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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 exact way it works is not fully understood, but one of the most important effects seems to be stopping the bacteria from making mycolic acid in their cell walls. Isoniazid is simply efficient at dividing cells.

Isoniazid Drug Recommendation

The therapy of latent tuberculosis infection (LTBI) and the preventive therapy of individuals who’ve had close contact with an open-lung tuberculosis affected person, however, in whom no infection has been detected (main prophylaxis), consists of Hyzyd, rifampicin, or mixture of remedies. The usual therapy for active 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 increase the danger of hepatotoxic reactions. Co-administration with corticosteroids might lower plasma ranges of Hyzyd by increasing metabolic or renal clearance; adjustment of Hyzyd dosage could also be required.

With concomitant use, 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, 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 caution 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 possible in a quantity equal in grammes 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 the case of persistent convulsions or the incidence of coma, repeat Hyzyd every 5–20 minutes till no convulsions happen. Isoniazid administration might stop isoniazid-induced coma. Additionally, in the case of convulsions and/or extreme deterioration of liver function lasting longer than 24 hours, additionally use haemodialysis. As a result, if not used, the metabolism of isoniazid decreases and the T1/2 could also be significantly extended. Because Hyzyd blocks CYP2C9, phenytoin shouldn’t be used to treat seizures.

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).

Monitoring for signs of hepatitis in the liver:

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

Determine serum transaminase (ASAT, ALAT) and bilirubin levels before starting treatment. Common checking of those ranges throughout therapy is really useful. During pregnancy, you should test every two weeks for the first eight weeks and then once a month after that. In the event of hypersensitivity reactions or severe or progressive hepatic impairment (ASAT and/or ALAT > 5 ULN or > 3 ULN and complaints), discontinue all tuberculosis medications immediately. The transaminases often normalise in hepatitis induced by Hyzyd and/or rifampicin 10–14 days after cessation of remedy. Resume the possibly hepatotoxic medicines one after the other when the enzyme ranges have dropped to  2 ULN. A session with a tuberculosis knowledgeable is often advisable if the discontinuation/resumption of tuberculosis medicine shouldn’t be identified, and likewise in the case of rifampicin monoresistance. Sufferers with persistent liver illness or extreme renal impairment usually tend to experience antagonistic reactions.

Pyridoxine prophylaxis (vitamin B 620 mg day by day) needs to be utilised in adults at a dose of > 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, as 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 and should not be thought of as an alternative to licenced healthcare or referral from the well-being treatment distributor.


⚠Disclaimer of liability

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Frequently asked questions

  1. What is Isoniazid Hyzyd?

    Isoniazid is an antibacterial medication that can be prescribed for the treatment of tuberculosis (TB) as well as for the prevention of this disease. When isoniazid is used to treat TB, it is always prescribed in conjunction with another medication.

  2. What to do if you miss a dose?

    If you forget to take a dose of isoniazid, you should take it as soon as you remember. However, if it is almost time for your next dose, you should skip the dose you missed and go back to your regular dosing schedule. You should never double your doses.

  3. What if u take too much Hyzyd?

    In the event of an overdose, contact your primary care physician or the emergency room of the hospital closest to you; you may require immediate medical attention. If necessary, you may also get in touch with the hospital’s poison control centre.

  4. 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.

  5. What Should I Avoid While Taking Isoniazid?

    While you are taking Hyzyd, you should avoid drinking alcohol or using illegal drugs because doing so could reduce the benefits of the treatment (for example, it could make your confusion even worse) and increase the adverse effects (for example, it could make you more sedated).

  6. What are the side effects of Isoniazid Hyzyd?

    Clumsiness or unsteadiness, urine that is dark in colour, loss of appetite, nausea or vomiting, numbness, tingling, burning, or pain in hands and feet, unusual tiredness or weakness, and yellowing of the eyes or skin are the most common adverse effects of this medication.

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