Health Library

Rifampin/isoniazid/pyrazinamide (By mouth)

Isoniazid (eye-soe-NYE-a-zid), Pyrazinamide (pir-a-ZIN-a-mide), Rifampin (rif-AM-pin)

Treats tuberculosis (TB). This medicine is an antibiotic.

Brand Name(s):

When This Medicine Should Not Be Used:

How to Use This Medicine:

Tablet

• Your doctor will tell you how much medicine to use. Do not use more than directed.
• Take this medicine on an empty stomach, 1 hour before or 2 hours after a meal, and with a full glass of water. It is important to take this medicine on a regular schedule.
• Take all of the medicine in your prescription to clear up your infection, even if you feel better after the first few doses.
• Your doctor may also want you to take pyridoxine (vitamin B6) every day to help prevent or lessen some of the side effects of isoniazid.
• Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Do not use this medicine if you also take lurasidone or medicine to treat HIV/AIDS, including atazanavir, darunavir, fosamprenavir, ritonavir, ritonavir-boosted saquinavir, saquinavir, or tipranavir.
• Do not use this medicine together with praziquantel. If you need to take praziquantel, you should stop using this medicine 4 weeks before starting praziquantel. You may restart this medicine one day after the last dose of praziquantel.
• Some foods and medicines can affect how rifampin/isoniazid/pyrazinamide work. Tell your doctor if you are using any of the following:
  • Atovaquone, clofibrate, clopidogrel, cycloserine, cyclosporine, diazepam, digitoxin, disulfiram, efavirenz, haloperidol, indinavir, irinotecan, levodopa, levothyroxine, meperidine, methadone, mifepristone, para-aminosalicylic acid, probenecid, quinine, simvastatin, tacrolimus, tamoxifen, theophylline, ticagrelor, toremifene, zidovudine, zolpidem, zopiclone
  • Birth control pills
  • Blood pressure medicine (including beta blockers, calcium channel blockers)
  • Blood thinner (including warfarin)
  • Medicine for heart rhythm problems (including disopyramide, mexiletine, propafenone, quinidine, tocainide)
  • Medicine for hepatitis C (including daclatasvir, simeprevir, telaprevir)
  • Medicine for seizures (including carbamazepine, phenytoin, primidone, valproic acid)
  • Medicine to treat depression (including SSRIs, TCAs)
  • Medicine to treat an infection (including cefazolin, chloramphenicol, ciprofloxacin, clarithromycin, cotrimoxazole, dapsone, doxycycline, fluconazole, itraconazole, ketoconazole, moxifloxacin, pefloxacin, telithromycin)
  • Narcotic pain reliever (including morphine, oxycodone)
  • Oral diabetes medicine (including glipizide, glyburide, rosiglitazone)
  • Steroid medicine (including prednisolone)
• If you use an antacid, take it at least 1 hour after you take rifampin/isoniazid/pyrazinamide.
• If you are taking itraconazole, do not use this medicine 2 weeks before and during itraconazole treatment.
• Avoid foods and drinks that are high in tyramine, because your blood pressure could get dangerously high. Your doctor should give you a complete list. In general, do not eat anything aged or fermented, such as most cheese, most alcohol, cured meat (such as salami), sauerkraut, and soy sauce. Check the expiration dates on packages. Tyramine levels get higher as food gets older or if it has not been refrigerated properly.
• Avoid eating certain types of fish, including tuna and skipjack, while you are using this medicine.
• Do not drink alcohol while you are using this medicine.

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, adrenal gland problem, blood clotting problems, diabetes, vitamin K deficiency, or porphyria (an enzyme problem). Tell your doctor if you drink alcohol.
• This medicine may cause the following problems:
  • Liver problems
  • Serious skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms (DRESS)
  • Eye or vision problems
  • Bleeding problems
  • Lung or breathing problems (including interstitial lung disease, pneumonitis, pneumonia, respiratory failure, pulmonary fibrosis, acute respiratory distress syndrome)
  • Increased levels of uric acid, which causes symptoms of gout
  • Thrombotic microangiopathy (damage in the smallest blood vessels), including hemolytic uremic syndrome and thrombotic thrombocytopenic purpura
• This medicine may turn your urine, saliva, sweat, teeth, and tears yellow, orange, red, or brown. This is normal. This side effect could also stain contact lenses.
• This medicine may make you bleed, bruise, or get infections more easily. Take precautions to prevent illness and injury. Wash your hands often.
• Call your doctor if your symptoms do not improve or if they get worse.
• Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, red skin rash
• Blurred vision
• Chest pain, dry cough, muscle aches, night sweats, unusual tiredness
• Dark urine or pale stools, nausea, vomiting, loss of appetite, stomach pain, yellow skin or eyes
• Fever, chills, cough, sore throat, body aches
• Joint pain or swelling
• Numbness, tingling, or burning pain in your hands, arms, legs, or feet
• Trouble breathing, coughing up blood, nosebleed
• Unusual bleeding, bruising, or weakness

If you notice these less serious side effects, talk with your doctor:

• Headache, dizziness
• Mild nausea, vomiting, diarrhea, or stomach pain

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Last Updated: 9/6/2024