INHi is used by some Cpni doctors, especially due to it's efficacy in the Mitchell/Stratton studies. Because of a potential for liver toxicity, and early reputation that it is significantly so, it's safety among most doctors is considered low. However, more current studies using large cohorts in public health for treating TB have shown different results. I've excerpted the conclusions and given links for a couple studies below.
The following study of over 11,000 people looks at long term safety of INH for treatment of TB, which requires long-term use. I just quote the conclusions and give title and link:
http://jama.ama-assn.org/cgi/content/abstract/281/11/1014Hepatotoxicity Associated With Isoniazid Preventive Therapy
A 7-Year Survey From a Public Health Tuberculosis Clinic
Charles M. Nolan, MD; Stefan V. Goldberg, MD; Susan E. Buskin, PhD
JAMA. 1999;281:1014-1018.
Context Isoniazid preventive therapy for latent tuberculosis (TB) infection has been debated because of the risk of hepatotoxicity. The frequency of hepatotoxicity was 0.5% to 2.0% in early studies but may have changed with new criteria for diagnosis and patient selection.
Objective To determine the rate of isoniazid hepatotoxicity in patients managed according to current guidelines and practice standards.
...
Conclusions The rate of isoniazid hepatotoxicity during clinically monitored preventive therapy was lower than has been reported previously. Clinicians should have greater confidence in the safety of isoniazid preventive therapy.
And:
American Journal of Respiratory and Critical Care Medicine Vol 168. pp. 412-413, (2003)
© 2003 American Thoracic Society
Isoniazid for Latent Tuberculosis Infection
Approaching 40 and Reaching Its Prime
Charles M. Nolan, M.D....The article in this issue of AJRCCM (pp. 443–447) by LoBue and Moser (11) adds additional data to substantiate the safety of isoniazid therapy. These authors reported a rate of hepatotoxicity of only 0.3% among 3,788 patients starting isoniazid treatment for latent tuberculosis infection, with no hospitalizations or deaths. This publication also extends the understanding of the safety profile of isoniazid by reporting that only 6.8% of persons who failed to complete isoniazid treatment did so because of an adverse drug effect...
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CAPii for Cpni 11/04. Dxii: 25yrs CFSii & FMSii. Currently: 250 aithromycin mwf, doxycycline 100mg BIDii, Tiniii 1000mg/day pulses; Vit D2000 units, T4 & T3, 12mg Iodoral
Jim, I know hepatoxicity is
Also no matter how much you or I are uneasy with this, many people are treating themselves and they need to stick with something kinder. There are many people even ion this site who are temporarily stopped by their physician when taking INH because of raised liver enzyme levels. Never mind whether this stopping and starting is a good thing or not, many people would not know if they were doing it themselves, so what we need to do is concentrate on hw to get more GPs to do more than just blithely dismiss the treatment, whether because they think MS should be treated by a neurologist who still blindly thinks of it as an auto-immunei disease, or thinks that chronic fatigue and fibromyalgiai are more diseasesi of the neurotic imagination. Too many still do...........Sarah
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Sarah- I absolutely agree
Sarah- I absolutely agree that INHi should only be used with a Doctor's monitoring. Every place it's mentioned in the Handbook that is emphasized, and it's potential liver toxicity as well. I don't think it's an especially appropriate drug for MSi, or many of the Cpni related diseasesi. Where it has the most significant effect, at least clinically, is in Chronic Fatigue Syndromei and Fibromyalgia, diseases where it is likely that a main culprit infected by Cpn is the immunei cells, which INH seems to clear the best. I would not recommend self treating with it. For those worried about liver toxicity, I think Dr. Stratton's suggested use of INH as a pulsed treatment, with the flagyli/tinii pulse is probably the safest alternative as you are not using it long enough to build up liver toxicity unless your liver is already compromised (only your doctor can know this for sure). On the other hand, if the pulses are agony for you, adding INH is not going to make it better!
On CAPi's protocol for Cpn in CFSi/FMSi since December 2004.
Currently: 150mg INH, Doxyi/Zithi, Tini pulses
"I really didn't say everything I said." Yogi Berra
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CAPi for Cpni 11/04. Dxi: 25yrs CFSi & FMSi. Currently: 250 aithromycin mwf, doxycycline 100mg BIDi, Tinii 1000mg/day pulses; Vit D2000 units, T4 & T3, 12mg Iodoral