Q: 28 years male has recently started on Isoniazide (INH) after he tested positive for PPD during a routine employment exam. He is now admitted with a seizure. What is the treatment?
Answer: IV Pyridoxine (Vitamin B6)
Five grams of IV pyridoxine given over 5-10 minutes is sufficient to abolish the neurologic effects of isoniazid in most cases. Repeat dosing may be required for persistent seizure activity. Patients usually do not respond to most of the antiepileptics.
#neurology
#pharmacology
References:
1. Tsubouchi K, Ikematsu Y, Hashisako M, Harada E, Miyagi H, Fujisawa N. Convulsive seizures with a therapeutic dose of isoniazid. Intern Med. 2014;53(3):239-42. doi: 10.2169/internalmedicine.53.1303. PMID: 24492693.
2. Minns AB, Ghafouri N, Clark RF. Isoniazid-induced status epilepticus in a pediatric patient after inadequate pyridoxine therapy. Pediatr Emerg Care. 2010 May;26(5):380-1. doi: 10.1097/PEC.0b013e3181db24b6. PMID: 20453796.
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