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Isoniazid

Hydrazide Isonicotinic Acid


Presentation

  • The diagnosis of INH overdose should be considered in any patient who presents to emergency medical services (EMS) with the triad.[ncbi.nlm.nih.gov]
  • Here, there is a report of a 38-year-old man who presented with non-pruritic skin plaques, caused by isoniazid-resistant Mycobacterium tuberculosis, over his buttock, inguinal area and earlobe.[ncbi.nlm.nih.gov]
  • Clinicians should be aware of this adverse effect of isoniazid and that it may present with a broad clinical picture.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Clinicians should be aware of this adverse effect of isoniazid and that it may present with a broad clinical picture.[ncbi.nlm.nih.gov]
  • PURPOSE: In the present study, we aim to identify that ursolic acid (UA), a widely distributed pentacyclic triterpene, may act as an effective antagonist of PXR and its sister NR receptor, constitutive androstane receptor (CAR, NR1I3).[ncbi.nlm.nih.gov]
Fatigue
  • Metabolic Frequency not reported : Anorexia, hyperglycemia, metabolic acidosis, pellagra, pyridoxine deficiency [ Ref ] Gastrointestinal Frequency not reported : Epigastric distress, nausea, pancreatitis, vomiting [ Ref ] Other Frequency not reported : Fatigue[drugs.com]
  • These include any of the following: unexplained anorexia, nausea, vomiting, dark urine, icterus, rash, persistent paresthesias of the hands and feet, persistent fatigue, weakness or fever of greater than 3 days duration and/or abdominal tenderness, especially[medlibrary.org]
  • These include any of the following: unexplained anorexia, nausea, vomiting, dark urine, icterus, rash, persistent paresthesias of the hands and feet, persistant fatigue, weakness or fever of greater than 3 days duration and/or abdominal tenderness, especially[rxwiki.com]
  • These symptoms and signs include: Unexplained loss of appetite Nausea Vomiting Dark urine Yellow skin or a yellowish tinge to the whites of the eyes Persistent fatigue Weakness Fever of greater than 3 days duration Abdominal tenderness or discomfort,[medicinenet.com]
Vietnamese
  • Abstract A 30-year-old Vietnamese woman, about 19 weeks pregnant, was admitted for acute cerebral infarction with stenosis of the left middle cerebral artery (LMCA), tuberculous meningitis, and miliary tuberculosis.[ncbi.nlm.nih.gov]
Nausea
  • She presented with a 4 month history of persistent occipital headaches associated with intermittent nausea and vomiting.[ncbi.nlm.nih.gov]
  • We present a case of a 32-year-old woman admitted to our clinic reporting abdominal pain, nausea and vomiting for 2 days.[ncbi.nlm.nih.gov]
  • Check with your doctor immediately if any of the following side effects occur while taking isoniazid: More Common Clumsiness or unsteadiness dark urine loss of appetite nausea or vomiting numbness, tingling, burning, or pain in hands and feet unusual[drugs.com]
  • Isoniazid Overdose Symptoms of an isoniazid overdose may include: Dizziness Blurred vision Hallucinations Loss of consciousness Nausea Seizures Slurred speech Very slow or rapid breathing Vomiting Confusion Unusual drowsiness Increased thirst or urination[everydayhealth.com]
  • Symptoms suggestive of liver toxicity include nausea, vomiting, abdominal pain, dark urine, right upper quadrant pain, and loss of appetite. Black and Hispanic women are at higher risk for isoniazid-induced hepatotoxicity.[en.wikipedia.org]
Abdominal Pain
  • We here present a case initially involving a complaint of lower abdominal pain, which was diagnosed after a long diagnostic work-up as tuberculous salpingitis and which is rare in women in developed countries.[ncbi.nlm.nih.gov]
  • We present a case of a 32-year-old woman admitted to our clinic reporting abdominal pain, nausea and vomiting for 2 days.[ncbi.nlm.nih.gov]
  • Symptoms suggestive of liver toxicity include nausea, vomiting, abdominal pain, dark urine, right upper quadrant pain, and loss of appetite. Black and Hispanic women are at higher risk for isoniazid-induced hepatotoxicity.[en.wikipedia.org]
  • Other important side effects of isoniazid include: Nausea Vomiting Abdominal pain Dry skin Fever Skin rashes and eruptions Swollen lymph nodes Reductions in white blood cells (which increases the risk of infection) Reductions in platelets (which increases[medicinenet.com]
Jaundice
  • A fifteen-year-old girl was treated with isoniazid (INH) for latent tuberculosis infection (LTBI), and subsequently developed epigastric pain, vomiting, and jaundice after three months of treatment. Acute fulminant hepatic failure was diagnosed.[ncbi.nlm.nih.gov]
  • By the 46th day, the patient had developed asthenia, adynamia, choluria, acholia, jaundice and nausea.[scielo.org.co]
  • Adverse Reactions: Peripheral neuropathy (esp. in slow acetylators), elevated serum transaminases (SGOT; SGPT), bilirubinemia, bilirubinuria, jaundice, hepatitis (may be fatal), nausea, vomiting, epigastric distress, pancreatitis, blood dyscrasias, hypersensitivity[empr.com]
  • Prophylaxis and therapy of tuberculosis, usually in combination with other tuberculostatics (prevention of the development of resistances ) 4 Side effects Gastrointestinal problems CNS disorders Peripheral neuropathy Allergies Hepatotoxicity Intrahepatic jaundice[flexikon.doccheck.com]
  • -The WHO classifies this drug as compatible with breastfeeding; the breastfed infant should be monitored for jaundice.[drugs.com]
Skin Plaque
  • Here, there is a report of a 38-year-old man who presented with non-pruritic skin plaques, caused by isoniazid-resistant Mycobacterium tuberculosis, over his buttock, inguinal area and earlobe.[ncbi.nlm.nih.gov]
Auditory Hallucination
  • She reported that 1 day following the initiation of INH and pyridoxine, she experienced auditory hallucinations. She recalled hearing a voice that commanded her to “take the pills.”[doi.org]
Salpingitis
  • We here present a case initially involving a complaint of lower abdominal pain, which was diagnosed after a long diagnostic work-up as tuberculous salpingitis and which is rare in women in developed countries.[ncbi.nlm.nih.gov]
Seizure
  • Isoniazid toxicity should be suspected in any patient who comes to the emergency department with refractory seizures and metabolic acidosis.[ncbi.nlm.nih.gov]
  • Isoniazid (INH) is an effective treatment for tuberculosis and among the most common causes of drug-induced seizures in the United States.[ncbi.nlm.nih.gov]
  • Seizures refractory to standard anticonvulsant therapy were controlled with the administration of pyridoxine. Most reported cases of isoniazid-induced convulsive seizures occurred as a result of an overdose due to attempted suicide.[ncbi.nlm.nih.gov]
  • One hour after onset of these symptoms, the patient suffered the 1st of 4 generalized tonic-clonic seizures, each reported to last a few minutes. Between seizures, she was reported to be agitated and unresponsive to commands.[doi.org]
Peripheral Neuropathy
  • Co. was found to be ineffective in preventing peripheral neuropathy, which occurred in five of the 18 patients receiving this preparation, as compared with six of the 18 who received a placebo, calcium gloconate.[iris.paho.org]
  • For Healthcare Professionals Applies to isoniazid: intramuscular solution, oral syrup, oral tablet General The most commonly reported side effects included mild and transient elevation of serum transaminase levels, peripheral neuropathy, and hepatitis[drugs.com]
  • Side effects may include hepatitis (especially in older patients), peripheral neuropathy, dizziness, and headache.[britannica.com]
Confusion
  • Isoniazid Overdose Symptoms of an isoniazid overdose may include: Dizziness Blurred vision Hallucinations Loss of consciousness Nausea Seizures Slurred speech Very slow or rapid breathing Vomiting Confusion Unusual drowsiness Increased thirst or urination[everydayhealth.com]
  • Do not confuse it with chemotherapy or chemo drugs used for the treatment of cancer Q. Is Isoniazid bacteriostatic or bactericidal? Isoniazid is a bacteriostatic antibiotic.[1mg.com]
  • […] develop 3g (40mg/kg) – seizures, metabolic acidosis, coma 10g (130 mg/kg) – always lethal without treatment CLINICAL FEATURES dizziness, blurred vision, photophobia, nausea and vomiting tachycardia, mydriasis, dysarthria, ataxia and hyperreflexia rapid confusion[lifeinthefastlane.com]
  • Until levels of in vitro resistance that correlate with clinical outcome are defined, giving in vitro susceptibility results to clinicians is likely to confuse treatment rather than aid it.[doi.org]
Headache
  • She presented with a 4 month history of persistent occipital headaches associated with intermittent nausea and vomiting.[ncbi.nlm.nih.gov]
  • At 2 months after the initiation of the therapy (about one week after the change in the anti-tuberculosis drug regimen), his spinal fluid was examined, given his complaints of headache and vomiting.[ncbi.nlm.nih.gov]
  • Upon arrival to tertiary care hospital in 3.5 h of poisoning she had persistent vomiting, dizziness and headache. On examination, she was drowsy but arousable, orange-red discoloration of the body was noted even with the dark skin complexion.[ncbi.nlm.nih.gov]
  • Side effects may include hepatitis (especially in older patients), peripheral neuropathy, dizziness, and headache.[britannica.com]
  • Check with your doctor if redness or itching of the skin, hot feeling, fast or pounding heartbeat, sweating, chills or clammy feeling, headache, or lightheadedness occurs while you are taking this medicine.[mayoclinic.org]
Stupor
  • Massive poisoning results in coma preceded by respiratory depression and stupor. Severe intractable seizures may occur. Emesis and gastric lavage can be of value if instituted within a few hours of ingestion.[apps.who.int]
  • The first signs and symptoms of isoniazid toxicity usually appear 30 minutes to two hours after ingestion and include nausea, vomiting, slurred speech, dizziness, tachycardia and urinary retention, followed by stupor, coma and recurrent grand mal seizures[aafp.org]
  • […] and treatment Early signs and symptoms of overdose include nausea, vomiting, slurred speech, dizziness, blurred vision, and visual hallucinations, occurring 30 minutes to 3 hours after ingestion; gross overdose causes CNS depression progressing from stupor[glowm.com]
  • With marked overdosage, respiratory distress and CNS depression, progressing rapidly from stupor to profound coma, are to be expected, along with severe, intractable seizures.[rxmed.com]

Workup

Liver Biopsy
  • Although her follow-up liver biopsy indicated lymphocytic inflammation, she is now asymptomatic with normal hepatic transaminases.[ncbi.nlm.nih.gov]

Treatment

  • Overall, 140 patients (84.8%) had a successful treatment outcome while 12 (7.2%) had an unsuccessful treatment outcome of failure (n 2; 1.2%), relapse (n 4; 2.4%) or all cause mortality (n 6; 3.6%).[ncbi.nlm.nih.gov]
  • Treatment of isoniazid-resistant tuberculosis with the WHO standard regimen for new patients resulted in treatment failure, relapse, and acquired multidrug resistance in 11% (6-17), 10% (5-15) and 8% (3-13), respectively; treatment with the standard WHO[ncbi.nlm.nih.gov]
  • Therefore, pharmacological and surgical treatment should be avoided.[ncbi.nlm.nih.gov]
  • In the treatment of tuberculosis, resistant organisms may multiply and the emergence of resistant organisms during the treatment may necessitate a change in the regimen.[web.archive.org]
  • (See "Treatment of pulmonary tuberculosis in HIV-uninfected patients" and "Treatment of latent tuberculosis infection in HIV-uninfected adults" and "Treatment of pulmonary tuberculosis in HIV-infected adults" and "Treatment of latent tuberculosis infection[web.archive.org]

Prognosis

  • Neither variable seems to contribute to severity of psychosis or ultimate prognosis.[journals.lww.com]
  • Antituberculosis therapy-induced acute liver failure: magnitude, profile, prognosis, and predictors of outcome. Hepatology. 2010;51:1655-74. [ Links ] 6. Reuben A, Koch DG, Lee WM.[scielo.org.co]
  • In each of the trials, the prognosis variables were equally distributed between groups at the beginning of the trial.[cid.oxfordjournals.org]
  • Prognosis of tuberculosis in married women. Tubercle 1954; 35: 28–30 CrossRef PubMed Google Scholar 7. Raeburn HE, Clancy FJ. Management of pregnancy in tuberculosis patients. Tubercle 1955; 36: 127–8 CrossRef PubMed Google Scholar 8.[doi.org]

Etiology

  • The etiology may be pathological, pharmacological, or idiopathic reasons. The present report describes a case of gynecomastia due to isoniazid therapy.[ncbi.nlm.nih.gov]
  • Usual etiologies of pancreatitis were eliminated. Because of vomiting, antituberculosis therapy was withdrawn and symptoms disappeared.[ncbi.nlm.nih.gov]
  • Based on the exclusion of other etiologies, rapid improvement with cessation of INH, and the recurrence of the fever and myalgia with re-administration of a reduced dose of INH, we diagnosed him with INH-induced rhabdomyolysis.[ncbi.nlm.nih.gov]
  • Drug-induced fever and tumor fever were suspected as causes, but the etiology could not be determined.[ncbi.nlm.nih.gov]
  • Acute liver disease of any etiology. Warnings/Precautions: Impaired renal or hepatic function. Monitor hepatic and ocular function. Alcoholism. Diabetes. Increased risk of liver damage with increasing age.[empr.com]

Epidemiology

  • , United Kingdom. 4 Field Epidemiology Training Programme, Public Health England, London, United Kingdom. 5 European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden. 6 Field Epidemiology[ncbi.nlm.nih.gov]
  • Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 7 Statens Serum Institut, Copenhagen, Denmark. 8 Epidemiology Department, Social Medicine Institute, University of Rio de Janeiro, Brazil. 9 Montreal Chest Institute[ncbi.nlm.nih.gov]
  • Author information 1 Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 2 Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland. 3 Department of Clinical[ncbi.nlm.nih.gov]
  • Despite seven decades of INH use, our knowledge in key areas such as the epidemiology of resistant strains, their clinical consequences, whether tailored treatment regimens are required and the role of INH resistance in fuelling the MDR-TB epidemic is[ncbi.nlm.nih.gov]
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and[ingentaconnect.com]
Sex distribution
Age distribution

Pathophysiology

  • It is unclear whether the observed prodromal symptoms and frank psychosis in patients taking INH represent a lesser degree of GABA-mediated disinhibition or a different pathophysiology entirely.[journals.lww.com]
  • The pathophysiology of DILI is not fully understood. One hypothesis is that an inflammatory reaction results in release of bacterial lipopolysaccharides which act in conjunction with drug metabolites to cause DILI.[scielo.org.co]
  • Implicated drugs, pathophysiology and management. Drug Saf. 1995; 13:94-104. [PubMed 7576268] 163. Centers for Disease Control and Prevention.[web.archive.org]
  • Implicated drugs, pathophysiology and management. Drug Saf. 1995; 13:94-104. 163. Centers for Disease Control and Prevention.[drugs.com]

Prevention

  • The incremental cost effective ratio was US 405.93 per TB case prevented and US 174.15 per death averted.[ncbi.nlm.nih.gov]
  • However, active tuberculosis must be treated with multiple concomitant anti-tuberculosis medications to prevent the emergence of drug resistance.[medlibrary.org]
  • Use of isoniazid in alcoholic and smoker patient required a caution for prevention of neurological adverse reactions. Pyridoxine should always be prescribed to such patients for the prevention of such adverse reaction.[ncbi.nlm.nih.gov]
  • Abstract Despite the recent rollout of Isoniazid Preventive Therapy (IPT) to prevent TB in people living with HIV in South Africa, adherence and completion rates are low.[ncbi.nlm.nih.gov]
  • BACKGROUND: Tuberculosis (TB) screening affords clinicians the opportunity to diagnose or exclude TB disease and initiate isoniazid preventive therapy (IPT) for people living with HIV (PLHIV).[ncbi.nlm.nih.gov]

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