China is a big country with tuberculosis, and the number of patients ranks the third in the world, after India and Indonesia. Tuberculosis seriously endangers people's health, and is one of the major diseases that our country focuses on prevention and control.
Tuberculosis is a chronic infectious disease that requires long-term multi drug treatment. In the process of long-term treatment, patients often need to use other drugs at the same time due to the combination of other diseases, which increases the risk of drug interaction, leading to increased adverse drug reactions or reduced efficacy. Common complications include common cold, gastrointestinal diseases, hypertension, coronary heart disease, diabetes, fungal diseases, etc.
Frontline anti tuberculosis drugs have significant advantages in efficacy and safety, and are recommended by the World Health Organization as the preferred anti tuberculosis drugs, including isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin, rifampicin, and rifampicin. 90% of tuberculosis patients take first-line anti tuberculosis drugs. When taking anti tuberculosis drugs, attention should be paid to the interactions with other disease drugs.
1、 Anti tuberculosis drug isoniazid: It is a synthetic antibacterial drug with bactericidal effect, which is effective against Mycobacterium tuberculosis, mainly bacteria in the growth and reproduction period. Its mechanism of action involves inhibiting the synthesis of mycolic acid and causing cell wall rupture.
1. Aspirin: it can partially acetylate isoniazid, reduce the absorption and excretion of isoniazid, thus reducing the efficacy of isoniazid. Therefore, when tuberculosis patients need to use it together, they should not take it at the same time.
2. Acetaminophen: increases the amount of toxic metabolites formed by isoniazid, thereby increasing liver and kidney toxicity.
3. Aminophylline: Isoniazid can inhibit the metabolism of aminophylline in the liver, leading to an increase in blood drug concentration. Therefore, when isoniazid is used in combination with it, the dosage of aminophylline should be adjusted appropriately.
4. Gastrointestinal drugs: Isoniazid forms chelates with metal ions such as calcium, magnesium, iron, aluminum, bismuth, etc. in the gastrointestinal tract, which affects absorption and reduces efficacy. Clinical practice should avoid taking magnesium trisilicate, aluminum hydroxide, ferrous sulfate, etc. at the same time. If they must be used in combination, attention should be paid to the time of use, with a recommended interval of at least 2 hours.
5. Anticholinergic drugs: isoniazid can enhance the adverse reactions of anticholinergic drugs such as atropine and probenxin, such as increased intraocular pressure and urinary retention in elderly patients. Close observation is required when combined with isoniazid.
6. Vitamin B6: Due to the structural similarity between isoniazid and vitamin B6, isoniazid hinders the utilization of vitamin B6 or increases the excretion of both in urine, leading to vitamin B6 deficiency and the occurrence of peripheral neuropathy. Therefore, patients who use isoniazid for a long time should take vitamin B6 in addition.
8. Carbamazepine: Isoniazid can inhibit the metabolism of carbamazepine, increase its blood concentration, and cause toxic reactions;
9. Antifungal drugs such as ketoconazole and miconazole: When used in combination with isoniazid, isoniazid can reduce the blood concentration of both drugs, so caution should be exercised.
10. Glucocorticoids: When isoniazid is combined with glucocorticoids such as prednisolone, it can increase the metabolism and excretion of isoniazid in the liver, leading to a decrease in isoniazid blood concentration and affecting the therapeutic effect.
11. Alcohol: It can easily cause liver toxicity reactions induced by isoniazid and accelerate its metabolism. Therefore, it is necessary to adjust the dosage of isoniazid and closely observe the signs of liver toxicity. Avoid alcoholic beverages during medication.
2、 Rifampicin class anti tuberculosis drugs: Rifampicin class includes rifampicin, rifampicin, and rifampicin, among which rifampicin has the strongest anti tuberculosis effect on Mycobacterium tuberculosis. It can interfere with RNA synthesis, thereby affecting the growth and reproduction of Mycobacterium tuberculosis, ultimately leading to its death.
1. Alcohol: Drinking alcohol can increase the incidence of rifampicin induced liver toxicity and increase the metabolism of rifampicin. It is necessary to adjust the dosage of rifampicin and closely observe whether patients have liver toxicity.
2. Sulfonylurea hypoglycemic drugs: There is a significant interaction with rifampicin, and when used in combination, the patient's blood glucose level must be dynamically monitored.
3. Blood pressure lowering drugs: There is a significant interaction with rifampicin, and when used in combination, the patient's blood pressure level must be dynamically monitored.
4. Oral contraceptives: Rifampicin can promote the metabolism of estrogen or reduce its enterohepatic circulation, reducing the effectiveness of oral contraceptives, leading to irregular menstruation, menstrual bleeding, and unplanned pregnancies. Therefore, when taking rifampicin, other contraceptive methods should be used instead.
5. Rifampicin can also weaken the efficacy of the following drugs: (1) Aminophylline and Theophylline; (2) Adrenal cortex hormone; (3) Antifungal drugs such as miconazole or ketoconazole; (4) Verapamil, digoxin glycosides, simvastatin, and clofibrate; (5) Anticoagulants: coumarin or indanedione derivatives; (6) Stability, etc. Combined use with rifampicin can significantly reduce the blood drug concentration of these drugs, and even lose their efficacy.
3、 Anti tuberculosis drug ethambutol: ethambutol interferes with the biosynthesis of cell walls, leading to the death of Mycobacterium tuberculosis. Antacids containing aluminum hydroxide are recommended to be taken at least 4 hours after taking ethambutol, as they can inhibit the absorption of ethambutol. The combination of ethambutol and aminoglycoside antibiotics and other neurotoxic drugs can cause neurotoxicity to overlap, greatly increasing the probability of optic neuritis or peripheral neuropathy.
4、 Antituberculotic drug pyrazinamide: pyrazinamide interferes with the metabolism of Mycobacterium tuberculosis, ultimately leading to its death. When pyrazinamide is used in combination with allopurinol, colchicine, and probenecid, it can increase blood uric acid levels, thereby reducing the efficacy of these anti gout drugs; Combined use with nicotinamide can increase adverse reactions. Pyrazinamide combined with diuretics, low-dose aspirin or niacin can aggravate uric acid retention.
5、 Antituberculotic drug streptomycin: Streptomycin destroys the integrity of the cell membrane of Mycobacterium tuberculosis, ultimately inhibiting or killing the bacterium. The toxicity of streptomycin increases when used in combination or sequentially with erythromycin, chloramphenicol, vancomycin, cisplatin, aspirin, indomethacin, chloroquine, furosemide, alkaline drugs (such as sodium bicarbonate, aminophylline, etc.), mannitol, amphotericin B, colistin, polymyxin, cephalosporin antibiotics, or other aminoglycoside antibiotics; Combined use with neuromuscular blocking drugs (such as muscle relaxants, general anesthetics, sleeping pills, etc.) can cause respiratory paralysis and respiratory arrest.
Therefore, patients with underlying diseases should inform their doctors of their condition before starting anti tuberculosis treatment, so that doctors can adjust medication reasonably.