Many antitb agents are known to be cause of psychiatric adverse events i. Consider measuring liver function tests to rule out drug induced hepatic dysfunction refer to. Major toxic reactions are peripheral neuropathies at conventional dosage and seizures from overdosage. Isoniazidinduced psychosis in a patient on dots therapy masood i. Mania induced by isoniazid preventive therapy during steroid. Isoniazid and ethambutolinduced psychosis europe pmc. Cyp2e1 genotype and isoniazid induced hepatotoxicity in patients treated for latent tuberculosis. The administration of pyridoxine, which has been advocated for the prevention and treatment of isoniazidinduced neurologic manifestations, failed to achieve desired results in isoniazidinduced psychosis. The presumed mechanism of inhinduced seizure involves a decrease in the availability of gaba, which is the major inhibitory neurotransmitter in the central nervous. One female and two male patients aged 35 years, 55 years and 60 years respectively developed psychosis following isoniazid administration. Most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol embinduced psychosis being rare.
Isoniazid preventive therapy in hivinfected pregnant and postpartum women. A case of isoniazidinduced psychosis in a 42yearold man with. We suspected isoniazid induced psychosis, so it was discontinued on day 3. Acute psychosis after recent isoniazid initiation europe. The appearance of acute psychosis following administration of inh is most often seen in those who have an antecedent history of unstable person ality, although it can occur in otherwise normal people. Homicide by a tuberculous prisoner possibly having drug induced acute delusional psychosis. Isoniazid induced psychosis self harm behaviour with. A case of isoniazidinduced psychosis in a 42yearold man. 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. Acute psychosis induced by inh, especially when given as part of the dots regimen, has a variable presentation, and should always be kept.
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. Bacause of the excerbation of organising pneumonia, we increased the dose of prednisolone 20 mg on. Other presumed toxic reactions are autonomic neuropathy. Isoniazid induced psychosis i ip is well reported with varied clinical presentations. This product also contains as inactive ingredients. 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. Isoniazid undergoes extensive metabolism that takes place in the mucosal cells of the small intestine and in the liver.
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. Inh induced psychotic diseases are rarely encountered, and the most common ones are psychosis, obsessivecompulsive disease, and mania 3. 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. Pdf isoniazid and ethambutolinduced psychosis researchgate. Highdose isoniazid induced mania a case report contributors. Vitamin b6 is used to prevent isoniazidinduced b6 deficiency and neuropathy in people with a risk factor, such as pregnancy, lactation, hiv infection, alcoholism, diabetes, kidney failure, or malnutrition. Isoniazid induced psychosis in a patient on dots therapy.
Thus, patients with isoniazid induced psychosis recover without specific treatment after the withdrawal of the offending drug. A case of isoniazidinduced psychosis in a 42yearold man with schizophrenia. If the address matches an existing account you will receive an email with instructions to reset your password. Pyridoxine deficiency may play a role in the pathogenesis of isoniazidinduced 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. The patients acute agitation was managed by 10mg of diazepam given iv and isoniazid was withdrawn. The lack of preexisting psychiatric illness and complete resolution of hallucinations and suicidal ideation upon discontinuation of the drug strongly supports the diagnosis of toxic psychosis due to isoniazid in this patient. Psychosis is a known complication of isoniazid therapy, although infrequent.
R, age 48, presents to the psychiatric emergency department ed for the third time in 4 days after a change in his behavior over the last 2. Mania induced by isoniazid preventive therapy during. What you need to know about your medicine for latent. San francisco, california soon after isoniazid was employed in the treatment of tuberculosis, several investigators noted the occurrence of peripheral neuropathy in adult patients treated with the drug. A case of isoniazidinduced delirium the journal of. Apr 03, 2008 thus, patients with isoniazid induced psychosis recover without specific treatment after the withdrawal of the offending drug. Subsequently, the psychotic symptoms resolved within 1 week and she became polite and independent. Several neuropsychiatric adverse effects, following both therapeutic and overdose use of isoniazid, have been described and isoniazid induced psychosis, although uncommon, has been reported in the. Isoniazid preventive therapy and pregnancy outcomes in hivinfected women in the tshepiso cohort. Blurred vision or loss of vision, with or without eye pain. Pdf isoniazid induced psychosis a case report researchgate. Concurrentadministration of pyridoxinemay prevent neuropathy. Isoniazidinduced psychosis adekola o alao, jennifer c.
We report a case of classical mania and peripheral neuropathy in a patient diagnosed with extensively drug resistant pulmonary tuberculosis. Isoniazid and ethambutolinduced psychosis prasad r, garg r. People with liver dysfunction are at a higher risk for hepatitis caused by inh, and may need a lower dose. Cycloserine, an antitubercular agent, is an nmethyldaspartate receptor nmda partial agonist and has reported neuropsychiatric adverse effects. Although safety is not established, isoniazid has been used with ethambutol to treat tuberculosis in pregnant women without harm to the fetus.
Isoniazid inh has been associated with neuropsychiatric side effects commonly peripheral neuropathy and psychosis. Isoniazid and ethambutolinduced psychosis open access. With the increasing prevalence of tuberculosis in the us, more people are expected to receive treatment for tuberculosis. When isoniazid is to be taken 2 times a week, it should be given by directly observed therapy dot. 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. The role of pyridoxine supplementation in prevention or treatment of isoniazid associated psychiatric symptoms is unclear. Acute isoniazid inh overdose results in decreased pyridoxal5phosphate levels, decreased gammaaminobutyric acid gaba synthesis, increased cerebral excitability, and seizures. She was admitted to the hospital for epigastric and right sided flank pain of oneweek duration. Inhibition of isoniazid induced hepatotoxicity in rabbits by pretreatment with an amidase inhibitor. 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. Isoniazid and ethambutolinduced psychosis prasad r, garg. Antitubercular druginduced violent suicide of a hospitalised. Isoniazid and ethambutolinduced psychosis open access library.
Although druginduced liver injury dili caused by different drugs is somewhat different, the clinical characteristics of inhinduced liver injury. An initial diagnosis of druginduced psychosis was made after a thorough screening for organincity and a psychiatric consultation, with isoniazid being identified as the likely culprit. Feb 07, 2019 acute isoniazid inh overdose results in decreased pyridoxal5phosphate levels, decreased gammaaminobutyric acid gaba synthesis, increased cerebral excitability, and seizures. 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. Isoniazidinduced psychosis in a patient on dots therapy. Drugs such as isoniazid, cycloserine, ethambutol and flouroquinolones used in the treatment of tuberculosis have been reported to produce druginduced psychosis. Treatment for isoniazidinduced psychosis includes discontinuation of isoniazid 10, 12, addition of an antipsychotic 6, 7, or a combination of both 5, 9, 11. Isoniazid is distributed in the body with an apparent volume of distribution volume of 0. This case report adds to further literature on isoniazid induced psychosis along with describing new cluster of symptoms onset after very recent initiation, loosening of association, echolalia and proposing previous neurological insult as risk factor. 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. The first is that isoniazid acts as a monoamine oxidase mao. Isoniazid induced psychosis self harm behaviour with neuropathy and vitamin b6 deficiency. Isoniazid associated psychosis indian journal of pharmacy practice. Isoniazidinduced acute psychosis in a patient with.
The concomitant occurrence of inh and emb induced psychosis and in a single individual is extremely uncommon. 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. Adverse effects of isoniazid should be considered even if a long time has elapsed since its initiation. Thus, patients with isoniazid inducedpsychosis recover without specific treatment after the withdrawal of the offending drug. Cases of isoniazid induced psychiatric conditions reported in the literature include psychosis, obsessivecompulsive disorders, and mood alterations. Isoniazidinduced acute psychosis in a patient with pleural.
All the three received 300 mg of isoniazid daily for the management of pulmonary tuberculosis. A case of mania is rarely reported in this context. If it is still the same day, take the dose as soon as you remember. Isoniazidinduced lupus erythematosus presenting with. The exact mechanism of inh induced psychosis is unknown, but it has been suggested that as inh interacts with various metabolites which are necessary for normal functions of neurons, it may lead to. We performeda retrospective analysis of those patients in the literature and we report acase of isoniazidinduced psychosis in a 42yearold man with schizophrenia andalcohol dependence. Use for children aged 211 years and patients with underlying conditions associated with tb should be considered on a casebycase basis. Isoniazidinduced psychosis with obsessivecompulsive. An initial diagnosis of druginduced psychosis was made, once we considered the possibility that her psychotic symptoms could have been. In conclusion, we herein report a rare case of mania induced by isoniazid preventive therapy. 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. Pyridoxine and the isoniazidinduced neuropathy william mandel, m.
Weirdom and ervin reported on five cases of inhinduced acute psychosis. This time his lft revealed evidence of mild transaminitis alongwith. Each 5 ml teaspoonful of syrup contains 50 mg of isoniazid. Most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol emb induced psychosis being rare. Cases of isoniazidrelated psychiatric disorders reported in the literature include psychosis, obsessivecompulsive neurosis, and mania. Another possible mechanism of antibiotic induced cns excitability is through the glutamatergic system. Many hypotheses are available to explain the mechanism of iip but lack conclusive evidence in its favour. A 65yearold female diagnosed with latent mycobacterium tuberculosis infection was receiving oral isoniazid 300 mg daily. Cases of isoniazidinduced psychiatric conditions reported in the literature include psychosis, obsessivecompulsive disorders, and mood alterations. Such deficiency states maybe detected indirectly by measuring urinary metabolites of tryptophan. 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. In 1996, tiwari reported a case of isoniazid induced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case. Pdf most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol embinduced psychosis. The current case establishes neuropathy with vitamin b6 deficiency as a possible cause for iip warranting early clinicians.
Another possible mechanism of antibioticinduced cns excitability is through the glutamatergic system. Case report earlyonset severe isoniazidinduced motor. Guidelines for the management of adverse drug effects of. Isoniazid is an antibacterial available as a solution for oral administration. Feb, 2019 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. Oral desensitization protocol for rifampin and ethambutol. Cases of isoniazidrelated psychiatric disordersreported in the literature include psychosis, obsessivecompulsive neurosisand mania. Case report earlyonset severe isoniazidinduced motordominant neuropathy. Inhibition of isoniazidinduced hepatotoxicity in rabbits by pretreatment with an amidase inhibitor.
Isoniazidinduced psychosis annals of pharmacotherapy. Aluminumcontaining antacids may decrease absorption. Isoniazid is the most reliable and most commonly used medication for tuberculosis. Oral desensitization protocol for isoniazid appendix 3.
In 1996, tiwari reported a case of isoniazidinduced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case. They noted in creased psychomotor activity about one month. The mechanism of isoniazidinduced psychosis is not well understood, but isoniazid is known to interfere with several metabolic pathways essential for normal neuronal functioning. Several neuropsychiatric adverse effects, following both therapeutic and overdose use of isoniazid, have been described and isoniazidinduced psychosis, although uncommon, has been reported in the.