltrombopag
  • Doxycycline
  • Disulfiram
  • Disopyramide
  • Diltiazem
  • Dicumarol
  • Diazepam
  • Dexamethasone
  • Cortisone
  • Clofibrate
  • Clarithromycin
  • Citalopram
  • Chlorpropamide
  • Chloramphenicol
  • Caspofungin
  • Carvedilol
  • Carbamazepine
  • Buspirone
  • Bosentan
  • Bexarotene
  • Betamethasone
  • Atorvastatin
  • Aripiprazole Lauroxil
  • Anisindione
  • Aminosalicylic Acid
  • Aliskiren
  • Acetyldigoxin

In addition to specific medications causing side effects and interactions when taken alongside Rifampin, isoniazid, and pyrazinamide, certain foods or non-prescribed drugs such as alcohol and tobacco can cause adverse effects and interactions to become more prevalent. Certain medications should not be taken at the time of eating food or consuming certain substances, while other drugs may require food to be taken for it to be effective.

Using rifampin, isoniazid, and pyrazinamide with the following food or item is usually not recommended, but can be potentially unavoidable in some cases. If used at the same time frequently, your doctor may be required to alter the dosage of your medication, or how often you use rifampin, isoniazid, and pyrazinamide. Your doctor may also give you specific instructions on the best way to use the below at the same time as your medications.

  • Ethanol

Using rifampin, isoniazid, and pyrazinamide with any of the below can cause an increased risk of side effects, but this interaction may be unavoidable in some cases. When used together often, you can discuss with your doctor changing the dose or frequency of rifampin, isoniazid, and pyrazinamide, or give you can give you special instructions about the use of food, alcohol, or tobacco in combination with your medication.

  • Cheshire cheese
  • Sardinella
  • Skipjack
  • Swiss cheese
  • Tuna
  • Tyramine-containing food

The presence of other or additional medical problems or conditions can affect the use and results of rifampin, isoniazid, and pyrazinamide. It is critical that your doctor has your full medical history and is completely aware of any medical conditions you have, or have had previously, especially:

  • Acute Gout
  • Acute or severe liver disease
  • History of alcohol abuse - this can increase the chance of the patient contracting hepatitis
  • History of diabetes
  • Porphyria

Warnings

Rifampin, isoniazid, and pyrazinamide hold an FDA pregnancy category of C, which indicates that based on animal studies, no adverse effects have been shown that affect an unborn child or the mother during pregnancy. However, it is essential to discuss with your doctor the possible risks and benefits of taking this medication during pregnancy, to make an informed decision about your medication.

For breastfeeding mothers, there are no adequate or formal studies determining if infant risk is a possibility when the mother is taking Rifampin, isoniazid, and pyrazinamide. Due to this, it is also important to discuss these risks with your doctor before choosing this medicine.

It is essential to inform a doctor of any and all unusual or allergic reactions to any medications, including Rifampin, isoniazid, and pyrazinamide. It is also critical that everyone involved in your medical care is fully informed of any other allergies you have, including but not limited to dyes, preservatives, animals and foods. Non-prescription products should also be checked before consumption to avoid any potential allergic reactions.

Comprehensive studies have also not yet been performed that examine the age of the patient to the effects of the medication combination when prescribed to children that are younger than 15 years of age. It is important that a parent or guardian understands all the benefits and risks of Rifampin, isoniazid, and pyrazinamide before prescription for a minor.

With isoniazid therapy, Severe and sometimes fatal hepatitis has been seen to occur. This condition can occur even post-treatment by many months. The related risk for hepatitis connected to isoniazid has been seen to increase with both advancing age and alcohol use or abuse. Due to this, it is important that clinical evaluation, liver function tests and any other suitable tests should be performed monthly, and therapy discontinued if any symptoms or signs develop. Patients who are undergoing treatment for tuberculosis with Rifampin, isoniazid, and pyrazinamide should be given alternative treatment with appropriate medication. If therapy is required to be reinstituted after resolution of symptoms relating to hepatitis, gradual and small dose increases should be used, and treatment should be paused immediately if any indication of recurrent liver involvement is present.

Rifampin, isoniazid, and pyrazinamide should not be prescribed as a course of treatment if you are receiving certain medicines to support the treatment of an HIV infection including but not limited to:

  • Aptivus®
  • Atazanavir
  • Darunavir
  • Fortovase®
  • Fosamprenavir
  • Invirase®
  • Lexiva®
  • Norvir®
  • Prezista®
  • Reyataz®
  • Ritonavir
  • Saquinavir
  • Tipranavir

Liver problems are also more likely to occur should you drink alcoholic beverages often and regularly during the time you are taking rifampin, isoniazid, and pyrazinamide. The persistent and regular use of alcohol can also keep rifampin, isoniazid, and pyrazinamide from performing correctly. Therefore, it is recommended that you should limit the amount of alcohol you drink during your medication.

It is important to notify a doctor of any of the below conditions, as they can be symptoms of a disease known as drug reaction with eosinophilia and systemic symptoms (DRESS), which can be severe:

  • Chills
  • Cough
  • Fever
  • Sore throat
  • Swollen, painful, or tender lymph glands in the neck, armpit, or groin
  • Yellow skin or eyes

Additionally, it is critical that your contact your doctor immediately should you find yourself sufferings from difficulty reading, blurred vision or any other visual issues or changes during or on the completion of your treatment. It may be required for you to visit an ophthalmologist - or eye doctor - for further examination.

Check with your doctor immediately if you find yourself having consistent and uncomfortable joint pain, stiffness, or swelling on the lower back, side, stomach, feet or lower legs, you may be experiencing symptoms of Acute Gout.

One of the known side effects of Rifampin, isoniazid, and pyrazinamide is patient's urine, saliva, stool, sweat, tears and sputum turning an orange or brown colour. This is a common and expected side effect of the medication. Also, this drug combination can cause soft contact lenses to become discoloured, so during your treatment wearing this kind of contact lens is not recommended, due to their porous nature. This condition will end at the point that you stop taking Rifampin, isoniazid, and pyrazinamide.

If you feel tired and weak, or if you're feeling unsteady and have increased clumsiness, you may be experiencing the symptoms of liver or nerve problems that can develop later. If in addition, you're suffering a loss of appetite, numbness, nausea or vomiting, it's essential to contact a medical professional immediately.

Rifampin, isoniazid, and pyrazinamide in combination may also cause a variety of blood problems. These issues may result in a higher chance of infections, slower healing, and bleeding from the gums. It is recommended to be careful when using any regular toothbrushes, as well as dental floss, and toothpicks. Any dental work should be delayed until a time at which your blood counts have returned to normal, normally after treatment has concluded. Confirm any queries you may have with your doctor or dentist while undergoing your treatment.

Before you take medical tests of any type, ensure the medical doctor in charge is aware that you are currently under treatment with or have taken at any point rifampin, isoniazid, and pyrazinamide. The results of specific tests can be affected by rifampin, isoniazid, and pyrazinamide.

Birth control pills and medications may not function correctly during the time that you are taking rifampin, isoniazid, and pyrazinamide. To avoid becoming pregnant during your treatment, it is recommended to use another alternative form of birth control alongside your birth control pills. Other types of contraception may include condoms, contraceptive foams or jellies, or diaphragms.

It is important not to take any other medications, prescribed or otherwise, unless they have been discussed with your doctor and approved for your use. Not complying with this can result in negative side effects or worsened illness. This can include but is not limited to both prescription or nonprescription (over-the-counter [OTC]) medications as well as herbal or vitamin supplements.

Storage

Rifampin, isoniazid, and pyrazinamide should be stored in the closed container it was dispensed in at room temperature, and away from all heat, moisture, and direct light. This medication should be kept from freezing temperatures.

It is important to store all medications out of the reach of children and pets at all times, to ensure safety.

Never keep outdated medicine, use medication past its used-by date, or keep medicine no longer needed. Discuss with a doctor the best way to dispose of unused medications.

Summary

Rifampin, isoniazid, and pyrazinamide is a combination medication comprised of three anti-infective drugs. This medication is used together for the treatment of tuberculosis or TB. This medicine can be taken either as the sole medical treatment in a treatment plan for TB or can be used in combination with other medications for effective treatment.

The US brand name of rifampin, isoniazid, and pyrazinamide is Rifater, and dosage of this medication is based on a variety of factors including body weight, with each prescription created according to requirement. This medicine is solely available from a doctor via prescription, and should only be used as directed by medical professionals.

 

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Last Reviewed:
January 31, 2018
Last Updated:
February 10, 2018
Content Source: