The community health nurse prepares a teaching plan for a client with latent

tuberculosis who is prescribed oral isoniazid (INH). Which instructions should the nurse

include? Select all that apply.

Unordered Options Ordered Response

1. Avoid drinking alcohol

2. Expect body fluids to change color to red

3. Report yellowing of skin or sclera

4. Report numbness and tingling of extremities

5. Take with aluminum hydroxide to prevent gastric irritation

Explanation

Isoniazid (INH) is a first-line antitubercular drug prescribed as monotherapy to treat

latent tuberculosis infection. Combined with other drugs, INH is also used for active

tuberculosis treatment. Two serious adverse effects of INH use are hepatotoxicity and

peripheral neuropathy.

A teaching plan for a client prescribed INH includes the following:

• Avoid intake of alcohol and limit use of other hepatotoxic agents (eg,

acetaminophen) to reduce risk of hepatotoxicity (Option 1)

• Take pyridoxine (vitamin B6) if prescribed to prevent neuropathy

• Avoid aluminum-containing antacids (eg, aluminum hydroxide (Maalox))

within 1 hour of taking INH

• Report changes in vision (eg, blurred vision, vision loss)

• Report signs/symptoms of severe adverse effects such as:

o Hepatoxicity (eg, scleral and skin jaundice, vomiting, dark urine, fatigue)

(Option 3)

o Peripheral neuropathy (eg, numbness, tingling of extremities) (Options 4)

(Option 2) Rifampin, another antitubercular drug, often causes a red-orange

discoloration of body fluids (ie, urine, sweat, saliva, tears). However, this effect is not

associated with INH use.

(Option 5) Concurrent use of antacids containing aluminum decreases INH

absorption. The medication may be taken with food if gastric irritation is a concern.

Educational objective:

Common potential side effects of INH include hepatotoxicity (eg, jaundice, vomiting,

dark urine, fatigue) and peripheral neuropathy (eg, numbness, tingling of extremities).

Clients should avoid alcohol use and aluminum-containing antacids, and report any

experienced side effects to the health care provider immediately.