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This document outlines crucial safety and warning information regarding the use of this medication. It is essential to understand the potential risks and take necessary precautions. If you have any concerns, please discuss them with your healthcare provider.

• Liver Injury (Hepatitis): Isoniazid has been associated with severe and potentially life-threatening liver damage known as hepatitis. This risk is highest within the first three months of treatment but can occur at any time. Individuals over 35, those who consume alcohol regularly, Black or Hispanic women, and recent mothers are at increased risk. Regular liver function tests will be ordered by your healthcare provider to monitor your liver health. Immediately report symptoms such as loss of appetite, nausea, vomiting, dark urine, yellowing of the eyes or skin, rash, tingling in extremities, persistent weakness, fever lasting more than three days, or persistent pain on the right side of the abdomen.

• Interactions: Isoniazid can interact with various foods and medications. It's crucial to consult your healthcare provider about safe options. Specifically, avoid foods high in tyramine (e.g., cheese, red wine) or histamine (e.g., tuna, skipjack), as these can trigger side effects such as headaches, sweating, rapid heartbeat, flushing, and low blood pressure. For best results, take isoniazid on an empty stomach.

• Contraindications: Isoniazid should not be used if you have a history of liver complications from this medication or if you currently have active liver problems. Consult your healthcare provider if these conditions apply to you before starting treatment.

In case of overdose or severe side effects, seek immediate medical attention. Always follow your healthcare provider's instructions carefully to minimize risks and ensure safe use of this medication.

Common side effects:

• Tingling or numbness in hands and feet
• Rise in liver enzymes

Less common but important to monitor:

• Upset stomach
• Pancreatitis
• Abnormal blood cell counts
• Allergic reactions
• Low levels of vitamins b6 and b3
• High blood sugar
• Excessive body acid
• Enlarged breasts in men

Serious side effects:

• Signs of liver injury (loss of appetite, nausea or vomiting, dark urine, yellowing of eyes or skin)
• Rash
• Tingling of hands and feet
• Persistent weakness
• Fever lasting more than three days
• Right-sided abdominal pain that does not subside

Isoniazid, a medication commonly used to treat tuberculosis, can interact with various substances, including other medications, foods, and alcohol. Being aware of these interactions is crucial to ensure the medication's effectiveness and minimize potential side effects.

Drug Interactions:

• Antiepileptic Drugs: Isoniazid can slow the metabolism of medications like Phenytoin and Carbamazepine, leading to higher levels in the blood. This may increase the risk of side effects associated with these drugs. Regular monitoring and possible dose adjustments are recommended when these medications are used together.

• Benzodiazepines: The clearance of drugs such as Diazepam and Triazolam may be reduced when taken with isoniazid, potentially causing increased sedation. Patients should be monitored for enhanced sedative effects.

• Theophylline: Concurrent use with isoniazid can elevate theophylline levels, increasing the risk of toxicity. Monitoring theophylline concentrations and adjusting the dose as needed is advisable.

• Warfarin: Isoniazid may enhance the effects of warfarin, a blood thinner, by interfering with its metabolism, which can increase the risk of bleeding. Frequent monitoring of blood clotting times (INR) is essential when these drugs are combined.

• Serotonergic Medications: Isoniazid has weak monoamine oxidase (MAO) inhibiting activity. When combined with other serotonergic agents, such as certain antidepressants, there is a potential risk of serotonin syndrome, a serious condition characterized by symptoms like confusion, rapid heart rate, and high blood pressure. Caution is advised when these medications are used together.

Food Interactions:

• Tyramine- and Histamine-Rich Foods: Isoniazid can inhibit enzymes that break down tyramine and histamine. Consuming foods high in these substances, such as certain cheeses, red wine, and some fish (like tuna and herring), may lead to reactions including headaches, palpitations, flushing, and elevated blood pressure. Patients are advised to limit or avoid these foods during isoniazid therapy.

• Caffeine: Isoniazid may enhance the effects of caffeine, leading to symptoms like increased heart rate and restlessness. Reducing caffeine intake from sources like coffee, tea, and chocolate is recommended.

Alcohol Interaction:

• Liver Toxicity: Both isoniazid and alcohol can be harmful to the liver. Drinking alcohol while taking isoniazid increases the risk of liver damage. Patients should avoid alcohol consumption during treatment to reduce this risk.

Vitamin Interactions:

• Vitamin B6 (Pyridoxine): Isoniazid can interfere with vitamin B6 metabolism, potentially leading to nerve-related side effects such as tingling or numbness in the hands and feet. Supplementing with vitamin B6 (typically 10-50 mg daily) is often recommended to prevent these issues.

Antacids:

• Reduced Absorption: Antacids containing aluminum can decrease the absorption of isoniazid, reducing its effectiveness. If antacids are necessary, they should be taken at least one hour after isoniazid to minimize this interaction.

Patients should inform their healthcare providers about all medications, supplements, and dietary habits to manage potential interactions effectively. Regular monitoring and open communication with healthcare professionals can help ensure safe and effective treatment with isoniazid.