Decrease (-) Restore Default Increase (+)
Print    Email
Bookmark and Share

Health Information

Health Information

Health Information

Complementary and Alternative Medicine - Cam

Search Health Information    Isoniazid-Rifampin

Topic Contents

Isoniazid-Rifampin

Drug Information

Common brand names:

IsonaRif, Rifamate

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Vitamin B12

    Isoniazid may interfere with the activity of other nutrients, including vitamin B3 (niacin) , vitamin B12 , vitamin D , and vitamin E , folic acid , calcium , and magnesium .1 , 2 Supplementation with vitamin B6 is thought to help prevent isoniazid-induced niacin deficiency; however, small amounts of vitamin B6 (e.g. 10 mg per day) appear to be inadequate in some cases.3 People should consider using a daily multivitamin-mineral supplement during isoniazid therapy.

  • Vitamin B3

    Isoniazid is capable of causing vitamin B3 (niacin) deficiency, most likely due to its ability to interfere with cell-repair enzymes made from niacin. Significant niacin deficiency, also known as pellagra, features dermatitis, diarrhea , and dementia (impaired intellectual function). Supplementation with vitamin B6 is thought to reduce this risk, although small amounts (e.g. 10 mg daily) has been noted to be inadequate in some cases.4

  • Vitamin K

    Many antibiotics taken by mouth, including isoniazid, may kill friendly bacteria in the large intestine that produce vitamin K.5 Vitamin K1 (phylloquinone) is now found in some multivitamins .

  • Calcium

    Isoniazid may interfere with the activity of other nutrients, including vitamin B3 (niacin) , vitamin B12 , vitamin D , and vitamin E , folic acid , calcium , and magnesium .6 , 7 Supplementation with vitamin B6 is thought to help prevent isoniazid-induced niacin deficiency; however, small amounts of vitamin B6 (e.g. 10 mg per day) appear to be inadequate in some cases.8 People should consider using a daily multivitamin-mineral supplement during isoniazid therapy.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Folic Acid

    Isoniazid may interfere with the activity of other nutrients, including vitamin B3 (niacin) , vitamin B12 , vitamin D , and vitamin E , folic acid , calcium , and magnesium .9 , 10 Supplementation with vitamin B6 is thought to help prevent isoniazid-induced niacin deficiency; however, small amounts of vitamin B6 (e.g. 10 mg per day) appear to be inadequate in some cases.11 People should consider using a daily multivitamin-mineral supplement during isoniazid therapy.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Magnesium

    Isoniazid may interfere with the activity of other nutrients, including vitamin B3 (niacin) , vitamin B12 , vitamin D , and vitamin E , folic acid , calcium , and magnesium .12 , 13 Supplementation with vitamin B6 is thought to help prevent isoniazid-induced niacin deficiency; however, small amounts of vitamin B6 (e.g. 10 mg per day) appear to be inadequate in some cases.14 People should consider using a daily multivitamin-mineral supplement during isoniazid therapy.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin D

    Isoniazid may interfere with the activity of other nutrients, including vitamin B3 (niacin) , vitamin B12 , vitamin D , and vitamin E , folic acid , calcium , and magnesium .15 , 16 Supplementation with vitamin B6 is thought to help prevent isoniazid-induced niacin deficiency; however, small amounts of vitamin B6 (e.g. 10 mg per day) appear to be inadequate in some cases.17 People should consider using a daily multivitamin-mineral supplement during isoniazid therapy.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin E

    Isoniazid may interfere with the activity of other nutrients, including vitamin B3 (niacin) , vitamin B12 , vitamin D , and vitamin E , folic acid , calcium , and magnesium .18 , 19 Supplementation with vitamin B6 is thought to help prevent isoniazid-induced niacin deficiency; however, small amounts of vitamin B6 (e.g. 10 mg per day) appear to be inadequate in some cases.20 People should consider using a daily multivitamin-mineral supplement during isoniazid therapy.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

  • N-Acetyl Cysteine
    In patients being treated with a combination of drugs for tuberculosis (including isoniazid), supplementation with N-acetylcysteine (600 mg twice a day) reduced the amount of liver damage caused by the drugs21.
  • Picrorhiza

    Picrorhiza (Picrorhiza kurroa) is an herb from India with well-established anti-inflammatory and liver protective actions.23 Use of a combination formula known as Liv.100 that contains picrorhiza protected animal livers against damage caused by isoniazid and other antituberculosis antibiotics.24

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Support Medicine

  • Licorice

    The potent anti-inflammatory substance known as glycyrrhizin from licorice has been combined with isoniazid for treatment of tuberculosis. An older study found a benefit from combining the two compared to using isoniazid alone.25 Glycyrrhizin was given by injection, so it is not certain if licorice extracts containing glycyrrhizin would be as effective given by mouth. The treatment required at least three months of administration.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduces Effectiveness

  • none

Potential Negative Interaction

  • Foods with Histamines

    Isoniazid has some monoamine oxidase inhibitor (MAOI) activity.26 Isoniazid can alter metabolism of tyramine-containing foods, leading to reactions associated with MAOI drugs ( diarrhea , flushing, sweating, pounding chest, dangerous changes in blood pressure, and other symptoms).27 People taking isoniazid should avoid tyramine-containing foods. Isoniazid can also alter metabolism of histamine-containing foods, leading to headaches, sweating, pounding chest, flushing, diarrhea, low blood pressure, and itching.28 People taking isoniazid should avoid histamine-containing foods (such as tuna, sauerkraut juice, or yeast extract).

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Foods with Tyramine

    Isoniazid has some monoamine oxidase inhibitor (MAOI) activity.29 Isoniazid can alter metabolism of tyramine-containing foods, leading to reactions associated with MAOI drugs ( diarrhea , flushing, sweating, pounding chest, dangerous changes in blood pressure, and other symptoms).30 People taking isoniazid should avoid tyramine-containing foods. Isoniazid can also alter metabolism of histamine-containing foods, leading to headaches, sweating, pounding chest, flushing, diarrhea, low blood pressure, and itching.31 People taking isoniazid should avoid histamine-containing foods (such as tuna, sauerkraut juice, or yeast extract).

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required 

  • Vitamin B6

    Isoniazid can interfere with the activity of vitamin B6.32 Vitamin B6 supplementation is recommended, especially in people with poor nutritional status, to prevent development of isoniazid-induced peripheral neuritis (inflamed nerves).33 One case is reported in which injectable vitamin B6 reversed isoniazid-induced coma.34 In another case, however, 10 mg per day of vitamin B6 failed to reverse isoniazid-induced psychosis. The author suggested that higher amounts (e.g., 50 mg per day) may be needed.35 Although the optimal amount remains unknown, some doctors suggest that adults taking isoniazid supplement with 100 mg of vitamin B6 per day to prevent side effects. However, as animal studies suggest that very large amounts of vitamin B6 can interfere with the effect of isoniazid,36people taking isoniazid should consult their doctor to determine the appropriate amount of vitamin B6 to take.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

References

1. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 231–2 [review].

2. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 146–7.

3. Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced pellegra despite pyridoxine supplementation. Clin Exp Dermatol 1999;24:167–9.

4. Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced pellagra despite pyridoxine supplementation. Clin Exp Dermatol 1999;24:167–70.

5. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 147.

6. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 231–2 [review].

7. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 146–7.

8. Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced pellegra despite pyridoxine supplementation. Clin Exp Dermatol 1999;24:167–9.

9. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 231–2 [review].

10. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 146–7.

11. Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced pellegra despite pyridoxine supplementation. Clin Exp Dermatol 1999;24:167–9.

12. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 231–2 [review].

13. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 146–7.

14. Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced pellegra despite pyridoxine supplementation. Clin Exp Dermatol 1999;24:167–9.

15. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 231–2 [review].

16. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 146–7.

17. Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced pellegra despite pyridoxine supplementation. Clin Exp Dermatol 1999;24:167–9.

18. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 231–2 [review].

19. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 146–7.

20. Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced pellegra despite pyridoxine supplementation. Clin Exp Dermatol 1999;24:167–9.

21. REF:Baniasadi S, Eftekhari P, Tabarsi P, et al. Protective effect of N-acetylcysteine on antituberculosis drug-induced hepatotoxicity. Eur J Gastroenterol Hepatol 2010;22:1235-8.

22. Baniasadi S, Eftekhari P, Tabarsi P, et al. Protective effect of N-acetylcysteine on antituberculosis drug-induced hepatotoxicity. Eur J Gastroenterol Hepatol 2010;22:1235-8.

23. Floersheim GL, Bieri A, Koenig R, Pletscher A. Protection against Amanita phalloides by the iridoid glycoside mixture of Picrorhiza kurroa (kutkin). Agents Actions 1990;29:386–7.

24. Saraswathy SD, Shyamala Devi CS. Hepatoprotective effect of Liv.100, a polyherbal formulation, on mitochondrial enzymes in anti-tubercular drug-induced liver damage in rats. J Clin Biochem Nutr 1999;26:27–34.

25. Aoki K, Tokiwa T, Yamamoto T, Teramatsu T. Combined treatment of pulmonary tuberculosis with glycyrrhizin and INH. Acta Tubercul Japon 1963;13:32–9.

26. Threlkeld DS, ed. Systemic Anti-Infectives, Antituberculosis Drugs, Isoniazid. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1990, 382–5.

27. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 146.

28. Threlkeld DS, ed. Systemic Anti-Infectives, Antituberculosis Drugs, Isoniazid. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1990, 382–5.

29. Threlkeld DS, ed. Systemic Anti-Infectives, Antituberculosis Drugs, Isoniazid. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1990, 382–5.

30. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 146.

31. Threlkeld DS, ed. Systemic Anti-Infectives, Antituberculosis Drugs, Isoniazid. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1990, 382–5.

32. Goldman AL, Braman SS. Isoniazid: a review with emphasis on adverse effects. Chest 1972;62:71–7 [review].

33. Mandell GL, Petri WA Jr . Antimicrobial Agents: Drugs used in the chemotherapy of tuberculosis, Mycobacterium avium complex disease and leprosy. In Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 9th ed. New York: McGraw-Hill, 1996, 1158.

34. Brent J, Vo N, Kulig K, Rumack BH. Reversal of prolonged isoniazid-induced coma by pyridoxine. Arch Intern Med 1990;150:1751–3.

35. Chan TYK. Pyridoxine ineffective in isoniazid-induced psychosis. Ann Pharmacother 1999;33:1123–4 [letter].

36. McCune R, Deuschle K, McDermott W. The delayed appearance of isoniazid antagonism by pyridoxine in vivo. Am Rev Tuberculosis 1957;76:1100–5.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

© 2014 St. Mary's Health System   |  3700 Washington Avenue  |  Evansville, IN 47750  |  (812) 485-4000