Isoniazid and acetaminophen interaction

[duncan444]

Hello. I was recently diagnosed with inactive/latent tuberculosis and was given Isoniazid 300 mg to take for 6 months. At the clinic, they warned me that isoniazid is processed mainly by the liver and that drinking alcohol could cause liver damage in combination and should be avoided. I have no problem not drinking, but I take norco on a regular basis for chronic pain and I'm concerned that the acetaminophen in the norco's will combine with the isoniazid and cause severe liver damage.
Thus, as of yet I havent begun taking the antibiotics. Obviously, I need to begin the treatment asap but I've been on the pain medicine for 7 yrs and to stop now would result in awful withdrawal, not to mention the issue of daily pain. As of now, I take anywhere from 4-8 10/500 mg norcos a day (never exceeding the 4000mg daily acetaminophen limit) and I was wondering if I'll be ok if I continue with the norco as usual and also take the isoniazid. I've been doing some online research and it appears that isoniazid and acetaminophen are an awful combination for the liver. Even taking the amount of norco a day that I do is bad enough, and I take milk thistle, drink kombucha and do my best to limit the damage.
So far Ive had no problems and my liver function is normal if a little high from daily use. I'm aware that I could switch to norco's with a little less acetaminophen - like 300 or 325 mg - or even switch to oxycontin or something with aspirin like percodan but for the sake of this question I'd like to just focus on trying to keep things the way they are. I'd  like to stay with the hydrocodone as oxy is much stronger and things are already 'strong' enough.  So, if Im taking anywhere from 40-80 mg of hydrocodone and roughly 1500-4000 mg of acetaminophen a day and I begin the isoniazid treatment am I risking serious health problems? Any help or advice would be greatly appreciated! Thanks in advance,

Duncan

[duncan444]

After speaking with my doctor I've found that there really isn't a form of hydrocodone/acetaminophen that exists in a low enough doseage to make this combination safe unless I switch to a stronger, more concetrated pain reliever. I would really rather not do this, and so I was wondering if there are any other tb treatment options that don't impact the liver quite as hard. I did a little research and other than Isoniazid it appears that there's several other drugs they use, but it looks like they only usually prescribe them for patients with active tuberculosis. Does anyone know of any tb medications for inactive tb that don't have this damaging effect on the liver? Is there any way to make this work? I need to start these antibiotics soon, and jaundice is not an appealing future for me!

[Liz C, RPh]

Treatment with both acetaminophen and isoniazid may result in an increased risk of dangerous effects to your liver. Your acetaminophen dosage may need to be adjusted. Please discuss this with your doctor.