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Active Ingredient: Isoniazid
Brand Name: Hyzyd

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What is Isoniazid

Isoniazid is a tuberculostat; in excessive doses it’s bactericidal. The mechanism of motion shouldn’t be totally identified; one of the crucial necessary results appears to be inhibition of mycolic acid synthesis within the cell wall of the bacterium. Isoniazid is simply efficient in dividing cells.

Isoniazid Drug Recommendation

The therapy of latent tuberculosis an infection (LTBI) and the preventive therapy of individuals who’ve had shut contact with an open-lung tuberculosis affected person, however in whom no an infection has been detected (main prophylaxis), consists of Hyzyd, rifampicin or mixture remedy. The usual therapy of lively tuberculosis consists of a therapy routine of no less than 6 months with:

  • isoniazid
  • rifampicin
  • pyrazinamide
  • ethambutol.

Hyzyd Indications

  • Remedy of:
    • Energetic tuberculosis, together with different tuberculosis medicine;
    • A latent tuberculosis an infection (LTBI).

  • Prophylaxis of tuberculosis as monotherapy within the following conditions:
    • there’s a excessive threat of an infection, however such an an infection shouldn’t be (but) demonstrable;
    • an infection has demonstrably occurred however manifest signs of illness should not but current;
    • insufficient drug therapy of tuberculosis within the historical past;
    • Lung abnormalities discovered by probability and optimistic tuberculin response which point out a earlier historical past of tuberculosis.

What Should You Discuss To Your Doctor Before Using This Medicine+

  1. Being pregnant
    • Isoniazid crosses the placenta. At start, the serum focus of isoniazid within the umbilical twine is between 0-66% of that in maternal serum.
    • Teratogenesis: In depth expertise in people doesn’t point out an elevated threat of congenital abnormalities.
    • Pharmacological impact: Throughout being pregnant and put up partum there’s a barely larger threat of hepatotoxicity within the pregnant girl (see additionally part Warnings and Precautions).
    • Suggestion: Not treating tuberculosis throughout being pregnant is extra dangerous for the mom and baby (together with untimely start and low start weight) than treating it. Hyzyd can be utilized throughout being pregnant. Due to the elevated threat of neuropathy in pregnant ladies, pyridoxine (vitamin B6) also needs to be given: 20 mg 1×/day. Within the absence of indicators of lively tuberculosis, delay prophylactic use of isoniazid till after being pregnant if doable.

  2. Lactation
    • Isoniazid passes into breast milk in comparatively giant portions (focus equal to maternal plasma), however antagonistic results within the toddler have by no means been reported.
    • Suggestion: Can be utilized. Nevertheless, pay attention to doable liver toxicity within the toddler. Based on therapy guideline NVALT: attributable to elevated threat of neuropathy in breast-feeding ladies, additionally give pyridoxine (vitamin B6): often 10-20 mg 1×/day. Breastfeeding by ladies with a co-infection with HIV is suggested in opposition to; that is to stop transmission of HIV.

  3. Contraindications
    • acute liver illness equivalent to viral hepatitis and symptomatic hepatitis
    • severe isoniazid-associated liver harm, or severe Hyzyd-associated antagonistic occasions within the historical past, equivalent to:
      • fever
      • chills
      • rheumatic signs

Isoniazid Drug Interactions

Rifampicin, halothane, alcohol and likewise aminosalicylic acid improve the danger of hepatotoxic reactions. Co-administration with corticosteroids might lower plasma ranges of Hyzyd by rising metabolic or renal clearance; adjustment of Hyzyd dosage could also be required.

Hyzyd might improve plasma ranges of carbamazepine to generally poisonous ranges; with concomitant use, monitor plasma ranges of carbamazepine and search for early indicators of carbamazepine intoxication equivalent to:

  • headache
  • ataxia
  • somnolence
  • confusion
  • blurred imaginative
  • prescient
  • vomiting

Phenytoin plasma ranges may additionally improve, this appears to be particularly necessary with gradual acetylators. As well as, using isoniazid has been related to a rise in phenytoin plasma ranges, which appears to be particularly necessary with gradual acetylators. 

Isoniazid has gentle to reasonable MAO-inhibitory properties. Use warning when combining with serotonergic medicinal merchandise equivalent to serotonin reuptake inhibitors and test for indicators of serotonin syndrome when combining. Keep away from meals excessive in:

  • tyramine or histamine
  • attributable to inhibition of monoamine oxidase and histaminase
  • meals containing tyramine or histamine might trigger:
    • hypertension
    • tachycardia
    • palpitations
    • headache
    • extreme flushing
    • nausea

Isoniazid Dosage

  1. Remedy of tuberculosis (based on Tuberculosis Handbook 2019, KNCV Tuberculosis Fund)
    • Adults and kids > 25 kg physique weight
      • Intensive section: 5 mg/kg physique weight 1×/day (max. 300 mg day by day).
        • Remedy period: for two months, adopted by the continuation section. Customary therapy is together with rifampicin, pyrazinamide and ethambutol.
      • Continuation section: 5 mg/kg physique weight (max. 300 mg day by day). In commonplace therapy together with rifampicin.
        • With intermittent therapy: a dose of 15 mg/kg 3 times per week (max. 900 mg day by day) is feasible.
        • Remedy period: for no less than 4 months; preceded by roughly 2 months of steady remedy at 5 mg/kg per day. If a sputum tradition stays optimistic after two months of therapy and there may be cavity formation initially of therapy, the continuation section is prolonged to 7 months (whole therapy is then 2+7 months). In case of meningitis tuberculosis, additionally take into account extending therapy to 9 months. In instances of meningitis tuberculosis, as with pericarditis tuberculosis, the advice is so as to add corticosteroids.
    • Kids ≤ 25 kg physique weight
      • 10 (with a variety of 7-15) mg/kg physique weight 1×/day (max. 300 mg day by day). The fundamental ideas of therapy are the identical as in adults, excluding meningitis tuberculosis and osteoarticular tuberculosis for which 9-12 months of therapy is really useful.

  2. Tuberculous meningitis
    • Based on the producer: 10-30 mg/kg physique weight/day in 2-3 doses (steady therapy).
    • Remedy period: in instances of meningitis tuberculosis, the continuation section is prolonged to 7 months (whole therapy is then 2+7 months). The advice is so as to add corticosteroids as nicely. 

  3. Remedy of latent tuberculosis an infection (LTBI)
    • Adults
      • The dosages are the identical as for lively tuberculosis.
      • Remedy is aimed toward stopping lively tuberculosis within the affected person on the one hand, and stopping the particular person with LBTI from changing into an infectious supply and thus spreading tuberculosis on the opposite.
      • Period of therapy: The usual guideline is 6 months isoniazid or 3 months isoniazid and rifampicin. If the contaminated contact(s) have confirmed resistance to isoniazid, however are delicate to rifampicin: 4 months of rifampicin. Within the occasion of significantly impaired mobile immunity: earlier than (or throughout) anti-TNF-α remedy, or within the occasion of co-infection with HIV, notably if the CD4 depend is low, or if immunosuppressive treatment is used attributable to organ transplantation; on this case therapy for 9 months is really useful. This therapy period also needs to be utilized if there are fibrotic abnormalities on the chest X-ray which can be in line with previous tuberculosis that has by no means been handled; or 4 months together with rifampicin.
    • Kids
      • The WHO guideline recommends 10 mg/kg physique weight for LBTI youngsters. Within the case of monotherapy with isoniazid, it considerations a therapy period of 6 mnd. or together with rifampicin for 3 mnd. The selection of medicine and period of LTBI therapy in youngsters is similar as in adults. The dose of isoniazid for kids < 25 kg is 10 mg/kg physique weight.

  4. Major prophylaxis
    • Adults and kids ≥ 5 years with decreased resistance
      • In case of impaired resistance (e.g. HIV an infection (with low CD4 depend), TNF-α blocking or use of immunosuppressive medicine) and if a TB an infection shouldn’t be reliably demonstrated/might be demonstrated and after shut contact with a sputum ZN-positive affected person: apply full preventive therapy. Remedy period 9 months, or if isoniazid is mixed with rifampicin; 4 months.

  5. Kids from 6 months to five years
    • Begin as quickly as it’s identified that there was shut contact with a affected person with “open tuberculosis”, even when the tuberculin pores and skin take a look at is unfavorable and no matter whether or not the kid has been vaccinated with BCG.
    • Period of therapy: The first prophylaxis might be discontinued if after 2 months, on the second spherical of the contact investigation, there isn’t a proof of LTBI.

  6. Infants as much as 6 months.
    • The sensitivity of assessments to detect LTBI is decrease; a choice could also be made to present full preventive therapy (often 4 months Hyzyd and rifampicin).

  7. Diminished renal operate: Hyzyd is eradicated by haemodialysis and peritoneal dialysis; due to this fact administer instantly after dialysis. In renal impairment with out dialysis, no dose adjustment is required, however test for antagonistic reactions.
  8. Decreased hepatic operate: dosage fastidiously based on plasma degree.
  9. Administration
    • Drink or pill: take these no less than 1 hour earlier than or 2 hours after the meal. In case of abdomen complaints, these could also be taken throughout meals. The tablets might be divided into equal doses.
    • Intravenous injection: administer as a gradual i.v. injection (3-5 min) or as an i.v. infusion dissolved in sodium chloride resolution 0.9% (in 15 min).

Signs of Overdose

  • Pupil dilation
  • visible hallucinations
  • peripheral neuropathy
  • convulsions
  • coma
  • extreme metabolic acidosis
  • acetonuria
  • hyperglycaemia

Proper Usage of Isoniazid

Administer Hyzyd i.v. as quickly as doable in an quantity equal in grams to the quantity of Hyzyd ingested. The speed of administration is 500 mg/min. At an unknown dose, the Isoniazid dosage:

  • in adults is 5 g;
  • in youngsters 70 mg/kg (max. 5 g).

In case of persistent convulsions or the incidence of coma repeat Hyzyd each 5-20 minutes till no convulsions happen. Isoniazid administration might stop isoniazid-induced coma. In case of convulsions and/or extreme deterioration of liver operate lasting longer than 24 hours, additionally use haemodialysis, as a result of if not used, the metabolism of isoniazid decreases and the T1/2could also be extended significantly. The usage of phenytoin in instances of convulsions needs to be prevented, amongst different issues due to CYP2C9 inhibition by Hyzyd.

Isoniazid Precautions

Watch out with:

  • epilepsy or different neurological problems;
  • alcoholics;
  • AIDS sufferers;
  • severely impaired renal operate;
  • diabetes mellitus;
  • persistent liver illness (e.g. hepatitis);
  • G6PD deficiency (attributable to threat of haemolysis).

Liver operate: Monitor for signs of hepatitis:

  • nausea
  • vomiting
  • weak point
  • jaundice
  • darkish urine
  • fever
  • rash
  • paraesthesias

Decide serum transaminase (ASAT, ALAT) and bilirubin ranges initially of remedy. Common checking of those ranges throughout therapy is really useful. Throughout being pregnant, test each 2 weeks for the primary 8 weeks, then month-to-month thereafter. Cease administration in case of hypersensitivity reactions and in case of extreme or progressive hepatic impairment (ASAT and/or ALAT > 5× ULN or in case of > 3× ULN and complaints; quickly cease all tuberculosis medicines. The transaminases often normalize in hepatitis induced by Hyzyd and/or rifampicin 10-14 days after cessation of remedy. Resume the possibly hepatotoxic medicine one after the other when the enzyme ranges have dropped to < 2× ULN. Session with a tuberculosis knowledgeable is often advisable if the discontinuation/resumption of tuberculosis medicine shouldn’t be identified; and likewise in case of rifampicin monoresistance. Sufferers with persistent liver illness or extreme renal impairment usually tend to expertise antagonistic reactions.

Pyridoxine prophylaxis (vitamin B 620 mg day by day) needs to be utilized in adults at a dose > 5 mg/kg per day:

  • in gradual acetylators
  • in renal dysfunction
  • diabetes mellitus
  • within the aged
  • HIV-infected individuals
  • alcoholics
  • malnourished youngsters

The excipient propylene glycol, within the drink, might trigger severe uncomfortable side effects with extended use and/or use of excessive doses, particularly in instances of decreased metabolism, equivalent to in younger youngsters. 

Hyzyd Side Effects

  • Hepatitis
  • Poisonous epidermal necrolysis
  • Elevated serum transaminase ranges
  • Gynaecomastia
  • Hyperglycaemia
  • Neurotoxic reactions:
    • peripheral neuropathy
    • pyridoxine deficiency
    • optic neuritis
    • convulsions
    • psychological adjustments
    • muscle twitching
    • dizziness
    • headache
    • ataxia
    • stupor
    • poisonous encephalopathy
  • Hypersensitivity reactions
    • fever
    • different pores and skin reactions
    • vasculitis
    • lymphadenopathy
  • Hypotension
  • Optical atrophy
  • Haematological reactions
    • agranulocytosis
    • eosinophilia
    • thrombocytopenia
    • anaemia
  • Gastrointestinal problems
    • nausea
    • vomiting
    • dry mouth
    • epigastric discomfort
  • Pancreatitis
  • Metabolic acidosis
  • Pellagra
  • Alopecia
  • Rheumatic signs, paraesthesia, muscle weak point


Information concerning psychotic disorders, included within the review of Isoniazid, is used for the informative features exclusively as well as should not be thought-about to alternative to licensed healthcare or referral of the well being treatment distributor.


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Frequently asked questions

  • What is Isoniazid Hyzyd?

    Isoniazid is used for treating or preventing tuberculosis (TB). If you are using Isoniazid to treat TB, it should always be used along with another medicine. Isoniazid is an antibacterial. 

  • What to do if you miss a dose?

    If you miss a dose of Isoniazid, take it as quickly as potential. However, whether it is virtually time to your subsequent dose, skip the missed dose and return to your common dosing schedule. Do not double doses.

  • What if u take too much Hyzyd?

    If an overdose happens, name your physician or call your nearest hospital. You might have pressing medical care. You might also contact the poison management at your local hospital.

  • How to store Isoniazid?

    Store Isoniazid between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. 

  • What Should I Avoid While Taking Isoniazid?

    Avoid consuming alcohol or utilizing unlawful medicine when you are taking Hyzyd. They might lower the advantages (e.g. worsen your confusion) and improve hostile results (e.g. sedation) of the remedy.

  • What are the side effects of Isoniazid Hyzyd?

    The most common side effects includes clumsiness or unsteadiness, dark urine, loss of appetite, nausea or vomiting, numbness, tingling, burning, or pain in hands and feet, unusual tiredness or weakness and yellow eyes or skin.

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Last Updated on November 14, 2021 by Toni El Clikos

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