Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Udupi, Karnataka, India.
Department of Psychiatry, Father Muller Medical College Hospital, Father Muller Road, Kankanady, 575002, Mangalore, Karnataka, India.
Eur J Clin Pharmacol. 2024 Nov;80(11):1725-1740. doi: 10.1007/s00228-024-03738-x. Epub 2024 Aug 13.
Isoniazid, a first-line antitubercular drug, is associated with nervous system adverse drug reactions such as seizures, peripheral neuropathy, and psychosis. This systematic review of case reports and case series aimed to characterize the demographic, social, and clinical factors associated with isoniazid-induced psychosis in patients with active tuberculosis (TB) and those who received isoniazid for latent TB infection (LTBI).
We comprehensively searched the Embase, PubMed, and Scopus databases to identify relevant studies published between the date of inception of the database and June 2024.
A total of 28 studies, including 21 case reports and 7 case series involved 37 patients who developed isoniazid-induced psychosis. A higher frequency of isoniazid-induced psychosis was observed during the first 2 months of treatment, with a relatively early onset observed among patients aged 18 years or less. Delusions and/or hallucinations are the common symptoms of isoniazid-induced psychosis. Psychomotor disturbances, disorganized speech or formal thought disorder, disorganized or abnormal behaviour, and neuropsychiatric symptoms (sleep disturbances, hostility or aggression, confusion, affective symptoms, anxiety symptoms, and cognitive difficulties) were the other symptoms observed in the included studies. More than 80% of cases rechallenged with isoniazid resulted in the recurrence of psychotic symptoms.
Patients with TB and LTBI should be assessed for psychotic and neuropsychiatric symptoms during isoniazid therapy, mainly in the first 2 months. Further research is required to understand the impact of underlying risk factors, such as genetic predisposition and isoniazid pharmacokinetics, as well as the clinical utility and dosage recommendations of pyridoxine for managing isoniazid-induced psychosis.
异烟肼是一种一线抗结核药物，与神经系统药物不良反应有关，如癫痫发作、周围神经病和精神病。本系统评价病例报告和病例系列旨在描述与活动性肺结核（TB）患者和接受潜伏性结核感染（LTBI）异烟肼治疗的患者中异烟肼引起的精神病相关的人口统计学、社会和临床因素。
我们全面搜索了 Embase、PubMed 和 Scopus 数据库，以确定在数据库成立日期至 2024 年 6 月期间发表的相关研究。
共有 28 项研究，包括 21 例病例报告和 7 例病例系列，涉及 37 名发生异烟肼引起的精神病的患者。在治疗的头 2 个月中，异烟肼引起的精神病的发生率较高，18 岁或以下的患者发病较早。妄想和/或幻觉是异烟肼引起的精神病的常见症状。在纳入的研究中还观察到精神运动障碍、言语紊乱或思维形式障碍、行为紊乱或异常、神经精神症状（睡眠障碍、敌意或攻击、混乱、情感症状、焦虑症状和认知困难）。重新使用异烟肼的病例中，超过 80%的病例再次出现精神病症状。
TB 和 LTBI 患者在异烟肼治疗期间应评估精神病和神经精神症状，主要是在前 2 个月。需要进一步研究以了解潜在风险因素（如遗传易感性和异烟肼药代动力学）以及吡哆醇在管理异烟肼引起的精神病方面的临床实用性和剂量建议的影响。
