Rifampicin+Isoniazid

Uses	Treatment of Tuberculosis
Therapy	Anti-Tubercular
Side Effects	Nausea, vomiting, abdominal pain, itching, headache, drowsiness, giddiness, fatigue, discolouration of urine/ secretions/ faeces, liver dysfunction, kidney dysfunction, visual changes, peripheral nerve disorders.

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Molecule Description

Rifampicin+Isoniazid contains two active medicines, Rifampicin and Isoniazid. It is a combination of two antibiotics that are used to manage tuberculosis.

Uses

Management of tuberculosis

Contraindications

When should one not use Rifampicin+Isoniazid

Patients who are hypersensitive to rifampicin, isoniazid or any of the other contents of this medicine.
It is contraindicated in persons with liver disease or jaundice.
Pregnancy
Patients having tingling, numbness, or any signs of peripheral nerve damage (neuropathy)

Side effects

Common side effects of this drug are:

Headache
Nausea
Skin rashes with or without itching
Urticaria (a skin condition with elevated red lesions on the skin)
Vomiting
Dizziness
Orange-red colour urine

Precautions and Warnings

Pregnancy

This medication is unsafe during pregnancy. Its use can result in bleeding in the infant after delivery. Inform your doctor regarding your pregnancy or intention to conceive at the time of prescription of Rifampicin+Isoniazid.

Breast Feeding

This medication is unsafe during breastfeeding as it can be transferred to the infant via breast milk. Inform your doctor if you are breastfeeding at the time of prescription of Rifampicin+Isoniazid.

Driving

Isoniazid has been associated with vertigo, visual disorders and psychotic reactions. It is not advisable to drive or operate any other heavy machinery when using this medication

Alcohol

It is not advisable to drink alcohol when using this medication as it can result in severe side effects. Daily consumption of alcohol with Rifampicin+Isoniazid also increases the chances of liver damage.

Other General Warnings

Talk to your doctor if

Both Rifampicin and Isoniazid cause liver dysfunction, so consult your physician before use in liver disease
Rifampicin may produce a discolouration (yellow, orange, red, brown) of the teeth, urine, sweat, sputum and tears.
You are an intravenous substance user. Use with caution.
You have kidney disease. Use with caution.

Mode of Action

How Does It Work?

Rifampicin works by blocking a bacterial enzyme called RNA Polymerase. This enzyme is needed for the bacteria to grow and divide. It is also needed to produce proteins that are essential for survival. Hence the inactivation of this enzyme kills the bacteria. Isoniazid works by blocking the production of mycolic acid, an essential part of the bacterial cell wall.

Interactions

Interactions with other medicines

Rifampicin is a potent inducer of a particular enzyme system involved in the metabolism of other medications. Dose adjustment may be needed in case of chronic use of any medications. For example, painkillers such as morphine.
Antacids (used in case of heartburn or stomach ulcers to reduce acid production) reduce the amount of rifampicin and isoniazid absorbed from the gut to the bloodstream. These include omeprazole, pantoprazole, etc.
Corticosteroids can reduce the plasma levels of isoniazid as they increase its metabolism and excretion.
There are increased chances of toxicity due to high doses of paracetamol in patients taking Rifampicin+Isoniazid.
Rifampicin+Isoniazid affects the blood levels of medications used in the treatment of seizures (fits), such as carbamazepine and phenytoin. The dose of these medicines has to be adjusted accordingly.
It reduces the efficacy of ketoconazole, an antifungal medication.

Interactions with food items

The content of isoniazid interacts with certain types of wine and cheese due to a high level of tyramine content in them.
Also avoid foods rich in histamine, such as tuna. Taking these foods with the medicine can result in flushing (redness of skin), reduced blood pressure, headache, and sweating.

Dosage

Overdose

An accidental or suspected overdose may present with symptoms including nausea, vomiting, dizziness, itching, severe stomach ache, breathing difficulties, delirium (confusion, deranged attention), and can progress to loss of consciousness or even death. It is advisable to rush the patient to the nearest hospital for emergency care.

Missed a Dose

If you miss a dose of this medicine, it is advised to take it as soon as possible. If the duration missed is too long, and it is almost time for the next dose, it is recommended to skip the missed dose. Do not double the dose of the medicine. The medicine needs to be taken daily as prescribed to ensure disease clearance.

Frequently Asked Questions (FAQs)

No, this medicine is only used for the treatment of cough due to tuberculosis. Please visit a doctor to find the cause of the cough and start the appropriate treatment

Always consult your doctor in the case of any side effects or problems during treatment for tuberculosis. Certain blood tests and dose adjustments may be required.

Nausea is a common side effect of Rifampicin+Isoniazid. Consult your doctor to understand what is the best way to manage it

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References:

Isoniazid Tablets, USP.

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