Drug General Information (ID: DDI0HWMJ48)
  Drug Name Rifabutin Drug Info Isoniazid Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antibiotics Antitubercular Agents
  Structure

 Mechanism of Rifabutin-Isoniazid Interaction (Severity Level: Minor)
     Increased risk of hepatotoxicity Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Rifabutin Isoniazid
      Mechanism Hepatotoxicity Hepatotoxicity
      Key Mechanism Factor 1
Factor Name Hepatotoxicity
Factor Description Combination of drugs that can induce hepatotoxicity may increase the risk of liver injury. Symptoms vary depending on the level of exposure and the total extent of liver damage, and may cause few symptoms if the damage is mild, and eventually lead to liver failure in patients with severe damage.
      Mechanism Description
  • Increased risk of hepatotoxicity by the combination of Rifabutin and Isoniazid 

Recommended Action
      Management Close monthly monitoring for clinical or laboratory evidence of altered hepatic function is recommended. Patients should be advised to promptly report early symptoms of hepatitis such as fatigue, weakness, malaise, anorexia, nausea, or vomiting. Discontinuation of either or both drugs may be necessary.

References
1 Abadie-Kemmerly S, Pankey GA, Dalvisio JR "Failure of ketoconazole treatment of blastomyces dermatidis due to interaction of isoniazid and rifampin." Ann Intern Med 109 (1988): 844-5. [PMID: 3190036]
2 Acocella G, Bonollo L, Garimoldi M, et al "Kinetics of rifampicin and isoniazid administered alone and in combination to normal subjects and patients with liver disease." Gut 13 (1972): 47-53. [PMID: 5060669]
3 Askgaard DS, Wilcke T, Dossing M "Hepatotoxicity caused by the combined action of isoniazid and rifampicin." Thorax 50 (1995): 213-4. [PMID: 7701468]
4 Canadian Pharmacists Association.
5 Cerner Multum, Inc. "Australian Product Information.".
6 Cerner Multum, Inc. "UK Summary of Product Characteristics.".
7 Kumar A, Misra PK, Mehotra R, et al "Hepatotoxicity of rifampin and isoniazid." Am Rev Respir Dis 143 (1991): 1350-2. [PMID: 1904700]
8 O'Brien RJ, Long MW, Cross FS, et al "Hepatotoxicity from isoniazid and rifampin among children treated for tuberculosis." Pediatrics 72 (1983): 491-9. [PMID: 6604257]
9 Product Information. INH (isoniazid). Ciba Pharmaceuticals, Summit, NJ.
10 Product Information. Mycobutin (rifabutin). Pharmacia and Upjohn, Kalamazoo, MI.
11 Product Information. Rifadin (rifampin). Hoechst Marion-Roussel Inc, Kansas City, MO.
12 Sarma G, Immanuel C, Kailasam S, Narayana AS, Venkatesan P "Rifampin-induced release of hydrazine from isoniazid." Am Rev Respir Dis 133 (1986): 1072-5. [PMID: 3717759]
13 Steele MA, Burk RF, Des Prez RM "Toxic hepatitis with isoniazid and rifampin." Chest 99 (1991): 465-71. [PMID: 1824929]
14 Yamamoto T, Suou T, Hirayama C "Elevated serum aminotransferase induced by isoniazid in relation to isoniazid acetylator phenotype." Hepatology 6 (1986): 295-8. [PMID: 3957235]