Inadequate Pyridoxine Stock and Its Effect on Patient Outcome

Burda, Anthony M.; Sigg, Todd; Haque, Danish; Bardsley, Christina Hantsch

doi:10.1097/01.pap.0000249903.15155.0c

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…Oxidative stress caused by antitubercular medicines leads to the depletion of glutathione, the major endogenous antioxidant (Stine and Chalasani ), while isoniazid depletes vitamin B6 stores (Burda et al. ). As a result, methionine, a precursor of glutathione and vitamin B6 need to be supplemented from external sources.…”

Section: Discussionmentioning

confidence: 99%

Methionine and vitamin B‐complex ameliorate antitubercular drugs‐induced toxicity in exposed patients

Amagon

Awodele

Akindele

2017

Pharmacology Res & Perspec

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Tuberculosis therapy utilizes drugs that while effective cause treatment‐related toxicity. Modulation of antitubercular drugs‐induced toxicity by methionine and vitamin B‐complex in patients was evaluated. 285 treatment‐naïve tuberculosis patients at the Chest Clinics of Infectious Diseases Hospital, Yaba and General Hospital, Lagos in Lagos, Nigeria was prospectively recruited and allotted into test (antitubercular medicines, methionine and vitamin B‐complex) and control groups (antitubercular medicines). Data on adverse drug reactions and blood samples were collected at initiation, 2 months and 6 months, and then analyzed. Red blood cells and packed cell volume were significantly higher (P < 0.05) in the test group compared to control at 6 months of therapy. At the end of 2 months, results showed a significant decrease (P < 0.001) in aspartate aminotransferase, alkaline phosphatase, alanine aminotransferase, urea, creatinine and total bilirubin in the test group compared to control. Reduced glutathione and superoxide dismutase were significantly increased (P < 0.001) and malondialdehyde significantly decreased (P < 0.001) in the test versus control groups at the end of 2 and 6 months. Adverse drug reactions were significantly lower (P < 0.001) in the test group (32.4%) compared to control group (56.2%), with 1 death. Hepatotoxicity was significantly higher (P = 0.026) in control (6.9%), compared to test group (0%). Alcohol and cigarette smoking were significantly (P = 0.019 and P = 0.027) associated with the occurrence of adverse drug reactions. Methionine and vitamin B‐complex modulated hepatic, renal, hematological, antioxidant indices and adverse effects in patients administered antitubercular medicines. Such interventions can enhance compliance and better treatment outcomes in tuberculosis patients.

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Section: Discussionmentioning

confidence: 99%

Methionine and vitamin B‐complex ameliorate antitubercular drugs‐induced toxicity in exposed patients

Amagon

Awodele

Akindele

2017

Pharmacology Res & Perspec

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“…Isoniazid is a rare poisoning and lack of rapid availability of i.v. pyridoxine is therefore a potential problem . Oral pyridoxine is a reasonable alternative if i.v.…”

Section: Isoniazidmentioning

confidence: 99%

Antidotes to coumarins, isoniazid, methotrexate and thyroxine, toxins that work via metabolic processes

Bateman

Page

2015

Brit J Clinical Pharma

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Some toxins cause their effects by affecting physiological processes that are fundamental to cell function or cause systemic effects as a result of cellular interaction. This review focuses on four examples, coumarin anticoagulants, isoniazid, methotrexate and thyroxine from the context of management of overdose as seen in acute general hospitals. The current basic clinical pharmacology of the toxin, the clinical features in overdose and evidence base for specific antidotes are discussed. The treatment for this group is based on an understanding of the toxic mechanism, but studies to determine the optimum dose of antidote are still required in all these toxins except thyroxine, where treatment dose is based on symptoms resulting from the overdose.

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“…Prior to the use of pyridoxine, isoniazid poisoning mortality in large cohorts often exceeded 20%, 54–56 which decreased when pyridoxine was used more systematically 36,48,57 . With appropriate doses of pyridoxine, mortality from isoniazid poisoning is rare, unless patients present late to care 38,39,42,43,58,59 . The last four years of data from the American Association of Poison Control Centers’ National Poison Data System lists 497 single substance isoniazid exposures of which 135 were moderately or severely toxic, but no fatalities 60–63 …”

Section: Introductionmentioning

confidence: 99%

“…In 2018 and 2019, there were shortages of injectable pyridoxine due to manufacturing problems 68,69 . Oral pyridoxine, crushed and given via nasogastric tube, has also been used successfully for treating isoniazid poisoning, 42,58,64,70,71 although not preferred as absorption may be impaired in critically ill patients 72 . If pyridoxine is unavailable, GABA A receptor agonists are used, but their effectiveness may be limited.…”

Section: Introductionmentioning

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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Inadequate Pyridoxine Stock and Its Effect on Patient Outcome

Cited by 6 publications

References 7 publications

Methionine and vitamin B‐complex ameliorate antitubercular drugs‐induced toxicity in exposed patients

Methionine and vitamin B‐complex ameliorate antitubercular drugs‐induced toxicity in exposed patients

Antidotes to coumarins, isoniazid, methotrexate and thyroxine, toxins that work via metabolic processes

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

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