Let's learn about the medicine capsules used to treat tuberculosis (Isoniazid; Rifampin)

Your doctor may have told you that you may have tuberculosis (TB). One of the special pills used to treat this is called `Isoniazid; Rifampin`. Simply put, this is an `Antibiotic` that kills the tuberculosis germs. But remember, it will not cure viral illnesses like the common cold or flu.

What are the things you need to tell your doctor before using this medicine?

Before you start taking this medicine, it is very important to give your doctor a clear picture of your health. Because some conditions may change the way you use this medicine, or you may need to be especially careful. Be sure to tell your doctor if you have any of the following:

• Diabetes Mellitus: If your blood sugar levels are high.
• Gout : A condition in which the joints become swollen and painful due to an increase in uric acid.
• HIV or AIDS conditions: These are conditions that affect the immune system.
• If you are a regular drinker: Combining alcohol with this medication can be harmful to the liver.
• Kidney disease: If the kidneys are not working properly.
• Liver disease: If there is any problem with the liver.
• Poor nutrition: This means you are not getting the nutrients you need.
• Nerve disorder such as numbness in the fingertips: If you have numbness in the limbs, or other nerve-related problems.
• If you wear contact lenses: This medication may require you to switch to glasses. Talk to your doctor about this.
• If you have previously had an allergic reaction to this medicine (Isoniazid, Rifampin), or to another medicine, food, or dye, such as ``Rifabutin''.
• If you are pregnant or trying to get pregnant.
• If you are a breastfeeding mother.

By telling your doctor these things, he can plan the treatment that best suits you.

How exactly do you use this medicine?

It is very important to use this medicine correctly for a speedy recovery . You need to take it at the right time, in the right amount, as the doctor says.

• You should take it by mouth: Swallow the medicine with a glass of water.
• Take it at the same time every day: It's best to take your medication at the same time every day, exactly as your doctor has prescribed.
• Take on an empty stomach: This is the most important thing. You should take this medicine at least an hour before or two hours after eating. That's when the medicine will be absorbed properly. For example, if you eat at 8 am, take the medicine before 7 am or after 10 am.
• Use it for the prescribed period: You must take this medicine until the doctor says, "Enough, stop." Even if you feel better after a few days, do not stop taking it . If you do, the tuberculosis germ will not be completely eliminated, the disease may worsen again, and the germ may even change to become resistant to the medicine. That is dangerous.
• If you are taking antacids: If you are taking antacids for heartburn or gastritis, do not take them at the same time as this TB medicine. It is best to take antacids at least one hour after taking the TB medicine.
• If given to children: Doctors prescribe this medicine to children over 15 years of age in some special cases. But there are some things to be careful about. Therefore, if you are giving this medicine to a child, talk to your doctor carefully and get advice.
• Overdose: If you think you have taken too much medication, go to the nearest hospital emergency department immediately, or call a poison control center.
• This medicine is for you only: The doctor has prescribed this medicine for you only. Do not give your medicine to anyone else, even if they have the same illness as you.

Remember, tuberculosis is not a disease to be trifled with. Therefore, it is important for life to take the medicine exactly as the doctor says, for the prescribed period of time!

What to do if you miss a dose of medication?

Oh, it can happen. Everyone forgets. Take your medicine as soon as you remember. However, if it is almost time for your next dose (for example, within a few hours), skip the missed dose and take your next dose at the scheduled time. Never take two doses at once, or take more than the recommended dose. Doing so can cause side effects.

What other medications should not be used with this medicine, or should I be careful with?

This is also a very important point. Some medications can cause problems when combined with `Isoniazid; Rifampin`. It is not good to take this with some medications at all . Some such medications are:

• `Artemether; lumefantrine` (a medicine for malaria)
• `Atomoxetine`
• Some antiviral drugs for HIV or hepatitis
• `Elagolix`
• `Idelalisib`
• `Isavuconazonium`
• `Lonafarnib`
• `Lorlatinib`
• `Lurasidone`
• `Praziquantel`
• `Ranolazine`
• `Voriconazole`

There may be other medications not on this list. Therefore, when you start this TB medication, you should tell your doctor about all the medications you are currently taking (prescribed by your doctor, purchased from the pharmacy, traditional medicines, vitamins, everything).

Also, there are other medications that you should be very careful about taking with this tuberculosis medication. Here are a few examples:

• Acetaminophen (Paracetamol)
• Antacids (take them at a later time as mentioned earlier)
• Some medications for blood pressure, heart disease, and heart rhythm disorders
• Some medications for depression, anxiety, or psychosis
• Some medications for diabetes (e.g. glipizide, glyburide)
• Some medications for fungal infections (e.g., fluconazole, itraconazole)
• Some medications used to treat seizures (e.g. carbamazepine, phenytoin)
• Some medications that help you sleep
• Medicines that prevent blood clotting (e.g. warfarin)
• Types of hormones, including birth control pills
• Steroid-type medications (e.g., prednisolone)

This list is not complete. Tell your doctor about any other medications, herbs, vitamins, or supplements you are taking, as well as if you smoke, drink alcohol, or use other drugs. Some things can interact with this medicine.

What should you be careful about when taking this medicine?

It's a good idea to pay attention to changes in your body while taking the medication.

• If symptoms do not improve or worsen: If you feel that your symptoms are not improving despite taking medication, or are getting worse, tell your doctor immediately.
• Diarrhea: If you have diarrhea for more than two days, or if your stool is very watery, do not take over-the-counter medications. Talk to your doctor immediately.
• Serious skin reactions: This is something to be concerned about. These can happen weeks or months after starting the medication. If you develop a rash with a fever, if the rash turns red or purple and then blisters and the skin peels off, or if you develop a red rash with swollen lymph nodes on your face, lips, neck, or armpits, you should tell your doctor right away.
• Blood work: Your doctor will order several blood tests to check your blood levels while you are taking this medication. Be sure to get them done.
• Vision changes: Your vision may be checked before you start taking the medication and while you are taking it. If you notice any changes in your vision (such as blurred vision, loss of clarity), tell your doctor right away.
• Birth control: If you are using birth control pills, they may not work as well while taking this medication. Therefore, talk to your doctor about using an additional form of birth control.
• Vitamin B6 and Vitamin D: While taking this medicine, you need to make sure that you are getting enough Vitamin B6 and Vitamin D. Talk to your doctor about the foods and vitamins you are taking. Your doctor may also recommend that you take these vitamins in addition.

What are the possible side effects of this medicine?

Like any medicine, this one can cause side effects in some people. But not everyone will. Some of them are serious and you should tell your doctor right away. Some of them are normal and will go away in a few days.

Side effects that you should tell your doctor about immediately:

• Allergic reactions: Skin rash, itching, hives, swelling of the face, lips, tongue, and throat.
• Bleeding: Black, tarry stools, vomiting coffee grounds, red or dark brown urine, small red/purple spots on the skin, easy bruising or bleeding.
• Liver injury: Pain in the upper right side of the abdomen, loss of appetite, nausea, light-colored stools, dark yellow/brown urine, yellowing of the eyes/skin, extreme fatigue.
• Rash, fever, and swollen lymph nodes.
• Redness, blistering, peeling, and peeling of the skin (even in areas where saliva is swallowed).
• Severe diarrhea, fever.
• Difficulty breathing.
• A condition called TTP (Thrombotic Thrombocytopenic Purpura): purple spots on the skin or inside the mouth, pale skin, yellowing of the eyes/skin, extreme fatigue, fever, fast or irregular heartbeat, confusion, vision changes, difficulty speaking/walking.

If you see something like this , see a doctor without delay.

Side effects that are usually not a big deal, but if they persist, you should tell your doctor :

• Change in the color of bodily fluids like urine, saliva, and sweat (it may be orange-red, which is normal, don't worry).
• Confusion.
• Dizziness.
• Drowsiness.
• Fatigue.
• Gas in the stomach.
• Headache .
• Heartburn.
• Loss of appetite.
• Nausea.
• Pain, numbness, or tingling in the limbs.
• Vomiting.

If these things continue, or if they bother you, tell your doctor.

How do you store the medicine properly? How do you dispose of it if it gets old?

It is also important to store your medication properly.

• Keep out of reach of children and pets.
• Store at room temperature (25 degrees Celsius / 77 degrees Fahrenheit). Keep away from excessive moisture.
• Do not use expired medications. Throw them away.

How to dispose of old or no longer needed medications:

• The best thing to do is to ask a pharmacy or law enforcement agency and hand these over to a place that has a medication take-back program.
• If not, check the medicine packet or the leaflet inside it to see if it can be thrown in the trash or flushed down the toilet. If you're not sure, ask your doctor or pharmacist.
• If you can throw it in the trash, take the medicine out of the packet, mix it with something like cat litter, soil, or coffee grounds, put it in a sealable bag or container, and throw it in the trash.

Take-Home Message

Okay, so let's remind you again of the most important points from what we've talked about.

Isoniazid; Rifampin is an antibiotic given for tuberculosis.

Just as the doctor says, it is essential to take this medicine on an empty stomach, at the right time, and for the right duration .

Be sure to tell your doctor about any other medications you are taking and any other illnesses you have.

Be aware of side effects, especially if you notice serious skin reactions, liver problems, or bleeding, and see a doctor immediately.

Do not stop taking the medicine halfway. To achieve a full recovery, take the medicine for as long as the doctor tells you.

If you have any further questions about this, don't hesitate to ask your doctor or pharmacist. I wish you good health!

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