Isoniazid

Isoniazid is the hydrazide of isonicotinic acid.Isoniazid is structurally similar to pyridoxine and introduced in 1952. It is the most active drug for the treatement of tuberculosis caused by susceptible strains used either alone or in combination with other drugs. It is prepared by chemical synthesis. It is available in combination with pyrazinamide, rifampicin, ethambutol, pyridoxine and cyanocobalamine.


Brands
RIMAZID RIMAZID AFRACIN AFRACIN AFRAZID AFRAZID AFRAZID-P RIFADOS RIMATOL RIMATOL RIMATOL-P ISOZIDE SYRUP RIMACTAL-INH RIMACTAL-INH RIFIN RIFIN RIFIN RIFIN-P RIFIN-P I.N.H. PANBUTOL RIMODIN PHAROZIDE MYRAZID MYRAZID NIAZID NIAZID RISO RISO RISO RISOMIDE RISOMIDE ERI-P ISONIAZID ISONIAZID ISONIAZID PYRATAR RIFA+FORT RIFA+PLUS CETAZID LEDERRIF-INH MYAMBUTOL-INH MYRIN MYRIN-P RIFAMPICIN+INH RIFAMPICIN+INH RAMBUZID TUBERIN TUBERIN-P POLYZIDE RIFAPIN-H RIFAPIN-H RIFAPIN-H RIFAPIN-H RIFATOL RIFAZOL PEDIATRIC SCHAZOBUTOL-H MYRAZID-P ISONIAZID ISONIAZID ISONIAZID TIBEX ETIBI INH I.N.H I.N.H I.N.H ISONIAZID NYDRAZIDE NYDRAZIDE NYDRAZIDE RIFATER RIFINAH RIFINAH RIFINAH TBRID RIFA 4 PLUS RIFAZOL+ SAMBUTOL-INH ISONIAZID FAIRZIDE ERI-PLUS CETAZID FORTE RIFAMATE-INH RIFAMATE-INH RIFAMATE-INH RIFINZID-4 RIFINZID FORTE WILBUTOL-H MYRIN-P FORTE TIBEX-P LISKOBUTOL-INH PHARBUTOL PLUS RIFIN FORTE RIMSTAR RIFEDOT-4 RIMCURE RIFAZID FORTE RIFAZID FORTE RIFAZID FORTE RIFAZID FORTE RIFAZID RIFAZID ACORET ACORET-P RIPNIZIDE RIPNIZIDE RIPNIZIDE TS ERI-P FORTE RIFA 4 UBUTOL+2 UBUTOL+2 UBUTOL+3 UBUTOL+3 THIACETAZONE I.N.H RIFASAL ISO CYREX ETHRIFIN CYREX-P ISOTHAM RIPE SONOREX SONOREX BUTAREX + INH ISONIAZIDE ISONIAZIDE ATD+1 ATD+2 ATD+3 ATD+4 RIFA + DS U-BUTOL+INH CAMBUTOL-INH ETHRIFID P AFRAZID INH AFRAZID INH TUBERCURE-P TUBER-HR MYCORID MYCORID P REMONIAZID ROMIZID ISOZIDE TABLET ISOZIDE TABLET ISOZIDE TABLET RISEN RISEN P RANBUTOL INH FORTE MYAMBUTOL INH FORTE TUBERWIN-P FORTE TUBERWIN-P FORTE RIMTHREE FDC RIFAZOL JUNIOR AMANTE-PF PIRE PIRE-P PIRE-R RIFAN TOLBUTAL PIRE+4 PIRE 3 PIRE 2 RIFIN-E RIMATOL FORTE P TUBERCURE INH TUBERCURE INH UBUTOL INH RIMKID STAND-INH RIN
Adult Dose
Dose: 300 mg
Single Dose: 300 (300)
Frequency: 24 hourly
Route: PO
Instructions: Give 30 min. before breakfast for 2 months.
Neonatal
Dose: 10 to 15 mg/kg
Single Dose: 12 (12.5)
Frequency: 24 hourly
Route: Intavenous
Instructions:
Paedriatic
Dose: 15 mg/kg
Single Dose: 15 (15)
Frequency: 24 hourly
Route: Intra Muscular
Instructions: Single Dose
Characteristics
Isoniazid also known as Isonicotic Acid Hydrazide, Isonicotic Acid Hydrazide, Isonicotic Acid Hydrazide. . It is of Synthetic origin and belongs to Hydrazine. It belongs to Antimycobacterial agent pharmacological group on the basis of mechanism of action and also classified in Antituberculous Drugs pharmacological group.The Molecular Weight of Isoniazid is 137.10. Its pKa is 1.8, 3.5, 9.5.
Contraindications
Isoniazid is contraindicated in conditions like Diabetes mellitus,Hypersensitivity,Seizures.
Effects
The severe or irreversible adverse effects of Isoniazid, which give rise to further complications include Hepatotoxicity, Pancreatitis, Lupus erythematosus, Peripheral neuropathy, Hepatotoxicity, Gynecomastia, Increase liver enzyme.Isoniazid produces potentially life-threatening effects which include Hepatitis. which are responsible for the discontinuation of Isoniazid therapy.The signs and symptoms that are produced after the acute overdosage of Isoniazid include Nausea, Vomiting, Tachycardia, Convulsions, Coma, Seizures, Urinary retention, Dizziness, Hyperreflexia, Slurred speech.The symptomatic adverse reactions produced by Isoniazid are more or less tolerable and if they become severe, they can be treated symptomatically, these include Nausea, Vomiting, Diarrhea, Fever, Skin rashes, Skin eruptions, Vasculitis, Skin eruptions, Skin rashes.
Indications
Isoniazid is primarily indicated in conditions like Acute leukemia, Mycobacterial infection, Prophylaxis of TB, Tuberculosis, Vestibular disorders, and can also be given in adjunctive therapy as an alternative drug of choice in Pulmonary TB.
Interactions
Isoniazid is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAlcoholAlcoholic patients show high INH-induced hepatotoxicity.ModerateCoadministration is considered as contraindicated and clinicians should aware of risk of hepatotoxicity.AlcoholAlprazolamAluminium Hydroxide and OxideBovine InsulinBromazepamCalciferolCarbamazepinePlasma concentration of Carbamazepine increased by Isoniazid also possibly increased isonizid hepatotoxicity by CYP450 3A4 inhibition.ModerateClose monitoring of hepatotoxicity and carbamazepine toxicity should be done and adjust carbamazepine dose.ChlorzoxazoneCycloserineIsoniazid enhances the adverse nervous system effects of Cycloserine.MinorClosely monitor the adverse nervous system effects.DiazepamDigitoxinDisulfiramCoadministration causes blockade of dopamine metabolism and results in excess dopaminergic activity.ModerateClosely monitored the altered mental status.Dose of disulfiram must be adjusted.EnfluraneMetabolite of isoniazid, hydrazine, facilitates the defluorination of enflurane results in increased level of inorganic fluoride in plasma leads to nephrotoxicity.ModerateClosely monitor the renal function prior to surgery.EstazolamEthionamide750 mg of ethionamide given with 10 mg /kg of Isoniazid will increase the serum concentration of Isoniazid EthosuximideEthosuximideFosphenytoinGestodeneHuman InsulinInsulin GlulisineIsoniazid, corticosteroids, niacin, diuretics, sympathomimetic agents (e.g., epinephrine, albuterol, terbutaline), phenothiazine derivatives, thyroid hormones, progestogens (e.g., in oral contraceptives), protease inhibitors, and atypical antipsychotics may reduce the blood-glucose-lowering effect.Isophane insulinKetoconazoleMagnesium Oxides and HydroxidesMetformin (HCl)Isoniazid decreases the hypoglycemic effect of metformin by interfering with blood glucose control.ModerateClosely monitor the blood glucose level. Adjust the dose of metformin accordingly.ParacetamolIsoniazid exacerbate the hepatotoxicity of acetaminophen by inducing its CYP450 2E1 metabolism results in toxic metabolites.ModerateCoadministration is considered contraindicated. Cmonitor the patient for hepatotoxicity. Aspirin is considered as safer alternative of paracetamol.ParoxetinePhenytoin (Na)Phenytoin (Na)PodophyllumThe risk of peripheral neuropathy may be increased during concurrent use of two or more agents that are associated with this adverse effect. In some cases, the neuropathy may progress or become irreversible despite discontinuation of the medications.ModerateCaution is advised during concomitant use of agents with neurotoxic effects. Patients should be monitored closely for symptoms of neuropathy such as burning, tingling, pain, or numbness in the hands and feet. Since the development of peripheral neuropathy may be dose-related for many drugs, the recommended dosages should generally not be exceeded.Porcine InsulinPrednisolone and Prednisoneisoniazid impair absorption of prednisolone and prednisonePrimidoneProthionamidePyrazinamidePyridoxinePyridoxine is used as an antidote of isoniazid.RifampicinRifampicinSalicylamideConcurrent use may increase the risk of side effects. SevofluraneStavudineTacrolimusTriazolamZalcitabineZalcitabineZiprasidoneLiver enzyme inhibitors (e.g isoniazid) decreases the metabolism of ziprasidone.Zolpidem (Tartrate) These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
False positive result of urine in diabetics using clinitest.
Risks
Drug should not be given to patients suffering from Kidney dysfunction, patients suffering from Liver Malfunction, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Oral Syrup, Inj Store at room temperature. Do not Freeze. Protect from Sunlight. Tab Store in a well closed container, Between 15°C-30°C. Protect from Sunlight and Moisture.
Warnings
Minimize alcohol consumption while taking isoniazid, because alcohol can reduce the effectiveness of this medication and increase side effect. It should be used with caution if patients have been treated for tuberculosis before, have kidney or liver problems, diabetes, history of alcohol use and of any drug allergy. Tyramine and histamine-containing foods may rarely interact with this medication, these foods include large amounts of fish, cheese, yeast extract or sausages. Consult the doctor or pharmacist immediately if patient suffer from flushing or a rapid heart beat. It should be used during pregnancy or lactation only if clearly needed.
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