DIARRHOEA AND VOMITING DUE TO ISONIAZID
A case report
(Ramalingam Tuberculosis Sanatorium, Perundurai)
The side reactions to I.N.A.H. most often cessation of diarrhoea and vomiting.
reported in association with the alimentary Since diarrhoea and vomiting as side effects
System are dryness of the mouth, nausea, of Isoniazid were not observed by us so far,
occasional vomiting and constipation. we tried to administer this drug from various
Constipation has been attributed to inhibi- Pharmaceuticals and in different forms to
tion of the gut by Isoniazid—(David et al).1 this patient, during his stay of one and a
Experiments have shown that Hydrazides half years. Every attempt to start Isoniazid
can antagonize the action of methacholine resulted in diarrhoea and vomiting which
and this can account for constipation-(Drill)2. subsided after withdrawal of this drug.
It is unusual to have vomiting and diarrhoea
as a result of Isoniazid therapy, not respond- DISCUSSION
ing to usual therapies except the withdrawal
of Isoniazid. Therefore a single case is repor- In the present case during one year and
ted below. seven months of his stay in the sanatorium,
whenever he was given I.N.A.H. in any form
Case Report either as tablets or syrup or in combination
N.R., aged 45 years, Muslim male was with P.A.S. he developed diarrhoea and
admitted in the above Sanatorium onlO-2-60 vomiting. The frequency of vomiting varied
for the treatment of extensive bilateral from 3 to 6 times a day and that of loose
pulmonary tuberculosis. History revealed motions 4 to 8 times a day. The only posi-
that treatment had been started one year tive finding in the stool was the excess of
ago with dihydrostreptomycin injections and mucus. Diarrhoea did not respond to the
isoniazid tablets, but since he developed usual therapies of Mist. Bismuth et Kaolin
diarrhoea and vomiting after isoniazid, it and starch and opium enema. Stemetil,
was replaced by Sodium Para-Amino-Salicy- Largactil and Anthisan did not do much
late granules. Investigations—Sputum—Posi- good to the vomiting.
tive for Acid Fast Bacillus. E.S.R.—124 mm. Psychosensitivity of the patient to this
in 1st Hour (Wintrobe’s). Hb. —13.5 Gms. drug could be excluded as aversion to a
R.B.C.—4.5 millions/c.mm. W.B C. Total particular drug can produce nausea and/or
Count — 11,00/c.mm, Dinferential Count Stab vomiting, but surely not such intense vomit-
8%, Seg 55%, Eosinophil 1%, Lymphocytes ing and diarrhoea. Syrup Opizide was put
35%, Monocyte 1%. Urine and Stool - in another bottle containing the label
normal. ‘Maltovit’ and was given to the patient say-
On 11-2-1960 Ambystrin (Squibb-dihydro- ing that it was a general tonic. But still he
streptomycin sulphate 0.5gm+ streptomy developed diarrhoea and vomiting.
cin sulphate 0.5 gm)—1 gm i.m. biweekly Surprisingly no gastro intestinal symptoms
and Nydrazid (Squibb-Isonicotinic Acid were observed when he was on P.A.S. alone
Hydrazide 100 mg. Tablet) 1 Tablet t.i.d. or in combination with dihydrostreptomycin;
were started. On the same day the patient but when he had P.A.S.’ in combination with
had six loose motions and vomited three I.N.A.H. or when I.N.A.H. was given alone,
times. Routine treatment with Mist. he developed vomiting and diarrhoea.
Bismuth et Kaolin and Stemetil tablets did Vomiting and diarrhoea developing im-
not control either the diarrhoea or vomiting. mediately even after the first dose of Isonia-
Repeated examinations of the stool were zid showed that the ailimentary system got
normal except for excess of mucus. The disturbed at once.
vomitus contained undigested food with
gastric juice and some mucus. In view of SUMMARY
the past history Nydrazid was stopped on 13-
2-1960. This resulted in the prompt A case of pulmonary tuberculosis with
Ind. J. Tub., Vol. XI, No 4
208 DIARRHOEA AND VOMITING
bilateral extensive disease with cavitations, but stopped on withdrawal of isoniazid.
positive sputum and high E.S.R. is being
reported, who developed diarrhoea and REFERANCE
vomiting as untoward manifestations to
isoniazid given in any form either as tablet, 1. David J.C. et al-Pharmacology and Pharma
syrup, or in combination with P.A.S. from Therapeutics, Fourth Edition –p.631 –
different companies. Diarrhoea and vomit- Varada
ing did not respond to the usual therapy of chary & Co., Madras, India.
Mist Bismuth et Kaolin, starch and opium- 2. Drill Victor A-Pharmacology in Medicin-
enema, Stemetil, Largactil and Anthisan, second Edition p. 1138-McGraw Hill Book
Ind. J. Tub., Vol. XI, No. 4