Updated January 15, 2013
There currently is a nationwide shortage of the TB drug isoniazid (INH), leading to temporary changes to MDH’s TB medications program. The shortage is expected to last until at least late February 2013 and possibly as late as April. Private pharmacies also are having trouble obtaining INH.
Starting immediately and until further notice, MDH will supply INH for high priority individuals only, including:
- Individuals with confirmed or suspected active tuberculosis (TB) disease
- High-risk individuals with latent TB infection (LTBI), including:
- persons with medical conditions that increase the likelihood of progression to active TB (e.g., HIV infection, diabetes, substance abuse, immunosuppression)
- children under age 5 years
- persons with radiographic findings consistent with prior TB (i.e., fibrosis, scarring)
- recent close contact to a known infectious TB case
- documented conversion from negative TB skin or blood test to positive skin or blood test within the last 2 years
- foreign-born persons from high risk countries who arrived in the United States within the past year
- Individuals who have already begun LTBI therapy and show evidence of adherence by regularly picking up their medication shipments (also consider the third bullet recommendation below)
During the shortage, MDH recommends that providers and local health departments:
- Notify the MDH TB program immediately if you have a patient on INH who is not picking up their refills regularly so that we can postpone or discontinue shipments.
- Consider prescribing rifampin daily for 4 months (6 months for children). (Warning: note potential rifampin interactions with certain HIV treatment drugs, hormonal contraceptives, anticoagulants, and other drugs.)
- Discontinue LTBI treatment when 6 months of INH has been completed (note: this is not recommended for HIV-infected persons, those with fibrotic lesions on CXR, or children. Those individuals should take the 9-month regimen.) Please notify the MDH TB program ASAP of your decision to stop treatment after 6 months so that we can discontinue refill shipments.
- For lower-risk patients who are likely to return to start treatment at a later date, postpone existing appointments for initiating INH therapy. Medical evaluation, including chest X-rays, to rule out active TB should continue to be performed as indicated. Advise these individuals that treatment of their LTBI is important but that it is safe to delay the start by up to several months.
- You may continue to submit requests for INH to MDH as usual, but shipments for patients who do not meet the above criteria will be delayed until INH is more readily available.
- Treatment for Latent TB Infection: Treatment Regimens
Information from CDC about LTBI treatment regimens. Attention: Non-MDH link
- 12-Week INH-RPT Regimen for Treatment of Latent TB Infection
Information about a shorter LTBI regimen. Certain restrictions apply.
- MDH Tuberculosis Medications Program
If you have questions, please call MDH at 651-201-5414 or toll free 877-676-5414.
- Notes from the Field: National Shortage of Isoniazid 300 mg Tablets
Information about the INH shortage from the Dec. 21, 2012, Morbidity and Mortality Weekly Report (MMWR). Attention: Non-MDH link