Optic Neuritis following Treatment with Isoniazid in a Hemodialyzed Patient

Sánchez-Andrade, A; Agüero, Juan José; Alonso, María del Mar; Rodríguez, Ernesto Suárez; Criado, José R.

doi:10.1159/000187227

Cited by 11 publications

(4 citation statements)

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“…A concern with ECTR is removal of pyridoxine 141 : Five patients experienced seizures after initiation of ECTR, although in four, the pyridoxine dose administered prior to ECTR was inadequate 9,100,105,107 . Several publications also report ESKD patients receiving therapeutic doses of isoniazid, who developed toxicity despite a therapeutic serum isoniazid concentration, including ototoxicity, 143 optic neuritis, 144,145 and encephalopathy 10,111,123,146–161 . Although the etiology of toxicity in these cases is likely multifactorial (malnutrition, uremia‐induced impairment of phosphorylation), the chronology supports the hypothesis of an ECTR‐induced reduction in concentrations of pyridoxine and pyridoxal 5'‐phosphate (the active form of pyridoxine) 141,162,163 …”

Section: Resultsmentioning

confidence: 99%

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

et al. 2021

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Isoniazid toxicity from self‐poisoning or dosing errors remains common in regions of the world where tuberculosis is prevalent. Although the treatment of isoniazid poisoning is centered on supportive care and pyridoxine administration, extracorporeal treatments (ECTRs), such as hemodialysis, have been advocated to enhance elimination of isoniazid. No systematic reviews or evidence‐based recommendations currently exist on the benefit of ECTRs for isoniazid poisoning. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup systematically collected and rated the available evidence on the effect of and indications for ECTRs in cases of isoniazid poisoning. We conducted a systematic review of the literature, screened studies, extracted data on study characteristics, outcomes, and measurement characteristics, summarized findings, and formulated recommendations following published EXTRIP methods. Forty‐three studies (two animal studies, 34 patient reports or patient series, and seven pharmacokinetic studies) met inclusion criteria. Toxicokinetic or pharmacokinetic analysis was available for 60 patients, most treated with hemodialysis (n = 38). The workgroup assessed isoniazid as “Moderately Dialyzable” by hemodialysis for patients with normal kidney function (quality of evidence = C) and “Dialyzable” by hemodialysis for patients with impaired kidney function (quality of evidence = A). Clinical data for ECTR in isoniazid poisoning were available for 40 patients. Mortality of the cohort was 12.5%. Historical controls who received modern standard care including appropriately dosed pyridoxine generally had excellent outcomes. No benefit could be extrapolated from ECTR, although there was evidence of added costs and harms related to the double lumen catheter insertion, the extracorporeal procedure itself, and the extracorporeal removal of pyridoxine. The EXTRIP workgroup suggests against performing ECTR in addition to standard care (weak recommendation, very low quality of evidence) in patients with isoniazid poisoning. If standard dose pyridoxine cannot be administered, we suggest performing ECTR only in patients with seizures refractory to GABAA receptor agonists (weak recommendation, very low quality of evidence).

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Section: Resultsmentioning

confidence: 99%

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

et al. 2021

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“…These reports indicate that the neurotoxic effects of isoniazid may be enhanced by co-morbidities like end stage renal disease requiring hemodialysis (8,9) or malnutrition (3). The onset of visual symptoms generally occurs within ten days of starting antitubercular therapy(2,4) but may occur even two to three months after initiation of therapy (2,3,8).…”

Section: Discussionmentioning

confidence: 99%

“…Some reports indicate that the use of oral prednisone is not useful (4). Discontinuation of INH is associated with improvement of the visual dysfunction as early as four days after discontinuation (4,9) with complete recovery usually taking four weeks (1,4,9) but rarely may take up to six months (3,8). In some cases a residual bitemporal hemianopsia may persist.…”

Section: Discussionmentioning

confidence: 99%

Bilateral optic neuritis due to isoniazid (INH)

et al. 2010

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“…Optic neuropathy, due to antitubercular drugs, has rarely been attributed to INH. An extensive literature search revealed only a handful of cases, where INH has been implicated as the causative agent for optic neuropathy [3,4]. Given that ethambutol is the more commonly associated antitubercular agent with optic neuropathy [5], the odds of overlooking INH as the offending agent is extremely high.…”

Section: Introductionmentioning

confidence: 99%

Isoniazid the Culprit Behind Toxic Optic Neuropathy

Ommurugan

Bhattacharjee

Patil

2017

Asian J Pharm Clin Res

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Literature regarding toxic optic neuropathy (TON) due to isoniazid (INH) is scarce. This diagnosis is often missed, leading to unnecessary delay in institution of corrective measures. Often, this delay can worsen the patient’s vision, with a high likelihood of development of serious damage to the patient’s vision. We report a case of a 49-year-old gentleman, afflicted with meningeal tuberculosis, who developed visual disturbances following the administration of antitubercular therapy. The patient’s vision improved dramatically following INH’s withdrawal. This case highlighted the need to keep INH as a possible cause for TON, especially if vision does not improve following ethambutol’s withdrawal. Further, this case attests to the need for thorough and periodic visual examinations in patients receiving antitubercular therapy.

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Optic Neuritis following Treatment with Isoniazid in a Hemodialyzed Patient

Cited by 11 publications

References 1 publication

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

Bilateral optic neuritis due to isoniazid (INH)

Isoniazid the Culprit Behind Toxic Optic Neuropathy

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