Drugs List

Therapeutic Indications

Uses

Tuberculosis - pulmonary

Contraindications

Hereditary fructose intolerance
Jaundice
Porphyria

Precautions and Warnings

Children under 18 years
Elderly
Females of childbearing potential
Haemoptysis
Patients over 35 years
Predisposition to peripheral neuropathy
Predisposition to seizures
Alcoholism
Breastfeeding
Diabetes mellitus
Epileptic disorder
Glucose-galactose malabsorption syndrome
Hepatic impairment
History of gout
History of psychosis
Malnutrition
Positive HIV status
Pregnancy
Severe renal impairment
Slow acetylator status

Consider vitamin K supplementation risk of vitamin K dependent coagulopathy
Advise ability to drive/operate machinery may be affected by side effects
Consult national/regional policy on the use of anti-infectives
Preparation contains sucrose
Advise patient to take at least 30 minutes before a meal
Treatment to be administered under the supervision of a specialist
Monitor renal function prior to initiating treatment
Monitor serum transaminases before treatment
Monitor transaminases monthly in patients at risk of hepatitis
Adverse effects may be seen after ingestion of high-tyramine foods/drinks
Advise patient that red discolouration of body fluids may occur
Advise patients to discontinue therapy if signs of hepatotoxicity occur
Advise patients to report signs of hepatic damage (malaise, jaundice etc.)
Discontinue if hepatitis develops
Discontinue if thrombocytopenia occurs
May cause hyperbilirubinaemia
May cause vitamin K dependent coagulopathy and severe bleeding
Discontinue and do not restart if hyperuricaemia + gouty arthritis develop
Discontinue and do not restart if purpura develops
Discontinue if haemolytic anaemia occurs
Discontinue if renal failure develops
Discontinue if symptoms of hepatic disease occur
Advise patient to seek medical advice before taking paracetamol products
Female: Barrier or non-hormonal contraception advised during treatment
Female: Oral contraception may not be adequate during treatment
Advise patient of importance of full compliance

Patients without pre-existing hepatic impairment and normal pre-treatment hepatic function will only require repeat hepatic function tests if fever, malaise, vomiting, jaundice or other deteriorations in their condition occur.

Patients treated for tuberculosis with rifampicin, isoniazid and pyrazinamide should have baseline measurements of hepatic enzymes, bilirubin, serum creatinine and a complete blood and platelet count.
Patients should be seen monthly during therapy and should be questioned regarding symptoms associated with adverse effects. All abnormalities should be investigated including laboratory testing when necessary.

Treatment should be discontinued if signs of hepatocellular damage or clinically significant changes in hepatic function occur. The need for alternate therapy should be considered. If rifampicin with isoniazid and pyrazinamide is reintroduced after hepatic function has returned to normal, hepatic function should be monitored daily.

Patients and their carers should be informed how to recognise signs of hepatic disorders and advised to discontinue treatment and seek immediate medical attention if these symptoms occur.

Hyperbilirubinaemia may occur at the start of treatment. This is due to rifampicin and bilirubin competing for hepatic excretory pathways. An isolated report showing moderate rises in serum bilirubin or transaminases is not an indication for treatment interruption. Decisions to cease treatment should be based on repeated tests, trends in level changes and the patients clinical condition.

Isoniazid treatment is associated with severe and sometimes fatal hepatitis. Patients should be monitored for the prodromal symptoms of hepatitis; such as fatigue, weakness, malaise, anorexia, nausea or vomiting. In the event of prodromal symptoms of hepatitis or signs of hepatic damage occur, discontinue treatment immediately.

Monitor transaminase monthly in patients over 35 years, there is an increased risk of isoniazid-associated hepatitis in this patient population.
The following factors are also associated with an increased risk of hepatitis:
Daily intake of alcohol
Chronic liver disease
Intravenous drug use
Black or Hispanic women

Elderly and malnourished patients may require vitamin B6 supplementation with isoniazid administration.

Patients with slow acetylation should be carefully monitored during treatment. Isoniazid is metabolised primarily by acetylation and dehydrazination.

Use with caution in patients with a history of gout. Patients should be transferred to a treatment regime without pyrazinamide if hyperuricaemia with acute gouty arthritis occurs.

Thrombocytopenia, with or without purpura, may occur during therapy. This is reversible if therapy is discontinued as soon as purpura appears. Cerebral haemorrhage and fatalities have been reported if therapy continued or resumed following the appearance of purpura.

Immunological reactions may occur with intermittent rifampicin therapy (less than two or three per week), therefore patients should be closely monitored. Patients should be advised of these reactions and warned not to interrupt their dosage regimens.

High doses may cause convulsions. This should be considered when treating patients with seizure disorders such as epilepsy.

Isoniazid may increase the formation of toxic metabolites of paracetamol if paracetamol is taken during isoniazid treatment. Advise patients that they should limit the use of paracetamol-containing products during treatment with isoniazid and, preferably, seek medical advice before taking paracetamol-containing products.

Patients receiving isoniazid may experience adverse effects (such as headache, sweating, palpitations, flushing and hypotension) after consuming certain foods or drinks. Tyramine-containing foods may cause an interaction due to the weak monoamine oxidase inhibiting activity of isoniazid and high-tyramine foods such as cheese, red wine, lager and preserved foods should be considered if a patient presents with such a reaction. Isoniazid may also inhibit diamine oxidase, causing an enhanced response to histamine-containing foods such as cheese or fish that is not fresh. The diet of the patient should be examined and advice to avoid such foodstuffs should be given in the event of such a reaction.

Pregnancy and Lactation

Pregnancy

Use rifampicin with isoniazid and pyrazinamide with caution in pregnancy.

Schaefer suggests rifampicin and isoniazid are drugs of choice for the treatment of tuberculosis, pyrazinamide can be used during pregnancy in those cases where resistance to the other first line drugs is known or suspected. Briggs suggests that rifampicin and isoniazid do not appear to be human teratogens and because active tuberculosis is a far greater risk to the foetus than the drug, pyrazinamide should not be withheld in pregnancy. The American Thoracic Society considers untreated tuberculosis as a greater hazard to a pregnant woman and her foetus than treatment with isoniazid.

The manufacturer suggests rifampicin with isoniazid and pyrazinamide should only be used in pregnancy if the potential benefit justifies the potential risk to the foetus.

Rifampicin
If rifampicin is administered during the last few weeks of pregnancy, post-natal haemorrhage in the mother and neonate may occur. Prophylactic therapy with vitamin K1 may be required.

Rifampicin crosses the human placenta to the foetus and appears in cord blood. The effect of rifampicin on the foetus is unknown. No controlled studies link the use of rifampicin to congenital defects in humans.

Animal studies have reported spina bifida in mice and rats and cleft palates in mice when administered rifampicin. Teratogenicity has been reported in rats and teratogenic effects have been shown with very high doses in animals.

Isoniazid
Isoniazid crosses the human placenta to the foetus.

Animal studies in mice, rats and rabbits have not revealed congenital anomalies however embryocidal effects were observed in rats and rabbits.

Pyrazinamide
Animal reproduction studies have not been conducted with pyrazinamide. A single report describes the use of pyrazinamide in a pregnant woman. No drug related foetal toxicity was mentioned. Based upon current reports a small risk of birth defects cannot be excluded. However, references caution that pyrazinamide should not be used routinely due to the lack of information on its clinical effects.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use rifampicin with isoniazid and pyrazinamide with caution in breastfeeding.

The Centres for Disease Control and prevention state that breastfeeding should not be discouraged in patients taking rifampicin, isoniazid or pyrazinamide. Low levels of all three drugs are excreted in breast milk, the concentrations of these drugs is not considered sufficient for treatment of tuberculosis in the breastfed infant.

Schaefer concludes that isoniazid (in combination with 0.5 to 1 mg of vitamin B6 prophylaxis per day for the infant), rifampicin and pyrazinamide are the tuberculostatics of choice during breastfeeding.
The manufacturer suggests that breastfeeding should not take place in patients receiving rifampicin with isoniazid and pyrazinamide unless the potential benefit to the patient outweighs the potential risk to the infant.

Infant should be monitored for early signs of neuropathy and convulsions.

Rifampicin
Rifampicin is excreted into human milk however Briggs suggests the levels excreted are thought to present low risk to the infant.

Isoniazid
Isoniazid and its metabolite are excreted in human milk. Briggs suggest monitoring the breastfed infant for peripheral neuritis and hepatitis.

Pyrazinamide
Pyrazinamide is excreted in human milk. Briggs suggests breastfed infants should be monitored for rare cases of jaundice, fever, loss of appetite, nausea and vomiting, thrombocytopenia, rash and arthralgia.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal discomfort
Acute interstitial nephritis
Acute renal failure
Acute tubular necrosis
Acute yellow atrophy
Adrenal suppression
Aggravation of peptic ulcer
Agranulocytosis
Anaemia
Anaphylaxis
Angioedema
Anorexia
Arthralgia
Bone pain
Cerebral haemorrhage
Chills
Constipation
Convulsions
Death
Decrease in blood pressure
Diarrhoea
Dizziness
Dry mouth
Dysuria
Encephalopathy
Eosinophilia
Epigastric distress
Erythema multiforme
Exfoliative dermatitis
Fever
Flushing
Gout
Gynaecomastia
Haemolytic anaemia
Headache
Hepatic impairment
Hepatic tenderness
Hepatitis
Hyperglycaemia
Hypersensitivity reactions
Impaired memory
Increase in antinuclear antibodies (ANA)
Influenza-like syndrome
Intravascular coagulation (disseminated)
Itching
Jaundice
Leucopenia
Lyell's syndrome
Malaise
Menstrual disturbances
Muscle weakness
Myopathy
Nausea
Nervous system effects
Oedema
Optic atrophy
Optic neuritis
Pancreatitis
Paraesthesia
Pellagra
Pemphigoid reaction
Peripheral neuropathy
Polyneuritis
Possible staining of soft contact lenses
Pruritus
Pseudomembranous colitis
Psychosis
Rash
Reddish discolouration of body fluids
Respiratory symptoms
Shock
Shortness of breath
Sideroblastic anaemia
Stevens-Johnson syndrome
Systemic lupus erythematosus-like syndrome
Thrombocytopenia
Thrombocytopenic purpura
Urticaria
Vasculitis
Vertigo
Vomiting
Wheezing

Presentation

Oral formulations of rifampicin with isoniazid and pyrazinamide.

Drugs List

Therapeutic Indications

Uses

Tuberculosis - pulmonary

Dosage

Treatment should be given under close supervision of a respiratory or other suitably qualified specialist.

Treatment is recommended for the initial intensive phase of treatment of pulmonary tuberculosis, which lasts for 2 months. Administer daily and continuously during this period. Concurrent administration of ethambutol or intramuscular streptomycin is advised over the same period of time.

On completion of this intensive treatment phase, treatment can continue with a combination of rifampicin and isoniazid daily. See product information for further details.

Adults

Elderly

Children

Patients with Renal Impairment

Patients with Hepatic Impairment

Contraindications

Hereditary fructose intolerance
Jaundice
Porphyria

Precautions and Warnings

Children under 18 years
Elderly
Females of childbearing potential
Haemoptysis
Patients over 35 years
Predisposition to peripheral neuropathy
Predisposition to seizures
Alcoholism
Breastfeeding
Diabetes mellitus
Epileptic disorder
Glucose-galactose malabsorption syndrome
Hepatic impairment
History of gout
History of psychosis
Malnutrition
Positive HIV status
Pregnancy
Severe renal impairment
Slow acetylator status

Consider vitamin K supplementation risk of vitamin K dependent coagulopathy
Advise ability to drive/operate machinery may be affected by side effects
Consult national/regional policy on the use of anti-infectives
Preparation contains sucrose
Advise patient to take at least 30 minutes before a meal
Treatment to be administered under the supervision of a specialist
Monitor renal function prior to initiating treatment
Monitor serum transaminases before treatment
Monitor transaminases monthly in patients at risk of hepatitis
Adverse effects may be seen after ingestion of high-tyramine foods/drinks
Advise patient that red discolouration of body fluids may occur
Advise patients to discontinue therapy if signs of hepatotoxicity occur
Advise patients to report signs of hepatic damage (malaise, jaundice etc.)
Discontinue if hepatitis develops
Discontinue if thrombocytopenia occurs
May cause hyperbilirubinaemia
May cause vitamin K dependent coagulopathy and severe bleeding
Discontinue and do not restart if hyperuricaemia + gouty arthritis develop
Discontinue and do not restart if purpura develops
Discontinue if haemolytic anaemia occurs
Discontinue if renal failure develops
Discontinue if symptoms of hepatic disease occur
Advise patient to seek medical advice before taking paracetamol products
Female: Barrier or non-hormonal contraception advised during treatment
Female: Oral contraception may not be adequate during treatment
Advise patient of importance of full compliance

Patients without pre-existing hepatic impairment and normal pre-treatment hepatic function will only require repeat hepatic function tests if fever, malaise, vomiting, jaundice or other deteriorations in their condition occur.

Patients treated for tuberculosis with rifampicin, isoniazid and pyrazinamide should have baseline measurements of hepatic enzymes, bilirubin, serum creatinine and a complete blood and platelet count.
Patients should be seen monthly during therapy and should be questioned regarding symptoms associated with adverse effects. All abnormalities should be investigated including laboratory testing when necessary.

Treatment should be discontinued if signs of hepatocellular damage or clinically significant changes in hepatic function occur. The need for alternate therapy should be considered. If rifampicin with isoniazid and pyrazinamide is reintroduced after hepatic function has returned to normal, hepatic function should be monitored daily.

Patients and their carers should be informed how to recognise signs of hepatic disorders and advised to discontinue treatment and seek immediate medical attention if these symptoms occur.

Hyperbilirubinaemia may occur at the start of treatment. This is due to rifampicin and bilirubin competing for hepatic excretory pathways. An isolated report showing moderate rises in serum bilirubin or transaminases is not an indication for treatment interruption. Decisions to cease treatment should be based on repeated tests, trends in level changes and the patients clinical condition.

Isoniazid treatment is associated with severe and sometimes fatal hepatitis. Patients should be monitored for the prodromal symptoms of hepatitis; such as fatigue, weakness, malaise, anorexia, nausea or vomiting. In the event of prodromal symptoms of hepatitis or signs of hepatic damage occur, discontinue treatment immediately.

Monitor transaminase monthly in patients over 35 years, there is an increased risk of isoniazid-associated hepatitis in this patient population.
The following factors are also associated with an increased risk of hepatitis:
Daily intake of alcohol
Chronic liver disease
Intravenous drug use
Black or Hispanic women

Elderly and malnourished patients may require vitamin B6 supplementation with isoniazid administration.

Patients with slow acetylation should be carefully monitored during treatment. Isoniazid is metabolised primarily by acetylation and dehydrazination.

Use with caution in patients with a history of gout. Patients should be transferred to a treatment regime without pyrazinamide if hyperuricaemia with acute gouty arthritis occurs.

Thrombocytopenia, with or without purpura, may occur during therapy. This is reversible if therapy is discontinued as soon as purpura appears. Cerebral haemorrhage and fatalities have been reported if therapy continued or resumed following the appearance of purpura.

Immunological reactions may occur with intermittent rifampicin therapy (less than two or three per week), therefore patients should be closely monitored. Patients should be advised of these reactions and warned not to interrupt their dosage regimens.

High doses may cause convulsions. This should be considered when treating patients with seizure disorders such as epilepsy.

Isoniazid may increase the formation of toxic metabolites of paracetamol if paracetamol is taken during isoniazid treatment. Advise patients that they should limit the use of paracetamol-containing products during treatment with isoniazid and, preferably, seek medical advice before taking paracetamol-containing products.

Patients receiving isoniazid may experience adverse effects (such as headache, sweating, palpitations, flushing and hypotension) after consuming certain foods or drinks. Tyramine-containing foods may cause an interaction due to the weak monoamine oxidase inhibiting activity of isoniazid and high-tyramine foods such as cheese, red wine, lager and preserved foods should be considered if a patient presents with such a reaction. Isoniazid may also inhibit diamine oxidase, causing an enhanced response to histamine-containing foods such as cheese or fish that is not fresh. The diet of the patient should be examined and advice to avoid such foodstuffs should be given in the event of such a reaction.

Pregnancy and Lactation

Pregnancy

Use rifampicin with isoniazid and pyrazinamide with caution in pregnancy.

Schaefer suggests rifampicin and isoniazid are drugs of choice for the treatment of tuberculosis, pyrazinamide can be used during pregnancy in those cases where resistance to the other first line drugs is known or suspected. Briggs suggests that rifampicin and isoniazid do not appear to be human teratogens and because active tuberculosis is a far greater risk to the foetus than the drug, pyrazinamide should not be withheld in pregnancy. The American Thoracic Society considers untreated tuberculosis as a greater hazard to a pregnant woman and her foetus than treatment with isoniazid.

The manufacturer suggests rifampicin with isoniazid and pyrazinamide should only be used in pregnancy if the potential benefit justifies the potential risk to the foetus.

Rifampicin
If rifampicin is administered during the last few weeks of pregnancy, post-natal haemorrhage in the mother and neonate may occur. Prophylactic therapy with vitamin K1 may be required.

Rifampicin crosses the human placenta to the foetus and appears in cord blood. The effect of rifampicin on the foetus is unknown. No controlled studies link the use of rifampicin to congenital defects in humans.

Animal studies have reported spina bifida in mice and rats and cleft palates in mice when administered rifampicin. Teratogenicity has been reported in rats and teratogenic effects have been shown with very high doses in animals.

Isoniazid
Isoniazid crosses the human placenta to the foetus.

Animal studies in mice, rats and rabbits have not revealed congenital anomalies however embryocidal effects were observed in rats and rabbits.

Pyrazinamide
Animal reproduction studies have not been conducted with pyrazinamide. A single report describes the use of pyrazinamide in a pregnant woman. No drug related foetal toxicity was mentioned. Based upon current reports a small risk of birth defects cannot be excluded. However, references caution that pyrazinamide should not be used routinely due to the lack of information on its clinical effects.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use rifampicin with isoniazid and pyrazinamide with caution in breastfeeding.

The Centres for Disease Control and prevention state that breastfeeding should not be discouraged in patients taking rifampicin, isoniazid or pyrazinamide. Low levels of all three drugs are excreted in breast milk, the concentrations of these drugs is not considered sufficient for treatment of tuberculosis in the breastfed infant.

Schaefer concludes that isoniazid (in combination with 0.5 to 1 mg of vitamin B6 prophylaxis per day for the infant), rifampicin and pyrazinamide are the tuberculostatics of choice during breastfeeding.
The manufacturer suggests that breastfeeding should not take place in patients receiving rifampicin with isoniazid and pyrazinamide unless the potential benefit to the patient outweighs the potential risk to the infant.

Infant should be monitored for early signs of neuropathy and convulsions.

Rifampicin
Rifampicin is excreted into human milk however Briggs suggests the levels excreted are thought to present low risk to the infant.

Isoniazid
Isoniazid and its metabolite are excreted in human milk. Briggs suggest monitoring the breastfed infant for peripheral neuritis and hepatitis.

Pyrazinamide
Pyrazinamide is excreted in human milk. Briggs suggests breastfed infants should be monitored for rare cases of jaundice, fever, loss of appetite, nausea and vomiting, thrombocytopenia, rash and arthralgia.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Counselling

Advise patient to take as a single dose, on an empty stomach, 30 minutes before or 2 hours after a meal.

Advise patient of importance of full compliance. Immunological reactions, including anaphylaxis, may occur with intermittent rifampicin therapy (less than two or three doses per week).

Advise patient that they should limit the use of paracetamol-containing products during treatment with isoniazid and, preferably, seek medical advice before taking paracetamol-containing products.

Advise patient tyramine-containing foods may cause an adverse reaction. High-tyramine foods include cheese, red wine, lager and preserved food.

Advise patient and their carers how to recognise signs of hepatic disorders and advised to discontinue treatment and seek immediate medical attention if these symptoms occur.

Advise patient that a reddish discolouration of the urine, sputum and tears and staining of contact lenses may occur during therapy.

Advise patient certain side effects of this medicine (vertigo, visual disorders, dizziness) may impair their ability to drive and operate machinery.

Side Effects

Abdominal discomfort
Acute interstitial nephritis
Acute renal failure
Acute tubular necrosis
Acute yellow atrophy
Adrenal suppression
Aggravation of peptic ulcer
Agranulocytosis
Anaemia
Anaphylaxis
Angioedema
Anorexia
Arthralgia
Bone pain
Cerebral haemorrhage
Chills
Constipation
Convulsions
Death
Decrease in blood pressure
Diarrhoea
Dizziness
Dry mouth
Dysuria
Encephalopathy
Eosinophilia
Epigastric distress
Erythema multiforme
Exfoliative dermatitis
Fever
Flushing
Gout
Gynaecomastia
Haemolytic anaemia
Headache
Hepatic impairment
Hepatic tenderness
Hepatitis
Hyperglycaemia
Hypersensitivity reactions
Impaired memory
Increase in antinuclear antibodies (ANA)
Influenza-like syndrome
Intravascular coagulation (disseminated)
Itching
Jaundice
Leucopenia
Lyell's syndrome
Malaise
Menstrual disturbances
Muscle weakness
Myopathy
Nausea
Nervous system effects
Oedema
Optic atrophy
Optic neuritis
Pancreatitis
Paraesthesia
Pellagra
Pemphigoid reaction
Peripheral neuropathy
Polyneuritis
Possible staining of soft contact lenses
Pruritus
Pseudomembranous colitis
Psychosis
Rash
Reddish discolouration of body fluids
Respiratory symptoms
Shock
Shortness of breath
Sideroblastic anaemia
Stevens-Johnson syndrome
Systemic lupus erythematosus-like syndrome
Thrombocytopenia
Thrombocytopenic purpura
Urticaria
Vasculitis
Vertigo
Vomiting
Wheezing

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: April 2016

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Summary of Product Characteristics: Rifater Tablets. Sanofi-Aventis. Revised March 2016.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 13 September 2017

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Isoniazid Last revised: February 4, 2016.
Last accessed: April 7, 2016.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Rifampin. Last revised: April 1, 2016.
Last accessed: April 7, 2016.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Pyrazinamide Last revised: March 10, 2015.
Last accessed: April 7, 2016.