How to manage spine TB in a person with psychotic symptoms?

Question

Hi doctor,

My son is 33 years old, and he has been diagnosed with spine TB. He was prescribed a tablet containing Rifampicin, Isoniazid, Ethambutol, and Pyrazinamide tablets along with Ursodeoxycholic acid, Pyridoxine (vitamin B6), and Febuxostat. Basically, he is a psychiatric patient and was better with Divalproex 500 mg and a tablet containing Chlorpromazine 50 mg, Trihexyphenidyl 2 mg, and Trifluoperazine, both 1 tablet a day. After the start of ATT, his psychotic symptoms have relapsed. The psychiatrist is of the opinion that the ATT tablet has triggered the psychotic symptoms. He added additional medicines. The pulmonologist has advised the medicine for one year. My son has just completed one month of medicine. Is there any alternative combination medicine for the tablet containing Rifampicin, Isoniazid, Ethambutol, and Pyrazinamide since it seems to have triggered the psychotic symptoms? Despite giving additional doses of psychiatric medicine, no improvement. Kindly advise.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Since you described that your son is on antitubercular medicines (ATT) along with psychiatric medicines, they do have drug-drug interactions. It is very necessary to continue with ATT along with psychiatric medicines. Drugs in ATT can lead to new onset psychiatric symptoms or worsening of the pre-existing ones. Steps to follow in such scenarios:

1. Consult a pulmonologist and psychiatrist on a regular basis.

2. Modify the dose of psychiatric medications, or if considered appropriate by a psychiatrist, new medicine may be added.

3. Even if the symptoms are persistent, ATT drugs can be modified (particularly the Isoniazid component of ATT causes such symptoms, so it can be substituted with other options. But this shall be done under the supervision of a pulmonologist and not on your own.

Continue ATT and psychiatric medications and follow up with a psychiatrist again. Then, follow up after a week. If his symptoms happen to worsen, then we will consider substituting medicines from ATT.

Take care and follow up.

I hope this information helps you.

Regards.