Health Guide

Rifampin/isoniazid/pyrazinamide (By mouth)

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

Treats tuberculosis (TB).

Brand Name(s):


There may be other brand names for this medicine.

When This Medicine Should Not Be Used:

This medicine is not right for everyone. Do not use it if you had an allergic reaction to rifampin, isoniazid, pyrazinamide, or similar drugs, or if you have liver disease, or acute gout.

How to Use This Medicine:


  • 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 medicine to treat HIV/AIDS, including atazanavir, darunavir, fosamprenavir, ritonavir, saquinavir, or tipranavir.
  • Some medicines can affect how rifampin/isoniazid/pyrazinamide work. Tell your doctor if you are using any of the following:
    • Clofibrate, cycloserine, cyclosporine, dapsone, diazepam, digitoxin, disulfiram, haloperidol, levothyroxine, meperidine, probenecid, quinine, tacrolimus, theophylline, or zidovudine
    • Birth control pills
    • Blood pressure medicine (including beta blockers, calcium channel blockers)
    • Blood thinner (including warfarin)
    • Medicine for heart rhythm problems
    • Medicine for seizures (including phenytoin)
    • Medicine to treat depression (including TCA)
    • Medicine to treat diabetes
    • Medicine to treat an infection (including ciprofloxacin, clarithromycin, fluconazole, itraconazole, ketoconazole)
    • Narcotic pain reliever
    • Steroid medicine
  • If you use an antacid, take it at least 1 hour after you take rifampin/isoniazid/pyrazinamide.
  • 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 taking 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, diabetes, or porphyria (an enzyme problem). Tell your doctor if your drink alcohol.
  • This medicine may cause the following problems:
    • Drug reaction with eosinophilia and systemic symptoms (DRESS), which can damage organs such as the liver, kidney, or heart
    • Eye or vision problems
    • Liver problems
    • Increased levels of uric acid, which causes symptoms of gout
  • This medicine may turn your urine, bowel movements, saliva, sweat, and tears red. This is normal. This side effect could stain contact lenses.
  • Call your doctor if your symptoms do not improve or if they get worse.
  • This medicine may make you bleed, bruise, or get infections more easily. Take precautions to prevent illness and injury. Wash your hands often.
  • 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
  • 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

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: 7/4/2018
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