isoniazid/pyrazinamide/rifampin

Generic Name: isoniazid, pyrazinamide, and rifampin (EYE soe NYE a zid, PIR a ZIN a mide, and rif AM pin)

Brand Names: Rifater

What is isoniazid, pyrazinamide, and rifampin?

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

The combination of isoniazid, pyrazinamide, and rifampin is used to treat tuberculosis (TB).

Isoniazid, pyrazinamide, and rifampin may also be used for other purposes not listed in this medication guide.

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

Take this medication for the full prescribed length of time. Your symptoms may get better before your infection is completely cleared. Isoniazid, pyrazinamide, and rifampin will not treat a viral infection such as the common cold or flu. Avoid drinking alcohol while taking isoniazid, pyrazinamide, and rifampin. Alcohol may increase your risk of liver damage. Isoniazid, pyrazinamide, and rifampin can make birth control pills less effective. Ask your doctor about using a different method of birth control while taking isoniazid, pyrazinamide, and rifampin. Avoid foods that are high in tyramine, listed in the "What should I avoid while taking isoniazid, pyrazinamide, and rifampin?" section of this leaflet. Tyramine can interact with this medication and cause unpleasant side effects.

What should I discuss with my healthcare provider before taking isoniazid, pyrazinamide, and rifampin?

You should not use this medication if you are allergic to isoniazid, pyrazinamide, or rifampin (Rifamate, Rifadin, Rimactane), or if you have:

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  severe liver disease;

  
  


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  active gout; or

  
  


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  if you have ever had drug fever, chills, and arthritis caused by taking this medication.

  
  

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use isoniazid, pyrazinamide, and rifampin:

• kidney disease;


• liver disease;


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  HIV;

  
  


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  porphyria;

  
  


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  gout;

  
  


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  diabetes; or

  
  


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  if you drink alcohol daily.

  
  

FDA pregnancy category C. It is not known whether isoniazid, pyrazinamide, and rifampin is harmful to an unborn baby. Before taking this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. Isoniazid, pyrazinamide, and rifampin can make birth control pills less effective. Ask your doctor about using a different method of birth control to prevent pregnancy while taking isoniazid, pyrazinamide, and rifampin. Isoniazid, pyrazinamide, and rifampin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take isoniazid, pyrazinamide, and rifampin?

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Take this medicine with a full glass (8 ounces) of water. Take isoniazid, pyrazinamide, and rifampin on an empty stomach, at least 1 hour before or 2 hours after a meal. Take this medication for the full prescribed length of time. Your symptoms may get better before your infection is completely cleared. Isoniazid, pyrazinamide, and rifampin will not treat a viral infection such as the common cold or flu.

To be sure this medication is not causing harmful effects, your liver function will need to be checked with blood tests on a regular basis. You may also need routine eye exams during treatment. Do not miss any follow-up visits to your doctor.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are taking isoniazid, pyrazinamide, and rifampin.

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

See also: Isoniazid/pyrazinamide/rifampin dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include nausea, vomiting, slurred speech, hallucinations, and seizure.

What should I avoid while taking isoniazid, pyrazinamide, and rifampin?

Avoid drinking alcohol while taking isoniazid, pyrazinamide, and rifampin. Alcohol may increase your risk of liver damage.

If you take an antacid, avoid taking it within 1 hour after you have taken isoniazid, pyrazinamide, and rifampin. Antacids can make it harder for your body to absorb rifampin.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, stop taking this medication and call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Certain foods can interact with isoniazid, pyrazinamide, and rifampin, causing unpleasant side effects. Avoid foods that are high in tyramine, including:

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  avocados, bananas, figs, raisins, and sauerkraut;

  
  


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

  
  


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

  
  


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  caffeine (including coffee, tea, cola); and

  
  


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  cheeses, including American, blue, boursault, brick, brie, camembert, cheddar, emmenthaler, gruyere, mozzarella, parmesan, romano, roquefort, stilton, and Swiss;

  
  


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  chocolate;

  
  


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  ginseng;

  
  


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  sour cream and yogurt;

  
  


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  soy sauce, miso soup, bean curd, fava beans; or

  
  


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  yeast extracts.

  
  

Do not wear soft contact lenses while taking isoniazid, pyrazinamide, and rifampin. This medicine may turn certain body fluids a red color (including tears, saliva, urine, and sweat). While this is a harmless side effect, it may permanently stain contact lenses.

Isoniazid, pyrazinamide, and rifampin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Isoniazid, pyrazinamide, and rifampin can cause severe liver symptoms. Stop taking this medication and call your doctor at once if you have any of these liver symptoms:

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  low fever;

  
  


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  nausea, stomach pain, loss of appetite;

  
  


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  dark urine, clay-colored stools; or

  
  


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  jaundice (yellowing of the skin or eyes).

  
  

Call your doctor at once if you have any other serious side effects such as:

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  fever, chills, body aches, flu symptoms, weakness, sores in your mouth and throat;

  
  


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  pale skin, easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  
  


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  feeling short of breath, feeling like you might pass out;

  
  


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  cough, chest pain or tightness;

  
  


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  diarrhea that is watery or bloody;

  
  


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  vision problems;

  
  


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  urinating less than usual or not at all; or

  
  


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  drowsiness, mood changes, increased thirst, swelling, weight gain.

  
  

Less serious side effects may include:

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  mild stomach pain, heartburn, diarrhea;

  
  


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  mild rash or itching;

  
  


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  muscle or joint pain;

  
  


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  drowsiness, dizziness, spinning sensation;

  
  


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  ringing in your ears; or

  
  


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  numbness or tingling in your legs.

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Isoniazid/pyrazinamide/rifampin Dosing Information

Usual Adult Dose for Tuberculosis -- Active:

44 kg or less: 4 tablets (200 mg isoniazid, 1200 mg pyrazinamide, and 480 mg rifampin total dose) orally once a day
45 to 54 kg: 5 tablets (250 mg isoniazid, 1500 mg pyrazinamide, and 600 mg rifampin total dose) orally once a day
55 kg or more: 6 tablets (300 mg isoniazid, 1800 mg pyrazinamide, and 720 mg rifampin total dose) orally once a day

Usual Pediatric Dose for Tuberculosis -- Active:

14 years or younger: The ratio of isoniazid, pyrazinamide, and rifampin in the combination tablet may not be appropriate; for example, isoniazid mg/kg doses are typically higher in pediatric patients than adults.

15 years or older:
44 kg or less: 4 tablets (200 mg isoniazid, 1200 mg pyrazinamide, and 480 mg rifampin total dose) orally once a day
45 to 54 kg: 5 tablets (250 mg isoniazid, 1500 mg pyrazinamide, and 600 mg rifampin total dose) orally once a day
55 kg or more: 6 tablets (300 mg isoniazid, 1800 mg pyrazinamide, and 720 mg rifampin total dose) orally once a day

What other drugs will affect isoniazid, pyrazinamide, and rifampin?

Many drugs can interact with isoniazid, pyrazinamide, and rifampin. Below is just a partial list. Tell your doctor if you are using:

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  cyclosporine (Gengraf, Neoral, Sandimmune);

  
  


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  haloperidol (Haldol);

  
  


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  nortriptyline (Pamelor),

  
  


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  probenecid (Benemid);

  
  


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  theophylline (Elixophyllin, Theo-24, Uniphyl);

  
  


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  an antibiotic such as ciprofloxacin (Cipro), clarithromycin (Biaxin), dapsone, erythromycin (E.E.S., Erythrocin, Ery-Tab), and others;

  
  


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  antifungal medication such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral);

  
  


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  a barbiturate such as butabarbital (Butisol), secobarbital (Seconal), pentobarbital (Nembutal), or phenobarbital (Solfoton);

  
  


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  birth control pills or hormone replacement therapy;

  
  


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  a blood thinner such as warfarin (Coumadin);

  
  


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  diabetes medications you take by mouth;

  
  


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  heart or blood pressure medication such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), digoxin (Lanoxin), diltiazem (Cartia, Cardizem), metoprolol (Toprol), propranolol (Inderal), nifedipine (Procardia), verapamil (Covera, Isoptin, Verelan), and others;

  
  


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  heart rhythm medication such as disopyramide (Norpace), mexiletine (Mexitil), quinidine (Quinaglute, Quinidex, Quin-Release);

  
  


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  narcotic medications such as buprenorphine (Buprenex, Subutex), fentanyl (Actiq, Duragesic, Fentora), methadone (Dolophine, Methadose);

  
  


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  a sedative such as diazepam (Valium);

  
  


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  seizure medication such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), primidone (Mysoline), valproic acid (Depakene);

  
  


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  a steroid such as prednisolone; or

  
  


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  a sulfa drug (Cotrim, Bactrim, Septra, SMX-TMP, and others).

  
  

There are many other medicines that can interact with isoniazid, pyrazinamide, and rifampin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

More isoniazid/pyrazinamide/rifampin resources

• Isoniazid/pyrazinamide/rifampin Side Effects (in more detail)
• Isoniazid/pyrazinamide/rifampin Dosage
• Isoniazid/pyrazinamide/rifampin Use in Pregnancy & Breastfeeding
• Isoniazid/pyrazinamide/rifampin Drug Interactions
• Isoniazid/pyrazinamide/rifampin Support Group
• 0 Reviews for Isoniazid/pyrazinamide/rifampin - Add your own review/rating

• Isoniazid/Pyrazinamide/Rifampin MedFacts Consumer Leaflet (Wolters Kluwer)


• Rifater Prescribing Information (FDA)


• Rifater Advanced Consumer (Micromedex) - Includes Dosage Information

Compare isoniazid/pyrazinamide/rifampin with other medications

• Tuberculosis, Active

Where can I get more information?

• Your pharmacist can provide more information about isoniazid, pyrazinamide, and rifampin.

See also: isoniazid/pyrazinamide/rifampin side effects (in more detail)