Overview
Isoniazid (INH), a first-line antitubercular medication, can cause nervous system adverse reactions, including peripheral neuropathy and psychosis 1. Isoniazid-induced neuropathy is a known complication of this essential medication.Diagnosis
Isoniazid-induced psychosis is characterized by symptoms such as delusions and/or hallucinations 1.
Other observed symptoms include psychomotor disturbances, disorganized speech or thought disorder, disorganized or abnormal behavior, and neuropsychiatric symptoms like sleep disturbances, hostility, confusion, affective symptoms, anxiety, and cognitive difficulties 1.
Psychotic symptoms often occur within the first 2 months of treatment, with earlier onset noted in individuals aged 18 years or younger 1.
Rechallenge with isoniazid in over 80% of cases resulted in recurrence of psychotic symptoms 1.Management
Discontinuation of isoniazid is the primary management strategy for isoniazid-induced psychosis 1.
Rechallenge with isoniazid can lead to recurrence of psychotic symptoms 1.Special Populations
Patients aged 18 years or younger may experience an earlier onset of isoniazid-induced psychosis 1.Key Recommendations
Patients with active tuberculosis (TB) and latent TB infection (LTBI) should be monitored for neuropsychiatric symptoms associated with isoniazid treatment 1. (Evidence: Expert opinion)
Consider isoniazid-induced psychosis in patients presenting with psychotic symptoms during TB treatment 1. (Evidence: Expert opinion)
Rechallenging patients with isoniazid after experiencing psychotic symptoms may lead to recurrence 1. (Evidence: Weak)References
1 B K, Appaji R, Thomas L, Baral T, N S, Chaithra et al.. Characteristics of isoniazid-induced psychosis: a systematic review of case reports and case series. European journal of clinical pharmacology 2024. link