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What Causes Severe Headache After Taking Rifampicin And Isoniazid?

Posted on Thu, 29 Sep 2016

Question: Hi, we are a couple from XXXXXXX settled in UK. I had active pulmonary TB and so far medicines have worked. My wife had positive skin test and her chest x-ray was normal. We were also planning for IVF treatment. Doctor advised that it is better to treat latent TB first and then go for IVF. She was put on Rifampicin and Isoniazid. But after two weeks she developed severe headache, nausea and small skin rashes. Her headache was extreme. Doctor stopped her medicines for 10 days and restarted only Isoniazid. She took Isoniazid for two weeks and first two weeks she was fine. After two weeks she developed bumps on her body and those bumps became red rashes next day. Her body felt itchy.

My Questions are:

1> Is it important to complete Latent TB treatment before doing IVF?

2> What if she wants to abandon latent TB treatment from now onwards? Will her latent TB bacteria become resistant to drugs?

3> What if she stops treatment for now and do IVF and then start latent treatment again?

Awaiting quick response.

Thanks in advance.

Answered by Dr. Shashi Dangwal (1 hour later)

Brief Answer:
It is better to complete the tb treatment before IVF treatment.

Detailed Answer:
Hello XXXX,

Thanks for posting your query on HCM.

Here are the answers to your questions:

1. Yes it is better to complete the latent tb treatment before IVF for the higher success of IVF treatment.

2. Chances of developing resistant tb in her case should she develop active tb in future are higher as compared to a person developing active tb who has never been exposed to tb drugs in the past.

3. Though tb drugs are given during pregnancy if such a need arises but if possible it is better to complete the tb treatment before IVF one for the success of IVF and two to minimise the chances of any harmful effects on the foetus.

I hope this answers your query.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Shashi Dangwal (19 hours later)

Dear doctor, thanks for your reply. Sorry for too many questions in one go. If I send too many follow ups questions, HCM blocks some of them saying overuse.
I unferstood the importance of treating latent TB before IVF.
1) initially she was on Rifampicin and Isoniazid with pyrodoxine and she developed severe headache, nausea, little rashes after two weeks. Dr here stopped all med for 10 days and restarted isoniazid and pyridixine only. After taking two weeks she developed red rashes like hives all over body. No headache or nausea. Today new rashes developed but old are lighter now. Why she is developing rashes after two weeks of taking medicines? Why not on from beginning?
2) do you think these rashes are reaction to isoniazid?
3) if she is reacting to isoniazid what other option are there to treat her latent TB?
4)Dr here said to stop isoniazid and wait until rashes clear and then they will decide plan. Are these rashes serious?
5) what can be done to treat these rashes? Photo attached

Awaiting your reply. Thanks. .

Answered by Dr. Shashi Dangwal (35 minutes later)

Brief Answer:
TB drugs are known to cause skin reaction.

Detailed Answer:
TB medicicines do have quite a few sideffects. Skin reactions are also one of them. Both rifampicin and isoniazide can cause skin reaction.
It can occur anytime during treatment but commonly seen around 2nd/3rd week.
The drugs are then stopped till lesions disappear and restarted one by one with lesser dose which is gradually increased. This is called desensitization. All this has to be under constant supervision of a pulmonologist.

Yes skin reaction can at times become serious.

Yes there are other tb drugs but they also need a pulmonologist's expert care.

My suggestion is you consult your treating physician/pulmonologist who can guide you and supervise your treatment.

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar