Rifampicin + Isoniazid + Pyrazinamide: Brands, Price & Uses in Bangladesh

Rifampicin + Isoniazid + Pyrazinamide is a fixed-dose combination (FDC) of three first-line antitubercular drugs used in the treatment of tuberculosis (TB).

Established / Guideline-Supported Uses

• Active pulmonary tuberculosis - as part of the intensive (initial) phase of standard first-line short-course anti-TB chemotherapy, usually together with ethambutol, per WHO/CDC and national TB programme guidance, typically for the first 2 months of treatment.
• Active extrapulmonary tuberculosis (e.g., lymph node, pleural, and other forms), used as part of a complete first-line regimen under specialist guidance.

Important Notes on Use

• Rifampicin + Isoniazid + Pyrazinamide must always be used as part of a complete, physician-directed multi-drug anti-TB regimen (never as a stand-alone treatment), typically combined with a fourth drug (ethambutol), and given under Directly Observed Therapy (DOT) where available, to reduce the risk of treatment failure and drug-resistant TB.
• After the intensive phase, treatment is usually continued with a two-drug regimen (rifampicin + isoniazid) for a further 4 months as part of the standard 6-month course; see Duration of Treatment.
• Use in drug-resistant TB, latent TB infection, or non-tuberculous mycobacterial disease is not supported and is outside the approved use of this combination.

Dosing of Rifampicin + Isoniazid + Pyrazinamide is weight-based and must be individualized and supervised by a physician or TB treatment programme.

Adult Dosing (typical weight-band approach, once daily)

The exact number of tablets is determined from the product-specific weight-band chart supplied with the formulation dispensed (tablet strengths vary by manufacturer). Treatment is given once daily, on an empty stomach, during the intensive phase (usually the first 2 months), ideally under Directly Observed Therapy (DOT). See Duration of Treatment for the full course.

Pediatric Dosing

Weight-band dosing using pediatric fixed-dose combination tablets is used per WHO guidance; see Pediatric Uses.

Renal / Hepatic Adjustment

No routine dose adjustment of this FDC is established for mild-to-moderate renal impairment; caution and specialist dosing guidance is needed in significant renal or hepatic impairment (see Precautions and Use in Special Populations). This combination is contraindicated in severe active liver disease.

Common and serious adverse effects reported with Rifampicin + Isoniazid + Pyrazinamide include:

Common

• Gastrointestinal upset (nausea, vomiting, loss of appetite, abdominal discomfort)
• Orange-red discoloration of urine, tears, sweat, and saliva (harmless, expected with rifampicin - may permanently stain soft contact lenses)
• Headache, dizziness

Less Common but Important

• Hepatotoxicity - elevated liver enzymes, jaundice (see Precautions and Warnings)
• Peripheral neuropathy (tingling/numbness in hands and feet), mainly from isoniazid
• Hyperuricemia and arthralgia/joint pain (from pyrazinamide)
• Skin rash, pruritus
• Flu-like syndrome (fever, chills, myalgia) with rifampicin, especially with intermittent dosing

Rare but Serious

• Severe hepatitis/hepatic failure
• Severe hypersensitivity reactions (Stevens-Johnson syndrome, thrombocytopenia, hemolytic anemia, acute kidney injury) - rare

Seek prompt medical attention for yellowing of the eyes/skin, dark urine, unexplained fatigue, persistent vomiting, or signs of severe skin reaction.