GA TB Reference Guide

Adverse Reactions	Gastrointestinal (GI) upset, hepatic enzyme elevations, hepatitis, peripheral neuropathy, mild effects on central nervous system (CNS), drug interactions
Monitoring	Order baseline hepatic chemistry blood tests (at least AST or ALT) for patients with specific conditions: Living with HIV, liver disorders, postpartum period (<3 months after delivery), regular alcohol use, injection drug use, or use of medications with known possible interactions. [Some clinicians prefer to obtain baseline tests on all adults]. Repeat measurements if: baseline results are abnormal client is at high-risk for adverse reactions client has symptoms of adverse reactions
Comments	Hepatitis risk increases with age and alcohol consumption. Pyridoxine can prevent isoniazid-induced peripheral neuropathy.

Adverse Reactions	Orange discoloration of body fluids (secretions, tears, urine) , GI upset, drug interactions, hepatitis, thrombocytopenia, rash, fever, influenza-like symptoms, hypersensitivity reaction i Many drug-drug interactions
Monitoring	Complete blood count (CBC), platelets and liver function tests. Repeat measurements if: baseline results are abnormal client has symptoms of adverse reactions Prior to starting RIF or RPT: need to carefully review all medications being taken by the patient with LTBI and ensure there is no contraindication to the use of that medication and RIF, RBT or RPT.
Comments	Hepatitis risk increases with age and alcohol consumption. Rifampin monotherapy is associated with lower risk of hepatotoxicity compared to INH monotherapy for patients being treated for LTBI. Need to carefully review for possible drug-drug interactions prior to starting RIF, RBT or RPT and ensure there are no contraindications to these agents prior to using them for the treatment of LTBI.

Adverse Reactions	See adverse effects associated with isoniazid alone and a rifamycin alone (see above)
Monitoring	Complete blood count (CBC), platelets and liver function tests. Repeat measurements if: baseline results are abnormal client has symptoms of adverse reactions Prior to starting RIF or RPT: need to carefully review all medications being taken by the patient with LTBI and ensure there is no contraindication to the use of that medication and RIF or RPT.
Comments	Approximately 4% of all patients using 3HP experience flu-like or other systemic drug reactions, with fever, headache, dizziness, nausea, muscle and bone pain, rash, itching, red eyes, or other symptoms. Approximately 5% of persons discontinue 3HP because of adverse events, including systemic drug reactions; these reactions typically occur after the first 3–4 doses, and begin approximately 4 hours after ingestion of medication.