Is isoniazid so safe to use in tuberculosis preventive. Isoniazid injection fda prescribing information, side. Severe reactions may occur with ingestion of foods containing high concentrations of tyramine. May 01, 2017 isoniazid is an antibiotic that is used as a firstline treatment for both latent and active pulmonary tuberculosis.
The present study was undertaken to confirm or to deny the earlier reports that the toxic effects resulting from large doses of isoniazid. It is quite true that for many years isoniazid was considered to be a virtually nontoxic drug. There are no adequate and wellcontrolled studies in pregnant women. The incidences of hepatotoxicity are ranged as the following. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. Among the 4 standard antitb drugs, isoniazid inh is the most likely to cause drug induced liver toxicity. Inh toxicity may appear within 30 minutes of ingestion 8,71. It will not work for viral infections such as common cold, flu.
Isoniazid comes as a tablet and a solution liquid to take by mouth without food. Acute isoniazid toxicity and the need for adequate pyridoxine. You may need to take other tb medicines in combination with isoniazid. Severe isoniazidassociated liver injuries among persons being treated for latent tuberculosis infection united states, 20042008 since the 1960s, 6 to 9 months of isoniazid inh has been the mainstay of treatment for latent tuberculosis infection ltbi, but its application has been limited by concerns about the toxicity of inh and the. It is believed that the toxicity may have resulted from a previously unrecognized interaction between isoniazid and acetaminophen and a molecular basis for this interaction has been proposed. Determination of the acute toxicity of isoniazid to three invasive carp species and rainbow trout in static exposures by theresa m. A large portion of the worlds population is infected with tb. 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. Accidental aiid intentional poisoning due to isoniazid. Management of common side effects of inh isoniazid, rif rifampin, pza pyrazinamide, and emb ethambutol 1. This study supports previous studies in finding that ingestion of more than 80 mgkg body weight produces severe central nervous system symptoms that are rapidly reversed with intravenous administration of pyridoxine. The classic clinical triad of acute isoniazid neurotoxicity which includes seizures, metabolic acidosis, and coma is well recognised.
A letter by kester, entitled isoniazid hepatotoxicity fact or fantasy 217. In a recent study 2 of 20 isoniazidassociated deaths, we noted that one of the patients case 5 had taken 8 acetaminophen tablets per day in the week before. If it is still the same day, take the dose as soon as you remember. Toxicological information the toxicological effects of this product have not been thoroughly studied. Keep inh out of reach from children to prevent accidental overdose. Isoniazid is also not a safe drug and without toxicity, and side effects. Active tb infection 1015 mgkgdayup to 300 mg drugdrug.
Isoniazid isonicotinic acid hydrazide inh is an antimicrobial that has been used as a firstline agent for prophylaxis and treatment of tuberculosis since 1952. Serious and sometimes fatal liver problems may occur during treatment with isoniazid or after you stop taking this medicine, especially if you are between the ages of 35 and 65. Get emergency medical help if you have signs of an allergic reaction hives, difficult breathing, swelling in your face or throat or a severe skin reaction fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling seek medical treatment if you have a serious drug reaction that can. From 2009 to 2014, there were 73 cases of isoniazid inh overdose reported by the american association of poison control centers national data collection system. Chronic administration may also induce several adverse effects see section 7. Acute isoniazid toxicity a young patient who ingested large quantity of isoniazid along with alcohol, presented with seizures, metabolic acidosis, coma and nodal. Many patients who are identified as being at risk of.
Jul 28, 2016 isoniazid is also not a safe drug and without toxicity, and side effects. Hepatotoxicity of antituberculosis therapy american thoracic society. Isoniazid toxicity is associated with a high mortality rate. Isoniazid should be used as a treatment for active tuberculosis during pregnancy because the benefit justifies the potential risk to the fetus. Mar 05, 2010 severe isoniazidassociated liver injuries among persons being treated for latent tuberculosis infection united states, 20042008 since the 1960s, 6 to 9 months of isoniazid inh has been the mainstay of treatment for latent tuberculosis infection ltbi, but its application has been limited by concerns about the toxicity of inh and the. An acute overdose of inh is potentially fatal and is characterized by repetitive seizures, unresponsive to usual anticonvulsants, metabolic acidosis with a high anion gap and coma. Isoniazid therapy in chronic ulcerative colitisa preliminary. Latent tb infection 10 20 mgkg day up to 300 mgday or 20 40 mgkg up to 900 mg 2 times weekly. Isoniazid toxicity with cerebellar ataxia in a child. Early signs of toxicity include nausea, vomiting, slurred speech, diziness, mydriasis, tachycardia followed by recurrent seizures, severe metabolic acidosis and coma. In addition, the toxicity of isoniazid to bighead carp, silver carp, and.
Isoniazid was identified as a potential toxicant for grass carp. Isoniazid active learning template medication laura lopez. The toxicity of isoniazid chemoprophylaxis was assessed in 83 health care workers hcws receiving a 6month course, in whom clinical toxicity and liver function were monitored. Keep isoniazid in the container that it came in and keep the container tightly closed. Severe isoniazidassociated liver injuries among persons.
Isoniazid has little significant or serious toxicity. Adverse effects of isoniazid have been reported by different researchers based on their clinical studies such as renal failure, liver injury and liver failure, development of agranulocytosis, isoniazidinduced tenosynovitis etc. In addition, the toxicity of isoniazid to bighead carp, silver carp, and oncorhynchus mykiss rainbow trout was evaluated. See what others have said about isoniazid, including the effectiveness, ease of use and side effects. Isoniazid dosage adjustments may be required in rapid acetylators.
Acute central nervous system cns toxicity typically occurs in isoniazid inh overdose, but it may also be found with therapeutic use if administered in conjunction with rifampin, ethanol, barbiturates, and other cyp450 inducers. Isoniazid inh is an antibiotic used to treat infection with mycobacterium tuberculosis tb. Isoniazid is an antibacterial available as 100 mg and 300 mg tablets for oral administration. Although the disease is inactive in the majority, up to 10 percent of these persons may become infectious in their lifetime. Full text is available as a scanned copy of the original print version. The first signs of isoniazid toxicity usually appear 30 minutes to two hours after ingestion, and include nausea, vomiting, slurred speech, and dizziness followed by stupor, coma, and recurrent grand mal seizures as well as metabolic acidosis. Isoniazid injection usp provides 100 mg isoniazid per ml with 0. Isoniazid toxicity in health care workers pdf paperity. Use for children aged 211 years and patients with underlying conditions associated with tb should be considered on a casebycase basis. Ingestion at concentrations greater than 30 mgkg can often produce seizures.
Pdf eight patients who had taken accidental overdose of isoniazid were followed in relation to its clinical manifestations, eeg changes and. Isoniazid preventive therapy and risk for resistant. Isoniazid is used to treat and to prevent tuberculosis tb. Symptoms suggestive of liver toxicity include nausea, vomiting, abdominal pain, dark urine, right upper quadrant pain, and loss of appetite. Feb 07, 2019 acute central nervous system cns toxicity typically occurs in isoniazid inh overdose, but it may also be found with therapeutic use if administered in conjunction with rifampin, ethanol, barbiturates, and other cyp450 inducers. Aidsinfo provides the following drug label solely as an example of the labels available for isoniazid. Your liver function may need to be checked every month while you are taking this medicine. Full text get a printable copy pdf file of the complete article 234k, or click on a page image below to browse page by page.
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 isoniazid side effects, images, uses, dosage. Patients should be carefully monitored for isoniazid toxicity. Patients with a recently positive purified protein derivative ppd skin test and normal chest radiograph findings routinely are given a 6 to 9month course of inh. Isoniazid was not teratogenic in reproduction studies in mice, rats, and rabbits. When treating active tb, isoniazid must be used with other tb medicines.
Isoniazid inh is the most likely tb drug to cause drug induced liver toxicity. However, current evidence suggests that isoniazid does induce p450iie1, a mixedfunction oxidase enzyme that appears to generate the toxic metabolites. Isoniazid toxicity presenting as seizures and metabolic. Isoniazid is an antibiotic and works by stopping the growth of bacteria. Concurrent use with isoniazid may increase hepatotoxicity. See the article isoniazid toxicity with cerebellar ataxia in a child. Oct 07, 2019 isoniazid is an antibiotic that fights bacteria.
Earlier studies were selected for their historical. Take all your medicines as prescribed by your doctor. Isoniazid is used to treat and to prevent tuberculosis. Do not use isoniazid if the original seal over the container opening is broken or missing. Throw away isoniazid that is no longer needed or expired out of date.
The incidence of acute and chronic toxicity from isoniazid inh may be reduced by applying the following measures. Dili may result from direct toxicity of the primary compound, a metabolite, or from an. The hepatic toxicity of isoniazid among rapid and slow acetylators of the drug. Adverse effects of isoniazid have been reported by different researchers based on their clinical studies such as renal failure, liver injury and liver failure, development of agranulocytosis, isoniazid induced tenosynovitis etc.
Injection solution several fdaapproved drug labels may be available for isoniazid. When isoniazid is to be taken 2 times a week, it should be given by directly observed therapy dot. Inh may be expected to increase in frequency because of the greatly expanded use of this medication for. If isoniazid overdosage occurs, treatment with pyridoxinevitaminbisinstituted. Acetaminophen, isoniazid, and hepatic toxicity annals of.
A report of severe acetaminophen toxicity was reported in a patient receiving isoniazid. Inh has since been associated with two syndromes of hepatotoxicity. A number of risk factors for the development of severe inh hepatotoxicity have been identified. However, current evidence suggests that isoniazid does induce p. Bcg vaccine may not be effective during isoniazid therapy.
Isoniazid is an antibiotic that is used as a firstline treatment for both latent and active pulmonary tuberculosis. Avoid prophylactic use of inh in the elderly, unless the potential benefit clearly outweighs the risk. Capitals indicate lifethreatening, underlines indicate most frequent. 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. Subsequently, pope 2 has shown that pyridoxal and pyridoxamine can interfere with the tuberculostatic action of isoniazid in vitro, and mccune 3 has shown an in vivo interference with isoniazid by pyridoxine.
Pdf isoniazid inh is highly effective for the management of tuberculosis. The delay of onset of symptoms may be shorter, depending on the dose and the rate of injection. Only select registry of toxic effects of chemical substances rtecs data is presented here. Recognition of isoniazid hepatitis was delayed because other drugs with greater hepatotoxic potential such as aminosalicylic.
Murphy and colleagues 1 recently reported a case of severe hepatotoxicity in a patient who had ingested both isoniazid and acetaminophen. Feb 07, 2019 the incidence of acute and chronic toxicity from isoniazid inh may be reduced by applying the following measures. Pdf accidental isoniazid poisoninga report researchgate. The selective toxicity of isoniazid to grass carp was verified as a response to an anecdotal report received in 20.
Isoniazid investigated as a drug, hormone, mutagen, primary irritant, reproductive effector, and tumorigen. Isoniazid side effects, dosage, interactions drugs. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain. However, it can cause liver injury and even liver failure. Most cases of inh hepatotoxicity are mild and commonly resolve despite continued therapy with inh. Management of common sign effects of inh final draft. Jul 06, 2018 it is believed that the toxicity may have resulted from a previously unrecognized interaction between isoniazid and acetaminophen and a molecular basis for this interaction has been proposed.
Isoniazid is the most reliable and most commonly used medication for tuberculosis. Tuberculosis can become resistant to treatment if isoniazid is used alone. Get a printable copy pdf file of the complete article. Relative risks rr for resistant tb in the isoniazid. Consumption of 2 g of inh can predispose a patient to acute toxicity. Isoniazid has a boxed warning for severe and sometimes fatal hepatitis, which is agedependent at a rate of 0. This study supports previous studies in finding that ingestion of more than 80 mgkg body weight produces severe central nervous system symptoms that are rapidly reversed. Apr 01, 2019 isoniazid is the hydrazide of isonicotinic acid. What you need to know about your medicine for latent. Isoniazid toxicity presenting as seizures and metabolic acidosis. Determination of the acute toxicity of isoniazid to three. Inclusion or absence of a drug label on the aidsinfo site does not imply endorsement or lack thereof by aidsinfo. Apr 15, 2019 isoniazid is the hydrazide of isonicotinic acid.
1050 356 194 275 49 1454 97 1457 471 59 229 1383 1394 937 618 694 1193 560 199 7 991 1342 560 931 493 516 1213 1214 765 1501 1328 345 1191 1346 1189 1045 457 377 111 696 1186 1418 1099