Such a drug is isoniazid isonicotinic acid hydrazide. Apr 03, 2008 thus, patients with isoniazid induced psychosis recover without specific treatment after the withdrawal of the offending drug. Patients receiving both rifampicin and isoniazid should be monitored closely for hepatotoxicity. Isoniazid preventive therapy in hivinfected pregnant and postpartum women. In several registry studies alcohol induced psychosis was the most common subtype of substance induced psychosis, and had a lower probability of transition to schizophrenia.
If it is still the same day, take the dose as soon as you remember. This product also contains as inactive ingredients. Drugs such as isoniazid, cycloserine, ethambutol and. Bedi, in 1994, reported a case of isoniazid psychosis in a 74yearold, who developed restlessness, irritability, aimless activity, and incongruous actions 10 days after starting isoniazid therapy. Acute psychosis induced by inh, especially when given as part of the dots regimen, has a variable presentation, and should always be kept in mind in the differential diagnosis. The concomitant occurrence of inh and emb induced psychosis and in a single individual is extremely uncommon. Treatment for isoniazid induced psychosis includes discontinuation of isoniazid 10, 12, addition of an antipsychotic 6, 7, or a combination of both 5, 9, 11. Isoniazid has not been shown to be carcinogenic in humans. Isoniazid is a medicine used alone or with other drugs to treat or prevent tuberculosis tb tb is an infectious disease that mainly impacts the lungs. Imran masood 1, sanjay bhat 1, aadil beigh 1, veena gupta 2 1 department of medicine, ascoms and hospitals, jammu, j and k, india 2 department of chest medicine and tuberculosis, ascoms and hospitals, jammu, j and k, india click here for correspondence address and email. We report a case of classical mania and peripheral neuropathy in a patient diagnosed with extensively drug resistant pulmonary tuberculosis.
Isoniazid syrup fda prescribing information, side effects. With regard to management, it is known that acute psychosis induced by isoniazid and ethambutol tends to subside once the precipitating stresses are over or their intensity is reduced. Discuss characteristics of phenothiazines and related antipsychotics. Antituberculosis therapy manifests both central and peripheral nervous system effects, which may compromise patient compliance. Isoniazid induced psychosis self harm behaviour with. Approximately three out of 100 people will experience an.
Isoniazid injection usp provides 100 mg isoniazid per ml with 0. Highdose isoniazid induced mania a case report contributors. Isoniazid inh has been associated with neuropsychiatric side effects commonly peripheral neuropathy and psychosis. Isoniazid can cause drug induced lupus dil when taken over longterm and chronic use. Getting help early can prevent a lifetime of pain and debilitation. About 3 percent of the population is at risk for psychosis, making the onset of psychosis more common than many severe, chronic diseases in youth, including type i diabetes. The psychosis resolved completely after completion of therapy for tuberculous meningitis and cessation of isoniazid. In 1996, tiwari reported a case of isoniazidinduced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case. Psychosis is a word used to describe medical conditions that affect the brain, so that what a person thinks is real is different from what other people think is real. Isoniazid as part of directly observed treatmentshort course dots regimen is universally used. Aluminumcontaining antacids may decrease absorption. People may also experience some cognitive and other symptoms. The experience of psychosis varies greatly from person to person. Aluminiumcontaining antacids may, delay absorption nd decrease serum concntrations o.
In other cases, the illness may last longer, but begin with a drug induced psychosis. Isoniazid inh inhibits the phosphorylation of pyridoxine and chelates whatever pyridoxal phosphate remains. When isoniazid is to be taken 2 times a week, it should be given by directly observed therapy dot. Because pyridoxal phosphate is a cofactor that is important to the gaba system, it has been hypothesized that the centrally diminished gaba activity may relate to the pathophysiology of isoniazid. In one study, concomitant use with isoniazid decreased isoniazid exposure by 2230%. Isoniazid side effects, dosage, interactions drugs. Toxic psychosis as a psychiatric side effect during antituberculosis therapy occurred when isoniazid was given in dose ranging from 2. One female and two male patients aged 35 years, 55 years and 60 years respectively developed psychosis following isoniazid administration. He was prescribed rifampicin, pyrazinamide, and ofloxacin and had no further psychotic symptoms.
The effectiveness of this type of treatment has brought about important improvements in the care and management of individuals. Less frequently, inh may be used as part of a combination regimen for nontuberculous mycobacterial infections. The first is that isoniazid acts as a monoamine oxidase mao. Isoniazid is an antibacterial recommended for all forms of tuberculosis in which organisms are susceptible. Isoniazid is the most reliable and most commonly used medication for tuberculosis.
Reactions 83 7 jan 2012 psychosis in an elderly patient. Dosage adjustments are often required based on patient age, renal and hepatic function, etc. Isoniazid undergoes extensive metabolism that takes place in the mucosal cells of the small intestine and in the liver. Isoniazid daily every day 9 months twice weekly m t w th f s sun your doctor may have you take vitamin b6 with your medicine. Therefore, patients given isoniazid should be carefully monitored and interviewed at monthl y intervals. Antipsychotic drugs 9 chapter objectives after studying this chapter, you will be able to 1. First isoniazid is inactivated through acetylation. Isoniazid induced psychosis in a patient on dots therapy. Isoniazid definition of isoniazid by medical dictionary. Tuberculosis can become resistant to treatment if isoniazid is used alone.
Psychosis in tuberculosis may result as adverse effects of antituberacular drugs including isoniazid, ciprofloxacin, etambutol and rifampicin 2,3 or maybe a presenting complaints in cases of intracranial tuberculoma. Drug induced psychosis most often occurs with those that abuse stimulants, which is why theres a subclassification known as stimulant psychosis. The administration of pyridoxine, which has been advocated for the prevention and treatment of isoniazid induced neurologic manifestations, failed to achieve desired results in isoniazid induced psychosis. Inh metabolites directly inhibit pyridoxine phosphokinase. Cases of isoniazidrelated psychiatric disorders reported in the literature include psychosis, obsessivecompulsive neurosis, and mania. Pdf isoniazid and ethambutolinduced psychosis researchgate. Psychotic mental illnesses are of major social and public health importance. Concomitant use with isoniazid may increase the plasma concentrations of isoniazid.
Psychosis can come on suddenly or can develop very gradually. Table 5 psychiatric morbidity and other factors affecting. Take isoniazid at around the same time every scheduled day. Isoniazid inh is an antibiotic used to treat infection with mycobacterium tuberculosis tb. Psychosis is a known complication of isoniazid therapy, although infrequent. Adverse events with 4 months of rifampin therapy or 9 months of isoniazid therapy for latent tuberculosis infection. Psychotic illnesses include schizophrenia, bipolar disorder and major depression. You may need to take other tb medicines in combination with isoniazid. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.
Read isoniazid, reactions weekly on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Discuss common manifestations of psychotic disorders, including schizophrenia. Side effects associated with the treatment of multidrugresi. What you need to know about your medicine for latent. When isoniazid is required in patients who are already receiving phenytoin, the phenytoin dose has to be adjusted because isoniazid decreases its clearance. With regard to management, it is known that acute psychosis induced by isoniazid and ethambutol tends to subside once the precipitating stresses are over or their. When this occurs, it is called a psychotic episode. Drugs such as isoniazid, cycloserine, ethambutol and flouroquinolones used in the treatment of tuberculosis have been reported to produce drug induced psychosis. Isoniazid induced psychosis i ip is well reported with varied clinical presentations.
Antipsychotic medication reference user guide usual dosage ranges represent treatment of schizophrenia in healthy adults unless otherwise indicated. Tuberculosis drug information guide curry international. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020. Cases of isoniazid induced psychiatric conditions reported in the literature include psychosis, obsessivecompulsive disorders, and mood alterations. Isoniazid, as part of dots regimen, is the first line of drug and very commonly used. Acute psychosis after recent isoniazid initiation ncbi. Isoniazid preventive therapy and pregnancy outcomes in hivinfected women in the tshepiso cohort. A person who has a psychotic illness may have delusions, hallucinations, confused thinking and abnormal behavior. Among the traditional forms of firstline antituberculosis. We describe the case of a 21yearold black woman, with no prior psychiatric history, who developed a psychotic episode four days after she was started on isoniazid.
Adverse effects include hepatitis, peripheral neurotoxicity. Although a majority of drug induced psychosis cases stem from stimulant use or abuse, there are plenty of other drugs besides stimulants that can cause psychosis. Scholars elective, university of western ontario, 1994 thesis submitted in partial fulfillment of the requirements for the degree of. Public health service surveillance study of,838 persons taking isoniazid, there were 8 deaths among 174 cases of hepatitis. Case report antitubercular druginduced violent suicide of.
Significant cns disease, including seizure disorder, psychotic disease. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Isoniazidinduced psychosis in a patient on dots therapy. Gi disturbance was most pronounced after treatment with ethambutol and pas. Psychosis usually first appears in a persons late teens or early twenties. Isoniazidinduced acute psychosis in a patient with. Gi disturbance was most pronounced after treatment with ethambutol and. Isoniazid and rifampicin induced oxidative hepatic injuryprotection by nacetylcysteine.
Psychosis affects the way a person thinks, feels and behaves. Compare characteristics of atypical antipsychotic drugs. The symptoms of dil include fever, elevated blood pressure, skin lesions, inflammation of the heart and lungs and arthritis. Isoniazid therapy is often associated with minor, transient and asymptomatic elevations in serum aminotransferase levels but, more importantly, isoniazid is a well known cause of acute clinically apparent liver injury which can be severe and is sometimes fatal. Many hypotheses are available to explain the mechanism of iip but lack conclusive evidence in its favour. A case of mania is rarely reported in this context. The mechanism of isoniazid induced psychosis is not well understood, but isoniazid is known to interfere with several metabolic pathways essential for normal neuronal functioning. Side effects of isoniazid isoniazid, warnings, uses. These include organic causes such as drug intoxication, metabolic and infective causes and functional disorders such as schizophrenia, bipolar disorder, schizophreniform psychosis and schizoaffective disorder. Nervous system effects of antituberculosis therapy springerlink. Treatment for isoniazidinduced psychosis includes discontinuation of isoniazid 10, 12, addition of an antipsychotic 6, 7, or a combination of both 5, 9, 11.
The current case establishes neuropathy with vitamin b6 deficiency as a possible cause for iip warranting early clinicians. Isoniazid is recommended as preventive therapy for certain individuals. Hence, it has become the point of interest in our case. History of liver damage or chronic alcohol ingestion. The current case establishes neuropathy with vitamin b6 deficiency. We performeda retrospective analysis of those patients in the literature and we report acase of isoniazid induced psychosis in a 42yearold man with schizophrenia andalcohol dependence. Isoniazid associated psychosis indian journal of pharmacy practice. Isoniazid has been found to be weakly mutagenic in strains ta 100 and ta 1535 of salmonella typhimurium ames assay without metabolic activation.
People with liver dysfunction are at a higher risk for hepatitis caused by inh, and may need a lower dose. Given the psychomotor agitation and insomnia presented by our patient, we choose to introduce olanzapine for its sedative properties, along with the discontinuation of isoniazid. Isoniazid is used to treat and to prevent tuberculosis tb. Sometimes these symptoms will rapidly resolve as the effects of the substances wear off. Although, associated psychosis in certain cases is documented earlier, type of symptoms and onset. An initial diagnosis of druginduced psychosis was made after a thorough screening for organincity and a psychiatric consultation, with isoniazid being identified. Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug induced changes in peripheral nerve function. Isoniazidinduced psychosis adekola o alao, jennifer c yolles, 1998. All the three received 300 mg of isoniazid daily for the management of pulmonary tuberculosis. The presumed mechanism of inh induced seizure involves a decrease in the availability of gaba, which is the major inhibitory neurotransmitter in the central nervous system cns, as well as a relative increase in the amounts of glutamate, the primary excitatory neurotransmitter.
Be alert for signs of drug induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Patients should be carefully monitored for isoniazid toxicity. Most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol emb induced psychosis being rare. Such deficiency states maybe detected indirectly by measuring urinary metabolites of tryptophan. Isoniazidinduced acute psychosis in a patient with pleural.
Isoniazid and ethambutolinduced psychosis open access library. Drug induced psychosis use of, or withdrawal from alcohol and drugs can be associated with the appearance of psychotic symptoms. These symptoms included depression, anxiety, nightmares, and psychotic. Isoniazid dosage adjustments may be required in rapid acetylators. Substance induced psychosis and criminal responsibility by michelle s. This is the first case of isoniazidassociated psychosis reported in a child. Apr 15, 2019 isoniazid is the hydrazide of isonicotinic acid. Substance induced psychosis and criminal responsibility.
However, early intervention is showing promising results. Each 5 ml teaspoonful of syrup contains 50 mg of isoniazid. Concurrentadministration of pyridoxinemay prevent neuropathy. Aug 29, 2012 nervous system toxicity with current antituberculosis pharmacotherapy is relatively uncommon, although the frequency of the usage of antituberculosis therapy requires that physicians be aware of such toxicity. Active tuberculosis must be treated with multiple concomitant antituberculosis medications to prevent the emergence of drug resistance. Jul 29, 2019 patients given isoniazid should be carefully monitored and interviewed at monthly intervals. The association of isoniazid and psychosis was first highlighted by jackson in 1957. In view of patients history and clinical findings, an initial diagnosis of pulmonary tuberculosis with. Thus, patients with isoniazid induced psychosis recover without specific treatment after the withdrawal of the offending drug. Pdf isoniazid induced psychosis a case report researchgate. Isoniazid induced psychosis self harm behaviour with neuropathy and vitamin b6 deficiency. Patients with diabetes should be carefully monitored, since blood glucose control may be affected by isoniazid.
Isoniazid and ethambutolinduced psychosis europe pmc. Many complications of the administration of isoniazid isonicotinic acid hydrazide. Isoniazid and ethambutolinduced psychosis open access. Daviss drug guide for rehabilitation professionals ciccone cd. Isoniazid and ethambutolinduced psychosis prasad r, garg r. Pdf on jan 1, 2000, rajpal s and others published isoniazid induced psychosis a case report find, read and cite all the research you need on researchgate. The word psychosis is used to describe conditions that affect the mind, in which people have trouble distinguishing between what is real and what is not. Vitamin b6 is used to prevent isoniazid induced b6 deficiency and neuropathy in people with a risk factor, such as pregnancy, lactation, hiv infection, alcoholism, diabetes, kidney failure, or malnutrition. Cognitive behavioural therapy for psychotic symptoms 7 introduction rationale for treatment since the 1950s, the usual firstline treatment for persons with chronic psychotic disorders has been neuroleptic medication.
When treating active tb, isoniazid must be used with other tb medicines. Isoniazid is distributed in the body with an apparent volume of distribution volume of 0. Monitor psychosis or other alterations in mental status. Black and hispanicwomen, women in thepostpartum period,or patients 50 yr qriskof. A large portion of the worlds population is infected with tb. False beliefs strongly held false beliefs, such as the belief that a famous person is speaking directly to them through the television or radio, or that. Although druginduced liver injury dili caused by different drugs is somewhat different, the clinical characteristics of inhinduced liver injury. Transition of substanceinduced, brief, and atypical. Isoniazid and ethambutolinduced psychosis prasad r, garg. If this drug is being widely used, it is important for us to be aware of its dangers. A case of isoniazidinduced delirium the journal of.
Isoniazid should be used with caution in patients with seizure disorders, a history of psychosis or hepatic impairment. Tuberculosis is one of the top 10 causes of death and the leading cause from a single infectious agent above hivaids. The diagnosis becomes especially challenging when the patient has tubercular meningitis or some other neurological disease. Isoniazid is an antibacterial available as a solution for oral administration. Adverse effects include hepatitis, peripheral neurotoxicity, lupus like syndrome, and central nervous system effects including dysarthria, seizures, irritability and even psychosis 2. Pdf most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol embinduced psychosis. A case of isoniazidinduced psychosis in a 42yearold man.
Isoniazid inh is used for treatment of tuberculosis as part of combination therapy or for latent tuberculosis infection as monotherapy or part of combination therapy. In 1996, tiwari reported a case of isoniazid induced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case. Notify the physician promptly if these symptoms develop see appendix d. The symptoms of psychosis are often categorized as either positive or negative. Concurrent use of alcohol, palclcetamol and other hepatotoxic medication may increase the incidence ol rifampicin induced hepatotoxicity. The advent of a new drug which is capable of causing convulsions, psychoses, and peripheral neuropathy as sidereactions is of interest to psychiatrists.
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