Treatment training manual

TB and ARV drug interactions summary

Table: TB drug side effects and interactions

Drug Side effects Potential drug interactions Notes
ethambutol Rash, joint pain, gut upset, fever, headache, dizziness, eyesight problems. Antacids. Check eyesight often.
isoniazid Gut upset, loss of appetite, fever, rash, liver problems, peripheral neuropathy. Phenytoin, antacids, alcohol, steroids. Take on an empty stomach. Take pyridoxine (vitamin B6) to prevent peripheral neuropathy. Monitor liver function.
pyrazinamide Gut upset, fever, rash, joint pain, hepatitis, gout, light sensitivity. None. Monitor liver function.
rifampicin Gut upset, rash, fever, orange urine/tears/saliva, light sensitivity, liver problems, acute renal failure PIs, NNRTIs, ‘-azole’ anti-fungal drugs, oral contraceptives, methadone, dapsone. Take on an empty stomach. Do not use with PIs or nevirapine.
rifabutin Gut upset, rash, eye inflammation, blood cell changes, joint pain, orange urine/tears/saliva, liver function changes, fever. PIs, NNRTIs, fluconazole, oral contraceptives, steroids, methadone. Avoid wearing soft contact lenses as they can become discolored. Avoid nevirapine.

Table: Which TB drugs go with different ARVs?

ARV Rifampicin Rifabutin Notes
nukes Use Use no interactions
efavirenz Use Use rifampicin: efavirenz dose usually 800mg daily – rifabutin: 450 or 600mg daily or 600mg twice weekly recommended
nevirapine Do not use Do not use high risk of liver toxicity
nelfinavir Do not use Use rifabutin: 150mg daily recommended
boosted PIs Do not use Use rifabutin: 150mg daily or 300mg twice weekly recommended

Last updated: 22 July 2009.