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Vitamins
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Dietary pyridoxine deficiency can also produce seizures. An example of this was an infant formula accidentally deficient in vitamin B6. Infants given a pyridoxine deficient diet for 1 to 6 months exhibit irritability and generalized seizures including infantile spasms (7). Certain drugs are pyridoxine antagonists. Isonicotinic acid hydrazide (INH), used to treat tuberculosis, and progesterone-estrogen contraceptives increase the requirements for pyridoxine. Seizures have been reported in association with INH administration (5).
Mycobacterium tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Isoniazid was discovered in 195263,64 as an analogue of nicotinamide, which was serendipitously discovered to kill M. tuberculosis while it was used as a remedy to treat the ill effects of cancer therapies.65 During the synthesis of one of these synthetic molecules, namely γ-pyridyaldehyde thiosemicarbazone, an intermediate was discovered to have surprisingly strong activity against TB. This intermediate was called isonicotinic acid hydrazide or INH.63,64 The combination of Streptomycin, p-amino salicylic, and Isoniazid was the first combination therapy that led to sterilizing chemotherapy.
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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
The primary metabolic route is the acetylation of isoniazid to acetyl-isoniazid by N-acetyltransferase found in the liver and small intestine. Acetyl-isoniazid is then hydrolysed to isonicotinic acid and monoacetylhydrazine; isonicotinic acid is conjugated with glycine to isonicotinyl glycine (isonicotinuric acid) and monoacetylhydrazine is further acetylated to diacetylhydrazine. Some unmetabolised isoniazid is conjugated to hydrazones. The metabolites of isoniazid have no tuberculostatic activity and, apart from possibly monoacetylhydrazine, they are also less toxic. The rate of acetylation of isoniazid and monoacetylhydrazine is genetically determined and there is a bimodal distribution of persons who acetylate them either slowly or rapidly. In patients with normal renal function, over 75% of a dose appears in the urine in 24 hours, mainly as metabolites. Small amounts of drug are also excreted in the faeces.
Advances in the design of combination therapies for the treatment of tuberculosis
Published in Expert Opinion on Drug Discovery, 2023
Jonah Larkins-Ford, Bree B. Aldridge
Historically, TB treatment was necessarily empirical and iterative. Until the mid-twentieth century, TB treatment consisted of palliative care and the isolation of infected individuals to minimize the spread of disease [1,2,9]. Drug treatment for TB had been long sought after but not proven effective until the discovery of streptomycin (S) and para-aminosalicylic acid (PAS) in 1944 [2,9]. These antibiotics were quickly found to be efficacious for treating TB in the clinic [2]. Only a few years after the first uses, treatment with both S and PAS in a clinical trial demonstrated the increased efficacy of combination therapies while preventing the development of common drug resistance in monotherapies [10]. The discovery of isonicotinic acid hydrazide (H, isoniazid) in 1952, which also displays activity against Mtb, quickly led to a three-drug combination therapy H+S+PAS that had predictably high cure (>90%) in patients with as low as 4% disease relapse [2,10].
Isonicotinic acid hydrazide (INH) versus extra-amniotic saline infusion (EASI) for cervical ripening at term: a randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2022
Ladan Haghighi, Behnaz Mohabbatian, Zahra Najmi, Samaneh Rokhgireh, Samira Saadatjoo, Yousef Moradi, Mojgan Mokhtari
Isonicotinic acid hydrazide, an anti-tuberculosis agent, is recently introduced as a cervical ripening agent (Haghighi and Mohabatian 2015; Haghighi et al. 2020). It acts via increasing collagen solubility due to inactivation of lysyl oxidase, which is responsible for initiation of cross-link formation in collagen (Carrington et al. 1984). Moreover, it has been suggested that INH may cause lysyl oxidase inhibition by competing for its obligatory cofactor, pyridoxal phosphate (Carrington et al. 1984). Reduction in collagen cross-linking has been shown to decrease mechanical strength of the resulting tissue (Mahendroo 2012). Finding an agent for cervical ripening without stimulating uterine contractions is ideal and the advantage of INH is the possibility to be used in the outpatient setting with no need for foetal monitoring and also in patients with prior caesarean section. In this randomised clinical trial, we compared the efficacy of isonicotinic acid hydrazide and EASI for pre-induction cervical ripening among women with term pregnancy and unfavourable cervix.
Parametric population pharmacokinetics of isoniazid: a systematic review
Published in Expert Review of Clinical Pharmacology, 2023
Jinmeng Li, Xinjun Cai, Yueting Chen, Chenyu Wang, Zheng Jiao
PubMed and Embase databases were systematically searched for studies on INH PPK reported before 30 January 2023, according to the principles of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement [17]. The following search terms were used: (‘isoniazid’ OR ‘isonicotinic acid hydrazide’ OR ‘isonex’) AND (‘population pharmacokinetic’ OR ‘pharmacokinetic modeling’ OR ‘nonlinear mixed effect model’ OR ‘NONMEM’ OR ‘WINNONMIX,’ ‘ADAPT,’ ‘P-PHARM,’ ‘nlmixed,’ ‘NLME,’ or ‘MONOLIX’). Detailed search strategies are listed in Supplementary Table S1. Additional relevant studies from the reference list of the included studies were also investigated to ensure the completeness of study identification.