The association of isoniazid and psychosis was first highlighted by jackson in 1957. You may need to take other tb medicines in combination with isoniazid. 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. 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. This is the first case of isoniazidassociated psychosis reported in a child. Such deficiency states maybe detected indirectly by measuring urinary metabolites of tryptophan. The psychosis resolved completely after completion of therapy for tuberculous meningitis and cessation of isoniazid. Psychosis usually first appears in a persons late teens or early twenties. The first is that isoniazid acts as a monoamine oxidase mao.
Monitor psychosis or other alterations in mental status. Drugs such as isoniazid, cycloserine, ethambutol and flouroquinolones used in the treatment of tuberculosis have been reported to produce drug induced psychosis. Approximately three out of 100 people will experience an. Psychotic mental illnesses are of major social and public health importance. Jul 29, 2019 patients given isoniazid should be carefully monitored and interviewed at monthly intervals. Drug induced psychosis most often occurs with those that abuse stimulants, which is why theres a subclassification known as stimulant psychosis. Drugs such as isoniazid, cycloserine, ethambutol and. Isoniazidinduced acute psychosis in a patient with.
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. A person who has a psychotic illness may have delusions, hallucinations, confused thinking and abnormal behavior. 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. Psychotic illnesses include schizophrenia, bipolar disorder and major depression. Tuberculosis is one of the top 10 causes of death and the leading cause from a single infectious agent above hivaids. Sometimes these symptoms will rapidly resolve as the effects of the substances wear off. Patients receiving both rifampicin and isoniazid should be monitored closely for hepatotoxicity. Many complications of the administration of isoniazid isonicotinic acid hydrazide. When isoniazid is to be taken 2 times a week, it should be given by directly observed therapy dot. Toxic psychosis as a psychiatric side effect during antituberculosis therapy occurred when isoniazid was given in dose ranging from 2. The symptoms of psychosis are often categorized as either positive or negative. 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. Psychosis is a known complication of isoniazid therapy, although infrequent. Black and hispanicwomen, women in thepostpartum period,or patients 50 yr qriskof.
Apr 15, 2019 isoniazid is the hydrazide of isonicotinic acid. Gi disturbance was most pronounced after treatment with ethambutol and pas. 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. Take isoniazid at around the same time every scheduled day. 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. Isoniazid inh inhibits the phosphorylation of pyridoxine and chelates whatever pyridoxal phosphate remains. Isoniazid and ethambutolinduced psychosis europe pmc. Isoniazid is distributed in the body with an apparent volume of distribution volume of 0. Isoniazid is an antibacterial available as a solution for oral administration. When treating active tb, isoniazid must be used with other tb medicines. 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 induced psychosis self harm behaviour with neuropathy and vitamin b6 deficiency.
Although druginduced liver injury dili caused by different drugs is somewhat different, the clinical characteristics of inhinduced liver injury. Isoniazid and rifampicin induced oxidative hepatic injuryprotection by nacetylcysteine. Reactions 83 7 jan 2012 psychosis in an elderly patient. When this occurs, it is called a psychotic episode. Public health service surveillance study of,838 persons taking isoniazid, there were 8 deaths among 174 cases of hepatitis. 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.
Concurrentadministration of pyridoxinemay prevent neuropathy. Concomitant use with isoniazid may increase the plasma concentrations of isoniazid. Isoniazid side effects, dosage, interactions drugs. Isoniazid undergoes extensive metabolism that takes place in the mucosal cells of the small intestine and in the liver. Isoniazid has been found to be weakly mutagenic in strains ta 100 and ta 1535 of salmonella typhimurium ames assay without metabolic activation. Aluminumcontaining antacids may decrease absorption.
A case of isoniazidinduced psychosis in a 42yearold man. Side effects of isoniazid isoniazid, warnings, uses. Isoniazid induced psychosis self harm behaviour with. First isoniazid is inactivated through acetylation. An initial diagnosis of druginduced psychosis was made after a thorough screening for organincity and a psychiatric consultation, with isoniazid being identified. Highdose isoniazid induced mania a case report contributors. 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. Case report antitubercular druginduced violent suicide of. Discuss characteristics of phenothiazines and related antipsychotics. 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 is recommended as preventive therapy for certain individuals. A case of isoniazidinduced delirium the journal of. Adverse events with 4 months of rifampin therapy or 9 months of isoniazid therapy for latent tuberculosis infection. Treatment for isoniazidinduced psychosis includes discontinuation of isoniazid 10, 12, addition of an antipsychotic 6, 7, or a combination of both 5, 9, 11.
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. The concomitant occurrence of inh and emb induced psychosis and in a single individual is extremely uncommon. Side effects associated with the treatment of multidrugresi. Isoniazid inh is an antibiotic used to treat infection with mycobacterium tuberculosis tb. We report a case of classical mania and peripheral neuropathy in a patient diagnosed with extensively drug resistant pulmonary tuberculosis. Compare characteristics of atypical antipsychotic drugs. Psychosis affects the way a person thinks, feels and behaves. Adverse effects include hepatitis, peripheral neurotoxicity, lupus like syndrome, and central nervous system effects including dysarthria, seizures, irritability and even psychosis 2. However, early intervention is showing promising results. Patients should be carefully monitored for isoniazid toxicity. Isoniazid as part of directly observed treatmentshort course dots regimen is universally used. Cases of isoniazidrelated psychiatric disorders reported in the literature include psychosis, obsessivecompulsive neurosis, and mania. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.
Isoniazid associated psychosis indian journal of pharmacy practice. In 1996, tiwari reported a case of isoniazid induced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case. Isoniazid syrup fda prescribing information, side effects. Isoniazid preventive therapy and pregnancy outcomes in hivinfected women in the tshepiso cohort. Isoniazid is an antibacterial recommended for all forms of tuberculosis in which organisms are susceptible. Apr 03, 2008 thus, patients with isoniazid induced psychosis recover without specific treatment after the withdrawal of the offending drug. 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. Acute psychosis after recent isoniazid initiation ncbi. Isoniazid inh has been associated with neuropsychiatric side effects commonly peripheral neuropathy and psychosis. 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. 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. Therefore, patients given isoniazid should be carefully monitored and interviewed at monthl y intervals. Tuberculosis drug information guide curry international.
Most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol emb induced psychosis being rare. 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. If it is still the same day, take the dose as soon as you remember. Isoniazid should be used with caution in patients with seizure disorders, a history of psychosis or hepatic impairment. Isoniazid preventive therapy in hivinfected pregnant and postpartum women. 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. Discuss common manifestations of psychotic disorders, including schizophrenia. Significant cns disease, including seizure disorder, psychotic disease. Daviss drug guide for rehabilitation professionals ciccone cd. Isoniazid dosage adjustments may be required in rapid acetylators.
Patients with diabetes should be carefully monitored, since blood glucose control may be affected by isoniazid. Substance induced psychosis and criminal responsibility. Such a drug is isoniazid isonicotinic acid hydrazide. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020. 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. Nervous system effects of antituberculosis therapy springerlink. Less frequently, inh may be used as part of a combination regimen for nontuberculous mycobacterial infections.
Hence, it has become the point of interest in our case. In view of patients history and clinical findings, an initial diagnosis of pulmonary tuberculosis with. Isoniazid injection usp provides 100 mg isoniazid per ml with 0. People with liver dysfunction are at a higher risk for hepatitis caused by inh, and may need a lower dose. Antituberculosis therapy manifests both central and peripheral nervous system effects, which may compromise patient compliance. Although, associated psychosis in certain cases is documented earlier, type of symptoms and onset. History of liver damage or chronic alcohol ingestion.
Notify the physician promptly if these symptoms develop see appendix d. Cases of isoniazid induced psychiatric conditions reported in the literature include psychosis, obsessivecompulsive disorders, and mood alterations. Psychosis can come on suddenly or can develop very gradually. The current case establishes neuropathy with vitamin b6 deficiency as a possible cause for iip warranting early clinicians. Inh metabolites directly inhibit pyridoxine phosphokinase. Isoniazid induced psychosis i ip is well reported with varied clinical presentations. Isoniazid and ethambutolinduced psychosis prasad r, garg. 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. Table 5 psychiatric morbidity and other factors affecting. Dosage adjustments are often required based on patient age, renal and hepatic function, etc.
Isoniazid is used to treat and to prevent tuberculosis 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. 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. Gi disturbance was most pronounced after treatment with ethambutol and. Isoniazid has not been shown to be carcinogenic in humans.
Dopamine hypothesis put forward by arvid carlsson the clinical features of schizophrenia sometimes extended to psychosis in general is. 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. In one study, concomitant use with isoniazid decreased isoniazid exposure by 2230%. 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. What you need to know about your medicine for latent. Substance induced psychosis and criminal responsibility by michelle s. Thus, patients with isoniazid induced psychosis recover without specific treatment after the withdrawal of the offending drug. When isoniazid is required in patients who are already receiving phenytoin, the phenytoin dose has to be adjusted because isoniazid decreases its clearance. This product also contains as inactive ingredients. 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. Many hypotheses are available to explain the mechanism of iip but lack conclusive evidence in its favour. The experience of psychosis varies greatly from person to person. Antipsychotic medication reference user guide usual dosage ranges represent treatment of schizophrenia in healthy adults unless otherwise indicated. The current case establishes neuropathy with vitamin b6 deficiency.
These symptoms included depression, anxiety, nightmares, and psychotic. Transition of substanceinduced, brief, and atypical. The effectiveness of this type of treatment has brought about important improvements in the care and management of individuals. Scholars elective, university of western ontario, 1994 thesis submitted in partial fulfillment of the requirements for the degree of. Isoniazid can cause drug induced lupus dil when taken over longterm and chronic use.
Avoid tyraminerich foods such as mature cheeses, salami, pickled herring, bovril, oxo, marmite or any similar meat or yeast extract or fermented soya bean extract, and some beers, lagers or wines or histaminerich foods such as very mature cheese or fish from the scromboid family e. Isoniazid induced psychosis in a patient on dots therapy. Read isoniazid, reactions weekly on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Isoniazidinduced acute psychosis in a patient with pleural. 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. He was prescribed rifampicin, pyrazinamide, and ofloxacin and had no further psychotic symptoms. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Isoniazid, as part of dots regimen, is the first line of drug and very commonly used. Among the traditional forms of firstline antituberculosis. 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.
Isoniazid and ethambutolinduced psychosis open access. Pdf most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol embinduced psychosis. Getting help early can prevent a lifetime of pain and debilitation. Isoniazidinduced psychosis in a patient on dots therapy. In 1996, tiwari reported a case of isoniazidinduced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case. Tuberculosis can become resistant to treatment if isoniazid is used alone. Isoniazid definition of isoniazid by medical dictionary. Adverse effects include hepatitis, peripheral neurotoxicity. 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. Active tuberculosis must be treated with multiple concomitant antituberculosis medications to prevent the emergence of drug resistance.
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. Concurrent use of alcohol, palclcetamol and other hepatotoxic medication may increase the incidence ol rifampicin induced hepatotoxicity. Antipsychotic drugs 9 chapter objectives after studying this chapter, you will be able to 1. Isoniazid and ethambutolinduced psychosis prasad r, garg r. 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. A large portion of the worlds population is infected with tb. 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.
The diagnosis becomes especially challenging when the patient has tubercular meningitis or some other neurological disease. 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. Isoniazid is the most reliable and most commonly used medication for tuberculosis. 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. In other cases, the illness may last longer, but begin with a drug induced psychosis. Pdf isoniazid induced psychosis a case report researchgate. Aluminiumcontaining antacids may, delay absorption nd decrease serum concntrations o. People may also experience some cognitive and other symptoms. 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. If this drug is being widely used, it is important for us to be aware of its dangers.
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