|
Anti-TB drug | Reported adverse event | Frequency of event | References |
|
Isoniazid (INH) or iproniazid (IPH) | Toxic psychoses developed while under treatment with isoniazid or iproniazid in combination with other antituberculous drugs | 5 cases seen at Charity Hospital of Louisiana, at New Orleans | [116] |
|
Cycloserine | Showed some type of neurologic or psychiatric disturbance of varying severity | 15 out of 30 TB patients 6 showed severe disturbance of function, either manifested by mounting signs of central nervous system instability (grand mal convulsions) or in borderline or outright psychosis. | [117] |
|
Isoniazid and ethambutol | Peripheral neuropathy is associated with the use of isoniazid | In approximately 17% of patients using doses of 300 mg daily and lower frequency to the use of ethambutol
| [118] |
|
Isoniazid and ethambutol | The optic neuritis manifests with reduced visual field or acuity or color vision
| Uncommon during the use of isoniazid and ethambutol/is related to generally at high doses or prolonged use | [118] |
|
Isoniazid | The behavioral disorders, changes in the rhythm of sleep, reduced memory, and psychosis have been described for the use of isoniazid. Seizures and coma are described by the excessive intake of isoniazid. | Alcoholism, diabetes mellitus, malnutrition, and uremia are all predisposing factors for neurological and psychiatric disorders listed here. | [118] |
|
streptomycin | The toxicity acoustic (or vestibular) is a complication related to the use of streptomycin. | | [118] |
|
Isoniazid | Minor adverse effects. Changes in behavior: headache, insomnia, euphoria, agitation, anxiety, and somnolence can occur in patients receiving isoniazid | | [119] |
|
Isoniazid | Major adverse effects: Psychosis, convulsive seizures, mental confusion, and coma. Attempted suicides have been reported to occur among patients using isoniazid | In patients receiving isoniazid, neurological and psychiatric manifestations are less common, more severe, and often difficult to diagnose. The differential diagnosis with tuberculous meningitis and hepatic encephalopathy should be established. | [119] |
|
Isoniazid | Out of the five psychotics, three were manic, and two were depressive. Among the six neurotics, three were depressive and one each of anxiety, obsessive compulsive, and phobic neurosis | 11 (five psychotics and six neurotics) out of 732 in patients of the hospital for tuberculosis and chest diseases, symptoms were nondose related | [120] |
|
Isoniazid | INH-induced psychosis | 8 cases of INH-induced psychosis out of 4960 hospitalised patients of pulmonary tuberculosis receiving INH | [121] |
|
Isoniazid | Toxic psychosis as a psychiatric side effect during antituberculosis therapy occurred when isoniazid was given in dose ranging from 2.6 milligrams to 4.5 milligrams/kg bodyweight, over a period of eight to thirty six weeks.
| Five cases developing psychosis while receiving isoniazid that presented with excessive argumentation, mental depression, euphoria, grandiose ideas, and complex delusions; none of these patients had any previous history of mental illness. | [122] |
|
Ethambutol and isoniazid | Concomitant occurrence of INH- and EMB-induced psychosis in a single individual | A case report: an extremely uncommon event | [123] |
|
Isoniazid | Symptoms of restlessness, irritability, emotional instability, agitation, apprehension, and fluctuation in behavior after isoniazid therapy | A case report
| [124] |
|
Isoniazid | A case of isoniazid psychosis in a 74-year-old, who developed restlessness, irritability, aimless activity, and incongruous actions 10 days after starting isoniazid therapy | A case report
| [125] |
|
Isoniazid | A case of isoniazid-induced psychosis with disturbed sleep, restlessness, and abnormal behavior | A case report
| [126] |
|
Ethambutol | A 40-year-old man with advanced HIV infection and mycobacterium avium complex infection experienced rapid cognitive decline after commencement of ethambutol, and symptoms fully resolved with cessation | A case report
| [127] |
|
Ethambutol | A case of a 51-year-old man with suspected tuberculosis (TB) pleurisy. An anti-TB trial with INH, rifampicin, and EMB was given initially. Dizziness, disorientation, and auditory and visual hallucinations developed after seven days of therapy. When the patient was challenged with EMB, the same psychiatric symptoms recurred but resolved again after discontinuation of EMB. | A case report
| [128] |
|
The neurological manifestations and toxicities of 12 antituberculosis drugs (isoniazid, rifampicin (rifampin), ethambutol, p-aminosalicylic acid, pyrazinamide, streptomycin, kanamycin, ethionamide, cycloserine, capreomycin, viomycin, and thiacetazone) are reviewed | In the Boston Collaborative Drug Surveillance Program performed in 1974. With rifampicin neurological complications have been observed infrequently, isoniazid is associated with a large number of accidental and intentional poisonings. | More than 35% of adverse effects associated with INH were psychiatric in nature, with an incidence of 1.9%. Adverse reactions to cycloserine are mainly dose related with neurological and psychiatric syndromes noted in up to 50% of patients. The highest incidence has been observed with Southwestern American Indians in which this agent was involved in 7% of all suicide attempts and 19% of the suicide deaths. | [129] |
|
Isoniazid | In Peru, severe psychiatric syndromes associated with INH
| Occurred in approximately 1.0% of tuberculosis cases between 1991 and 1999 | [130] |
|
Isoniazid | All case reports describing isoniazid-associated psychosis were reviewed. Studies were evaluated for the use of isoniazid, symptoms of psychosis, onset of symptoms, and dosage of isoniazid. The most common psychiatric symptoms associated with INH were delusions, generally presenting after approximately 4 weeks of taking the drug, and among patients of an average age of 35 years (range 17–53). They summarize risk factors as receiving a dose above 5 mg/kg; age 50 years or older; comorbid disease including diabetes mellitus, hepatic insufficiency, alcoholism, and hyperthyroidism; and past psychiatric history. | The incidence of isoniazid-associated psychosis is rare | [131] |
|
Isoniazid | A patient who developed a psychotic disorder after 4 months of isoniazid prophylaxis for a positive tuberculosis tine test. His symptoms resolved within 2 weeks of discontinuing the isoniazid. | | [132] |
|
Primary antituberculosis (anti-TB) drugs | Out of 1149 patients with established tuberculosis who initially received anti-TB therapy neuropsychiatric manifestations were observed during the initial phase of therapy. | In 0.7% of TB patients | [133] |
|
Ethionamide | Adverse reactions like anxiety, depression, and psychosis | Has been reported in 1%-2% of patients taking shorter courses of the drug, with higher rates reported with prolonged treatment | [134] |
|
Ethionamide | A patient being treated with streptomycin, isoniazid, pyrazinamide, ethionamide, and prednisolone developed an acute psychotic reaction and died after jumping from a second floor window. It is probable that the reaction was precipitated by the ethionamide. | A case report | [135] |
|
Ethambutol | Dizziness, disorientation, and auditory and visual hallucinations developed after seven days of therapy. Following discontinuation of anti-TB agents, the psychiatric symptoms subsided. When the patient was challenged with EMB, the same psychiatric symptoms recurred, but resolved again after discontinuation of EMB. EMB may be associated with mania, confusion, and psychosis. | A case report | [136]
|
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Fluoroquinolones | Have been implicated in rare occurrences of psychosis, depression, suicidal ideation, delirium, and nightmares. CNS toxicity occurs in 1%–4.4% of patients but with serious adverse occurring in less than 0.5% of patients. | A case of a woman who experienced an acute psychosis secondary to ciprofloxacin administration, which resolved on cessation of therapy. Two cases of organic psychosis, induced by ofloxacin. 8861 patients receiving ciprofloxacin were assessed worldwide, and 138 cases presented with various neurological adverse reactions. | [137] [138] [139] [140] |
|
Ofloxacin or ciprofloxacin | In a retrospective study conducted by the authors, 4189 reports of consultant psychiatric examinations were analyzed. In 29 patients, the suspicion of psychopathological ADR during treatment with ofloxacin or ciprofloxacin was documented. Psychopathological findings included delirious states, paranoid, depressive and manic syndromes, agitation, sleep disturbances, and stupor. In elderly patients, delirious and paranoid syndromes were predominant, whereas affective disturbances occurred more often in younger patients. | Reported psychiatric disturbance in 0.7% of 4189 individuals treated with either ofloxacin or ciprofloxacin. | [141] |
|
Cycloserine | Severe psychiatric manifestations—including hallucinations, anxiety, depression, euphoria, behavioral disorders, and suicidal ideation and/or attempts. Psychiatric symptoms appear most likely to present within the first 3 months of treatment. | Have been reported to occur in 9.7%–50% of individuals receiving CS. | [142] [143] [144] [145] [146] [147] [148] |
|