Isoniazid + Rifampicin

When ATH:
J04AM02

Characteristic.

Anti-tuberculosis combined tool.

Pharmacological action.
Antiphthisic, Antibacterial.

Application.

Tuberculosis (all forms).

Contraindications.

Hypersensitivity, hepatic failure, pregnancy (I trimester), lactation, childhood (to 12 лет и с массой тела менее 45 kg).

Restrictions apply.

Pregnancy (II–III trimesters), chronic renal failure, liver disease (incl. history), Saint Martin's evil, elderly and debilitated patients.

Side effects.

From the nervous system and sensory organs: headache, dizziness, ataxia, disorientation, reduced visual acuity; rarely — excessive fatigue or weakness, irritability, euphoria, insomnia, paraesthesia, numbness, optic neuritis, polyneuropathy, psychosis, mood lability, depression; in patients with epilepsy may be more frequent seizures.

Cardio-vascular system and blood (hematopoiesis, hemostasis): heartbeat, angina, increased blood pressure, очень редко — склонность к кровотечениям и кровоизлияниям; leukopenia.

From the digestive tract: nausea, vomiting, gastralgia, diarrhea, decreased appetite, erosive gastritis, pseudomembranous enterocolitis, increase in liver transaminases, giperʙiliruʙinemija, hepatitis, incl. toxic hepatitis.

With the genitourinary system: nefronekroz, interstitial nephritis; very rarely ginekomastia, menorragija, dysmenorrhoea.

Allergic reactions: skin rash, itch, hives, eozinofilija, hyperthermia, arthralgia, bronchospasm, angioedema.

Other: очень редко — индукция порфирии, myasthenia, hyperuricemia, worsening of gout.

When taking an irregular or resumption of treatment after interruption possible flu-like symptoms (fever, chills, headache, dizziness, myalgia), skin reactions, gemoliticheskaya anemia, trombotsitopenicheskaya purpura, acute renal failure.

Cooperation.

Совместим с противотуберкулезными ЛС, кроме циклосерина, the likelihood of side effects is reduced when combined with pyridoxine and glutamic acid. Reduces the effects of oral anticoagulants, oral hypoglycemic drugs, hormonal contraceptives, Digitalis preparations, dizopiramida, xinidina, glюkokortikoidov (rifampicin is an inducer of liver microsomal enzymes). Rifampin alters the elimination parameters of bromsulfalein. Isoniazid increases phenytoin concentrations.

Overdose.

Isoniazid. Symptoms: dizziness, dysarthria, slackness, disorientation, hyperreflexia, peripheral polyneuropathy, abnormal liver function, metabolic acidosis, giperglikemiâ, glycosuria, ketonwrïya, convulsions (1-3 hours after treatment), coma.

Treatment: peripheral polyneuropathy (B vitamins₆, B₁, B₁₂, ATP, glutamic acid, nicotinamide, massage, physiotherapy); convulsions (IM vitamin B₆ - 200-250 mg, I / 40% solution of dextrose — 20 ml, / m 25% a solution of magnesium sulfate — 10 ml, diazepam); abnormal liver function (methionine, thioctic acid, ATP, vitamin B₁₂).

Rifampicin. Symptoms: pulmonary edema, lethargy, confusion, convulsions.

Treatment: simptomaticheskaya therapy, gastric lavage, appointment of activated carbon, diurez.

Dosing and Administration.

Inside, by 1 table/day, throughout the course of short-term chemotherapy. Adults weighing less than 50 kg - 450 mg (in terms of isoniazid), with a mass of more than 50 kg - as much as possible to 600 mg. Children - 10–15 mg/day. In case of chronic renal failure - 8 mg / kg (in terms of rifampicin).

Precautions.

Severe and sometimes fatal hepatitis, associated with isoniazid therapy, It may develop even after many months of treatment. The risk of hepatitis depends on the age; sampling frequency: 0/1000 People under the age of 20 years, 3/1000 in the age group 20-34 years, 12/1000 in the age group 35-49 years, 23/1000 in the age group 50-64 years, 8/1000 the age 65 years. The risk of hepatitis is increased with daily alcohol consumption. Precise data on the percentage of fatalities in the isoniazid-induced hepatitis is not, but, According to U.S. Public Health Service Surveillance Study (PDR, 2005), among 13838 patients, poluchavshikh isoniazid, It was recorded 8 deaths from 174 cases of hepatitis. Therefore patients, poluchayushikh isoniazid, should be carefully examined on a monthly basis. Increased serum transaminases observed in approximately 10-20% of patients, usually within the first few months of treatment. Despite continued therapy, parameters return to normal, but in some cases developed progressive liver dysfunction. Patients should be instructed to contact their physician immediately if they experience any of the prodromal symptoms of hepatitis - fatigue, weakness, malaise, anorexia, nausea or vomiting. If symptoms and signs of liver dysfunction are detected (incl. increase in liver transaminases), drug immediately overturned, tk. while continuing to receive perhaps more serious liver damage.

With long-term use, systematic monitoring of liver function is indicated. (at least 1 once a month), peripheral blood, observation by an ophthalmologist. If persistent liver dysfunction develops, treatment is interrupted and resumed after complete normalization of clinical and laboratory parameters from low initial doses, with gradual increase.

Rifampicin okrashivaet a shell, sputum, sweat, mud, lacrimal fluid, urine, as well as soft contact lenses in orange-red color.

The treatment should not apply bromsulfaleinovyj test (false positive results are possible) and microbiological methods for determining the concentration of folic acid and vitamin B₁₂ serum. You should avoid drinking ethanol.