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Suggest Dosage For Isoniazid, Pyrazinamide And Ethambutol

Posted on Mon, 15 May 2017

Question: hi sir... my name is rajesh.... i was diagnosed with lymph node tb.. in february 2017... from two months i am taking AKT4 tablet... my weight is 68 kgs... i consulted another doctor and he said that i am taking inadequate dosage... in AKT 4-rifamin-450mg
Isoniazid-300mg
ethambol-800mg
Pyrazinamide-1500mg
now he is telling me to change other tablets macox plus-600mg,ethambol-1000mg,pyzina-750mg-2 tablets.... is it ok to change tablets after 2 months of cotinution of AKT4?
I am weight 68 kg... means rifamin should be 600mg?

Answered by Dr. Drkaushal85 (37 minutes later)

Brief Answer:
Yes, rifampicin should be 600mg.

Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern. I have gone through the images you have attached.
Yes, dose of Anti tubercular drugs depends on weight of patient.
AKT 4 is sufficient for patients weighing between 30-60 kgs.
For patients above 60kgs, AKT 4 will be under dose.
For your weight 68kgs, appropriate dosing is as follows.
1. Rifampicin 600mg
2. Isoniazid 300mg
3. Pyrazinamide 1500mg
4. Ethambutol 1200mg
Treatment of tuberculosis in divided in two phases.
1. Intensive phase for 2 months comprised of four drugs (rifampicin, isoniazid, pyrazinamide, ethambutol)
2. Continuation phase for 4 months comprised of two drugs (rifampicin and isoniazid).
So you have completed intensive phase (IP).
Now further prolongation of IP depends on your symptoms.
So please let me know
1. Lymphnode size is decreased or static or increasing?
2. Do you have cervical lymphnode?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (1 hour later)

yes sir... i started taking AKT 4 in february 14.. means this month april 14 its 2 months.... lymphnode is very small one sir... around 1.5 cm like that.. so its difficult to say its decreased or static... because its very small so i cant tell it.. but not increased...
i am sending position of that lymph node by uploading it... i rounded its position.
its below throati visited general medicine department.. didnt visited pulmanology department... they said i need to took medicines for around 9 months.. because its not related to lungs... so if tb came to other parts of body... you need to take medicines for 9 months.... they said after taking AKT 4 for 3months.. they will change the tablets... also i am taking medicines like rifamin in morning 8 am.... isozonamid+ethambol tablet in morning 10 am and benadon 40mg along with it... and 2 pyrazinamide tablets after lunch around 1:30 pm.... if i took all tablets together my stomach not accepting it.. like lot of dwosiness, nausia, weakness like that.. so i am using them around 2 hours gap... if i took those tablets like that i am feeling some what ok :)After 2 months... which tablets do i need to take? is it not reverted right? i am 24 years sir... and still studying MTECH... not even seen much life... still in college days ... what if it turns into MDR TB? am i going to fight it? i dont know.... lot of depression... sorry sir.. i am gone into flow... anyway am i going to get cured right?
i am taking pills regularly... but by changing times.. is it ok?

Answered by Dr. Drkaushal85 (19 minutes later)

Brief Answer:
No need to worry. It is 100% curable.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
First of all, don't worry too much and don't feel depressed.
TB is 100% curable. You just need to take your time drugs timely and for sufficient duration.
It is absolutely fine to split doses in anti tubercular drugs. So nothing to worry about it.
In my opinion, you should start Rcinex 600/300 once a day (in morning before breakfast).
Rcinex 600/300 is having rifampicin 600mg and isoniazid 300mg.
Take this drug daily for 4 months along with benadon.
Get done repeat ultrasound of neck after total 6 months of treatment.
Don't worry, you will be alright. Eat high protein diet like pulses, eggs, vegetables, milk and milk products.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (1 hour later)

thank you so much kausal bhayya.... after talking with you.. i feel kind of relaxed.... thank you so much sir.... :)

Answered by Dr. Drkaushal85 (4 minutes later)

Brief Answer:
I am glad that my advice is helping you.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I am glad that my advice is helping you.
It's always encouraging for doctors to hear positive feedback from patients.
Hope I have solved your query. If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (14 days later)

sir, i buy R-cinex 600 tablet... but it contains 3 tablets in one strip.. like AKT 4 these three also taken together? or each tablet of it contain rifamin-600mg & isoniazid 300mg?
medical shop keeper saying that all 3 tablets together is 600mg...so i confused... please clarify this..... i am sending pic of it too... uploading it see sir

Answered by Dr. Drkaushal85 (12 minutes later)

Brief Answer:
There is no picture of Rcinex tablet.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
Sorry to say but there is no picture of Rcinex tablet in your attachments.
Rcinex is Rifampicin and isoniazid. It is single tablet, not pack of three tablets.
So please send me picture before starting Rcinex.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Drkaushal85 (18 hours later)

Sir I uploaded it's pic... Check it once... Lot of medical shop keepers saying that it's a kit.. all 3 will be 600 mg... Not single tablet.... I am so confused
Sir can I use combination of R-cin-150 + R-cinex-450?

Answered by Dr. Drkaushal85 (37 minutes later)

Brief Answer:
Sorry to say but there is no picture in attachment.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
Sorry to say but there is no picture in your attachments.
Kindly attach picture and send it to me.
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Drkaushal85 (50 minutes later)

Now check it once sir.... My profile showing that I uploaded it's pics.... Sir I can use R-cin 150 & R-cinex 450 combination right.... I can't take all those 3 tablets of R-cinex 600 :(

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
Take single tablet of Rcinex 600 once daily.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I have seen the attachment.
You are having Rcinex (600/300). This contains Rifampicin 600mg and isoniazid 300mg.
So take Rcinex 600 single tablet in the morning.
No need to take all 3 tablets or extra Rifampicin 150mg.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Kampana