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

Rifampicin + Isoniazid + Pyrazinamide + Ethambutol is a fixed-dose combination (FDC) of four first-line antituberculardrugs used together for the treatment of tuberculosis (TB).

Established / Guideline-Supported Uses

• Intensive-phase treatment of active pulmonary and extrapulmonary tuberculosis intreatment-naive (new) adult and pediatric patients, as the standard first-line four-drug regimenrecommended by the World Health Organization (WHO), typically given daily for 2 months, ideallyunder directly observed therapy (DOT) where available.
• Used as part of a complete anti-TB treatment course, usually followed by a continuation phasewith a reduced-drug combination (e.g., rifampicin plus isoniazid) for a further 4 months, asdetermined by the treating physician based on national/WHO TB guidelines.

Not Indicated For

• Latent TB infection prophylaxis (single-agent isoniazid preventive therapy is used instead).
• Drug-resistant TB (multidrug-resistant/rifampicin-resistant TB) without modification of theregimen by a TB specialist, since Rifampicin + Isoniazid + Pyrazinamide + Ethambutol contains rifampicin and isoniazid to which resistancemay exist.

Rifampicin + Isoniazid + Pyrazinamide + Ethambutol must only be used under the supervision of a physician experienced in TB management.

Dosing of Rifampicin + Isoniazid + Pyrazinamide + Ethambutol is based on body weight and must be individualized and supervised by aphysician familiar with national/WHO tuberculosis treatment guidelines. The figures below reflecttypical WHO-recommended weight-band dosing for the standard intensive-phase 4-drug regimen; theexact number of tablets depends on the specific tablet strength dispensed.

Adult Dosing (by body weight, WHO weight-band approach)

Pediatric Dosing

Children are dosed using weight-band-specific pediatric fixed-dose combination formulations(with lower per-tablet strengths, per WHO pediatric dosing charts), under specialist supervision.See Pediatric Use.

Duration

Rifampicin + Isoniazid + Pyrazinamide + Ethambutol is typically given once daily for the 2-month intensive phase of a standard 6-monthtreatment course, followed by a continuation phase with fewer drugs, as prescribed. See Durationof Treatment.

How to Take

• Take the full dose at one time, once daily, preferably on an empty stomach (at least 1 hourbefore or 2 hours after food) with a full glass of water, as food can reduce absorption ofrifampicin.
• Ideally taken under directly observed therapy (DOT) as recommended by national TB programs.

Complete the full prescribed course of Rifampicin + Isoniazid + Pyrazinamide + Ethambutol exactly as directed by your physician;do not stop, extend, skip doses, or share this medicine with others without medical advice, as anincomplete or interrupted course risks treatment failure and the development of drug-resistanttuberculosis.

Because Rifampicin + Isoniazid + Pyrazinamide + Ethambutol combines four active drugs, side effects may arise from any single component.Report any new or worsening symptom to your physician promptly.

Common

• Loss of appetite, nausea, vomiting, abdominal discomfort
• Orange-red discoloration of urine, sweat, tears, and saliva (harmless effectof rifampicin, but can permanently stain soft contact lenses)
• Joint pain/arthralgia (related to pyrazinamide-induced hyperuricemia)
• Headache, dizziness

Less Common but Clinically Important

• Hepatotoxicity (raised liver enzymes, hepatitis, jaundice) — see Precautionsand Warnings for monitoring advice.
• Peripheral neuropathy (numbness/tingling in hands and feet), related toisoniazid; often prevented with pyridoxine (vitamin B6) supplementation.
• Visual disturbances (blurred vision, reduced visual acuity, color visionchanges/red-green color blindness, visual field defects) related to ethambutol — see Precautionsand Warnings.
• Skin rash, itching, and other hypersensitivity reactions.
• Flu-like syndrome (fever, chills, myalgia) — reported mainly with intermittent rifampicindosing schedules.

Rare but Serious

• Severe hepatic failure, thrombocytopenia, hemolytic anemia, acute kidney injury,Stevens-Johnson syndrome/toxic epidermal necrolysis (all rare).