Rifampicin + Isoniazid + Pyrazinamide + Ethambutol - Oral

Rifampicin, Isoniazid, Pyrazinamide and Ethambutol are combined in this medicine.

Rifampicin + Isoniazid + Pyrazinamide + Ethambutol is an antibiotic. It is used to treat an infection known as tuberculosis (TB).

Take Rifampicin + Isoniazid + Pyrazinamide + Ethambutol exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.

Take it on an empty stomach, at least 1 hour before or 2 hours after a meal. Try to take it at the same time each day.

The dose of this medicine will be decided by your doctor. Your doctor will advise you on the course of treatment depending on the severity of your infection and response to the medication.

Take Rifampicin + Isoniazid + Pyrazinamide + Ethambutol at regular intervals. Do not skip any doses. You must complete the entire course of this medicine. If you don't, the infection will not be properly controlled.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.

DO NOT double a dose under any circumstances.

If you often forget to take your medicine, let your doctor and pharmacist know.

Do not take Rifampicin + Isoniazid + Pyrazinamide + Ethambutol if you ever had an allergic reaction (e.g. rashes, breathlessness, swollen eyes) to this medicine or any of its ingredients.

Alert your doctor if you have the following conditions:

• history of liver inflammation due to use of other medication
• porphyria (an inherited disorder that causes skin or nervous system abnormalities)
• gout (high uric acid level in the blood)
• severe kidney disease

as Rifampicin + Isoniazid + Pyrazinamide + Ethambutol may not be suitable for you.

Do not take Rifampicin + Isoniazid + Pyrazinamide + Ethambutol with medicines used for fungal infection and HIV infection. Please see the section "Can I take this with other medicines?" below for more information.

Inform your doctor if you have the following conditions:

• eye problems
• history of gout
• diabetes
• fits or seizures
• liver disease
• moderate kidney disease

Let your doctor know if you are pregnant or breastfeeding.

Be sure to check with your doctor or pharmacist before giving Rifampicin + Isoniazid + Pyrazinamide + Ethambutol to the elderly or undernourished individual (person lacking nutrients or not getting enough food). Elderly people and undernourished individuals may be more sensitive to the side effects.

Notify your doctor if you consume large amounts of alcohol or if you are a frequent drinker.

Avoid wearing contact lenses during treatment as this medicine may permanently stain the contact lenses.

If you are going to have certain laboratory tests (e.g. blood folate or vitamin B₁₂ test), inform your doctor that you are taking this medicine.

Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.

Routine tests (e.g. liver and kidney function, complete blood count, blood uric levels, eye examination) may be done before and during treatment with this medicine. Your doctor will advise you about how often you need to have these tests.

What must I do to prevent spreading TB to other people?

TB is spread through the air, especially when you cough, sneeze or laugh. Always cover your mouth when you cough, sneeze or laugh. If you use tissue paper, seal it in a plastic bag before you throw it away. If you need to be around people for a long time, be sure to wear a mask that covers your mouth and nose to minimise the risk of passing the disease to other people.

You may still be able to infect others while undergoing treatment for TB. Your doctor may tell you to stay at home to avoid passing the disease to other people. You may need to sleep in a bedroom separate from your family members.

Be sure to finish the course of medication according to your doctor's instructions.

Rifampicin + Isoniazid + Pyrazinamide + Ethambutol may cause any of the following side effects: nausea, stomach pain, diarrhoea, bloatedness, drowsiness, dizziness, headache, muscle or joint pain, loss of appetite, and reddening of the face.

Your urine may look slightly red-orange in colour. This is normal while you are being treated with this medicine. It may also cause your saliva, stools, phlegm, tears, and sweat to change to red-orange in colour. This is harmless, do not be alarmed.

Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:

• yellowing of the skin or eyes, abdominal pain, dark coloured urine, tiredness, swelling in the legs and ankles
• rashes, breathlessness, swelling of the face, eyes or mouth
• unusual bleeding or bruising
• eye pain, blurred vision or other changes in vision
• tingling, numbness and pain usually in the hands and feet
• pain or difficulty in passing urine, change in how much urine is passed, blood in the urine

Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.

Do not take Rifampicin + Isoniazid + Pyrazinamide + Ethambutol with the following medicines:

• voriconazole (medicine to treat fungal infection)
• certain medicines for HIV infection e.g. atazanavir, saquinavir, fosamprenavir

Inform your doctor and pharmacist if you are taking any of these medicines:

• medicines that neutralise stomach acids
• birth control pills
• other medicines to treat fungal infection e.g. fluconazole, itraconazole, ketoconazole
• medicines for epilepsy (fits or seizures) e.g. phenytoin, carbamazepine
• blood-thinning medicines e.g. warfarin
• medicines for irregular heartbeat e.g. disopyramide, quinidine
• certain antibiotics e.g. clarithromycin, ciprofloxacin
• medicines for mood disorders e.g. haloperidol, clozapine
• medicines for high blood pressure e.g. diltiazem, verapamil, propranolol
• corticosteroids (anti-inflammatory medicines)
• strong painkillers e.g. methadone
• certain medicines to treat depression e.g. nortriptyline
• medicines for diabetes
• theophylline (asthma medicine)
• probenecid (medicine for gout)
• ciclosporin (medicine used in organ transplants or certain immune disorders)

This list does not include all medicines that may interact with Rifampicin + Isoniazid + Pyrazinamide + Ethambutol.

Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.

Avoid alcohol and other drinks that contain tyramine such as red wine and beer.

Avoid foods that are rich in tyramine, such as cheese, sausages, soya beans, fava beans, broad beans, and pickled foods like sauerkraut. Ask your doctor or dietitian about the types of food you should avoid.

Store in a cool, dry place away from the reach of children.

Medicines must not be used past the expiry date.