Cs or Trd, FQs, H, Eto or Pto
Visual or auditory hallucinations, delusions, paranoia and bizarre behaviour are hallmarks of psychosis. Health personnel should be familiar with these symptoms to allow early detection.
The most likely TB drug involved is Cs or Trd, but psychotic symptoms may occur with FQs, H, Eto or Pto.
History of psychosis is not a contra-indication to the use of the above-mentioned drugs, though psychotic symptoms are more likely to occur in such circumstances.
Some patients may need antipsychotic treatment throughout the duration of TB treatment.
Psychosis is generally reversible upon discontinuation of TB treatment.
For acute psychosis:
- If patients are at risk of harming themselves or others: urgent hospitalisation.
- Stop Cs or Trd.
- Treat the acute psychosis.
Once psychotic symptoms have resolved, antipsychotic treatment can be tapered most of the time. Cs or Trd can be resumed, generally at lower dose.
Antipsychotic treatment should be continued until the end of Cs or Trd treatment and then can usually be stopped gradually (do not stop it abruptly).
If the patient does not tolerate the reintroduction of Cs or Trd, another TB drug should be considered.
Whenever psychosis occurs in a patient on Cs or Trd, check the serum creatinine. Cs or Trd is 100% renally excreted and a decrease in renal function can result in toxic levels of Cs or Trd. In this case, a temporary withdrawal of Cs or Trd and re-introduction at an adjusted dose may be needed (Appendix 12).