Also indexed as: INH, Laniazid, Nydrazid
Isoniazid is an antibiotic used to prevent
and treat tuberculosis. To prevent development of resistant tuberculosis bacteria, people with
tuberculosis are treated with long courses of combination drug therapy, most commonly
isoniazid, rifampin, and pyrazinamide.
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
 May Be Beneficial: Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them. |
Calcium*
Folic acid*
Magnesium*
Vitamin B12
Vitamin B3 (niacin)
Vitamin D*
Vitamin E*
Vitamin K
|
| May Be Beneficial: Side effect
reduction/prevention—Taking these supplements may help reduce the likelihood and/or
severity of a potential side effect caused by the medication. |
Picrorhiza*
|
| May Be Beneficial: Supportive
interaction—Taking these supplements may support or otherwise help your medication
work better. |
Licorice*
|
Check: Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details. |
Vitamin B6
|
| Reduced drug
absorption/bioavailability |
None known
|
| Adverse interaction |
None known
|
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions with Dietary Supplements
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.1
Vitamin
B6
Isoniazid can interfere with the activity of vitamin B6.2 Vitamin B6
supplementation is recommended, especially in people with poor nutritional status, to prevent
development of isoniazid-induced peripheral neuritis (inflamed nerves).3 One case
is reported in which injectable vitamin B6 reversed isoniazid-induced coma.4 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.5 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,6 people taking isoniazid should consult their doctor to
determine the appropriate amount of vitamin B6 to take.
Vitamin
K
Many antibiotics taken by mouth, including isoniazid, may kill friendly bacteria in the large
intestine that produce vitamin K.7 Vitamin K1 (phylloquinone) is now found in some
multivitamins.
Other nutrient interactions
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.8 9 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.10
People should consider using a daily
multivitamin-mineral supplement during isoniazid therapy.
Interactions with Herbs
Licorice (Glycyrrhiza glabra)
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.11 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.
Picrorhiza (Picrorhiza kurroa)
Picrorhiza is an herb from India with well-established anti-inflammatory and liver protective
actions.12 Use of a combination formula known as Liv.100 that contains picrorhiza
protected animal livers against damage caused by isoniazid and other antituberculosis
antibiotics.13
Interactions with Foods and Other Compounds
Food
Food decreases absorption of isoniazid. Isoniazid should be taken one hour before or two hours
after eating. However, people may take isoniazid with food to decrease stomach
upset.14
Isoniazid has some monoamine oxidase inhibitor (MAOI) activity.15 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).16 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.17 People taking isoniazid should avoid
histamine-containing foods (such as tuna,
sauerkraut juice, or yeast extract).
Alcohol
Daily alcohol intake increases the risk of isoniazid-related hepatitis.18 Alcohol may interact with
isoniazid, causing facial flushing, headache, light-headedness, nausea, breathlessness, and
other symptoms.19 To prevent unwanted reactions, people taking isoniazid should
avoid alcohol-containing products.
References:1. Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced
pellagra despite pyridoxine supplementation. Clin Exp Dermatol
1999;24:167–70.
2. Goldman AL, Braman SS. Isoniazid: a review with emphasis on adverse
effects. Chest 1972;62:71–7 [review].
3. 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.
4. Brent J, Vo N, Kulig K, Rumack BH. Reversal of prolonged
isoniazid-induced coma by pyridoxine. Arch Intern Med 1990;150:1751–3.
5. Chan TYK. Pyridoxine ineffective in isoniazid-induced psychosis.
Ann Pharmacother 1999;33:1123–4 [letter].
6. McCune R, Deuschle K, McDermott W. The delayed appearance of isoniazid
antagonism by pyridoxine in vivo. Am Rev Tuberculosis 1957;76:1100–5.
7. Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 147.
8. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA:
Third Line Press, 1997, 231–2 [review].
9. Holt GA. Food & Drug Interactions. Chicago, Precept
Press, 1998, 146–7.
10. Darvay A, Basarab T, McGregor JM, Russell-Jones R. Isoniazid induced
pellegra despite pyridoxine supplementation. Clin Exp Dermatol
1999;24:167–9.
11. Aoki K, Tokiwa T, Yamamoto T, Teramatsu T. Combined treatment of
pulmonary tuberculosis with glycyrrhizin and INH. Acta Tubercul Japon
1963;13:32–9.
12. 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.
13. 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.
14. 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.
15. 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.
16. Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 146.
17. 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.
18. 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.
19. Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 144.