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  • Isoniazid Therapy (INH) for latent TB concerns

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    Old 01-21-2009, 08:07 PM   #1
    wildflower73
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    Unhappy Isoniazid Therapy (INH) for latent TB concerns

    Hi everyone. I am hoping to hear from some people that have taken this drug for a positive mantoux. I am a nursing student and had to have 2 TB tests a few months apart. My first was negative and the 2nd was over 10mm and I was told I have latent TB. I did have a negative chest x-ray.

    I have been advised to see a Dr. and get the prescription for INH. It doesn't sound like much fun to be on!! I was reading about many food restrictions...anything containing tyramine and no alcohol. I'm just curious about what kind of side-effects anyone has experienced. Can you not even have an occasional beer or glass of wine? Is that just because of how hard INH is on your liver or are there other effects? How often did your Dr. want liver function tests done? I've heard monthly and then every 3 months.

    Any information would be great. I'm trying to decide when and if I should start. I don't have a regular doctor or insurance at the moment.

    Will my chances of working in a hospital increase my chances of getting active TB or is this just having to do with my body's own immunity breaking down as I age? I'm 35 currently. Thanks for any input. Lisa

     
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    Old 01-22-2009, 08:19 AM   #2
    harka
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Hi there,

    Latent tuberculosis infection is a bit of sticky topic which is mostly based on the fact that, even today, our methods of diagnosing both active and latent TB infection are fairly primitive. Until the new "IGRA" assay is put in to widespread use, we are going to have to rely on the relatively unreliable TB skin test.

    In your case, obviously the reason they want to treat you is because you are a nursing student and if you were to ever reactivate your tuberculosis, you could potentially sicken hundreds of people. For a young person like you who, I'm assuming, has no other underlying health problems, other than the fact that it's somewhat annoying to take a pill for 9 months, the INH therapy should be a (relative) breeze.

    The two most common side-effects people have from INH are mood elevation (people feel GREAT while taking it...it does have antidepressive qualities) and also heartburn, which is easily treated with either H2 blockers or a proton pump inhibitor. The liver issues are commonly cited and to be fair, <1% of healthy individuals who have no underlying liver disease ever have a problem with hepatic issues on INH. Depending on the ID doc, you may get a baseline liver enzyme profile taken and then maybe one taken a month later. Other than that, unless you're symptomatic, you don't necessarily need to have blood taken every three weeks. In many people there is a rise of liver enzymes to about 2X normal, and this is okay granted the person has no symptoms.

    INH therapy for latent tuberculosis is excellent, but you need to remember that, even if you've been treated, it is possible for you to get re-infected so you need to maintain universal precautions regardless. Additionally, any further TB skin tests are useless for you because it is likely to always stay positive (EVEN if you've been treated) and if you were to ever be re-exposed to TB in the future, a negative test doesn't tell you anything either.

    Does that help?

     
    Old 01-23-2009, 05:55 AM   #3
    wildflower73
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Thanks for the information. It does help. Do you know if you really have to watch so closely what you eat while on INH. Do I just need to monitor side effects?

     
    Old 01-23-2009, 09:38 AM   #4
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Wildflower, Two of my children have been given the 9 month therapy for isoniazid. They were born in a country which gives a BCG shot after birth to build up immunity against TB. When we moved to the US, the TB skin test was positive and I refused the treatment based on the fact that they had been given the BCG. The typical scar is visible. The doctor told me they COULD have latent TB and they MUST have the treatment so I broke down. It was a VERY controversial time as there are not really any doctors familiar with the BCG. They had the liver function tests monthly and I do not remember any specific dietary restrictions (alcohol was not an issue due to age). Food decreases absorption of isoniazid. I believe Isoniazid should be taken one hour before or two hours after eating but you can check this to be sure.

    I am still confused about one part of it. I BELIEVE they will always test positive. Is there supposed to be some sort of letter issued from the physician with regard to the Isoniazid Therapy? What would happen if a future job required testing? Do you know?

    Last edited by hopalong_too; 01-23-2009 at 09:44 AM.

     
    Old 01-23-2009, 02:12 PM   #5
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Hi there,

    About the BCG vaccine: in adults, a positive skin test in the face of a remote history of BCG vaccine should be attributed to TB exposure and NOT the BCG vaccine. Immunity with the BCG vaccine wanes over time, and should not be used as an explanation to an adult with a positive TB skin test. With children it's different, and to be honest, I'm not sure what they're supposed to do; however, now that they're on treatment with INH they will clear any possible latent TB they have.

    As for things to watch while on INH: you have to watch eating foods that are high in tyramine levels like too much red wine, and certain soft cheeses. Isoniazid has some activity similar to previous antidepressants known as MAOIs and one can get a serotonin reaction. Otherwise, just avoid drinking too much alcohol.

     
    Old 04-28-2009, 10:59 PM   #6
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Hi,
    This might be a little late, but I only just now saw your message. I would get another test before taking any medication. Not everyone knows how to read the test result correctly. Inform yourself. Go online to get information about what the positive test result really looks like and more importantly what it feels like. Call the county health department and talk to a nurse about the test. Even nurses in hospitals can misread the skin test.
    But, if it actually is positive, it is still only latent, and you have the choice to take isoniazid or not. Inform yourself about the side effects as well.
    By the way, keep in mind that the people who say it is "easily" treated haven't gone through the treatment themselves.
    Good luck.

     
    Old 07-18-2009, 10:49 PM   #7
    FabxB
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Great info thus far...

    I am a 24 yr old male and have just been put on INH therapy and feel very uncomfortable with it. I am in the military and have a BCG record, my chest X-ray shows no signs of TB and they said I could have been exposed to it. I am in good health and rarely drink but I am very fearful of the Hepatitis possibility.

    Also, what about after you are done with the therapy? Is there any long term affects? What if you drink after the nine months? Is your liver more susceptible to damage because it was put under intense stress for so long or what about other long term affects?

    More info on this topic would be greatly appreciated, thank you.

     
    Old 07-19-2009, 08:34 AM   #8
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Especially because you're young, the occurrence of hepatitis from INH therapy is very slim. Even if you drink now, it's not going to be 100% horrible, but because of the interaction between INH and the liver, it's best to avoid all alcohol just to be safe. After the INH is done, there isn't any risk with alcohol--it's not like the INH somehow maintains a lasting inhibitory effect on your liver.

     
    Old 10-24-2009, 10:14 PM   #9
    dude200me
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Quote:
    Originally Posted by FabxB View Post
    Great info thus far...

    I am a 24 yr old male and have just been put on INH therapy and feel very uncomfortable with it. I am in the military and have a BCG record, my chest X-ray shows no signs of TB and they said I could have been exposed to it. I am in good health and rarely drink but I am very fearful of the Hepatitis possibility.

    Also, what about after you are done with the therapy? Is there any long term affects? What if you drink after the nine months? Is your liver more susceptible to damage because it was put under intense stress for so long or what about other long term affects?

    More info on this topic would be greatly appreciated, thank you.
    hey i am in the same boat right now, currently in us military and they also want me to go take these meds... also real unsure about it. i am 19yrs old, and recently got back from iraq any info will help

     
    Old 01-09-2010, 03:01 PM   #10
    wildflower73
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    Question Re: Isoniazid Therapy (INH) for latent TB concerns

    Hi - It's Lisa and I had questions way back about INH and finally decided to start taking the drug. I am almost done with nursing school and have been aware of many cases of TB in the hospital settings. I have been on INH for almost 3 months and had the Dr. do a baseline liver enzyme and just had one done again on Jan 5th.

    My SGOT went from 21 to 70 and the range should be 8-38 and my SGPT went from 18 to 82 -range 10-35. My Dr. didn't seem to be concerned and I realize that taking INH will cause the elevation. I haven't changed my drinking at all but am a moderate drinker. I have a few beers or glass of wine a couple times a week.

    I am curious to know if these lab values should be something I am concerned about and will they go back to normal once I am done with the INH. I am not even 1/2 through the 9 month plan or am I going to have irreversible damage to my liver? I don't have any s/s or jaundice or anything else.

    I am 36 and am in good health otherwise. Please let me know if you have information. Thanks!!

     
    Old 01-09-2010, 08:34 PM   #11
    harka
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Hey again,

    So yes, INH will make your liver enzymes go up and that's actually completely normal. In fact, if your enzymes don't at least slightly go up, I'd be surprised. Most TB docs are comfortable with the enzymes going up to FIVE TIMES the upper limit of normal before stopping the drug.

    Your enzymes are only slightly raised and I wouldn't worry about it.

     
    Old 08-01-2010, 06:40 AM   #12
    Jojack
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    Smile Re: Isoniazid Therapy (INH) for latent TB concerns

    I have just been told by my doctor that I have a positive PPD and a negative chest x-ray. I am glad I found this forum. I have the prescription in the mail to start the INH therapy. I was having second thoughts but now believe it is necessary as I am a healthcare worker. I do believe given that you are young and healthy you will be okay.

     
    Old 08-19-2010, 03:37 PM   #13
    hadaday
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Hello, Just wanted to let you know what I found while I was INH. My liver enzymes did go up to almost 3x normal which my doctor was concerned about. I have read that 5x the norm was ok but I also reshearched how many people died as a result of INH and it was generaly around the 5x norm. But reguardless it scared me enough to discontinue the treatment. I was 4mo in. I dont understand how they can say only 10 percent of people with latent tb ever become active and taking the INH is not a sure cure to keep you from becoming active yet they try to tell you if you dont take it you will develop it. Has anyone had the Quantiferion Gold blood test that is supposed to tell weather or not you actually have it? I did and the results we not very percise.. It read "latent TB likely". It is very confusing. I am in health care as well and it worries me often but Im afraid of the dammage from the INH.

     
    Old 08-24-2010, 07:44 AM   #14
    Jojack
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Wow! That is really scarry. I am only about two weeks in. My doctor told me about the blood test but did say it had not been perfected yet and is pertty much inconclusive. I am a Respiratory Therapist of all things,lol! I believed my doctor that this was the best treatment, only treatment. He had gone through the INH for 9months himself and said he never had problems with his liver. I just started an herbal supplemnet but one of the ingredients is Black Kohosh which has an unconfirmed chance of slight liver damage. I took 3 doses so far but will stop immediately! I go for liver test in September and will keep you posted on my counts. Thanks for the info! God speed.

     
    Old 06-06-2011, 05:51 PM   #15
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    Re: Isoniazid Therapy (INH) for latent TB concerns

    Hi--

    So I've been browsing this thread, but there is no decisive answer to my question. Essentially, I'm a 21 year old college student who has an internship in a pediatric ER this summer and I had a positive TB skin test and negative chest x-ray, but I still need to be on the INH for the positive test in order to keep my internship, which is fine, but I drink. Not heavily or extravagantly, but I do have the occasional glass or two of wine or a beer or two. Can I no longer do this and if I do am I putting myself in some great risk?

    Thanks!

     
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