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