Which drug used for tuberculosis can lead to peripheral neuropathy and requires supplementation with pyridoxine (Vitamin B6)?

Isoniazid is known for its association with peripheral neuropathy, particularly because it interferes with the metabolism of pyridoxine (Vitamin B6). This interaction can lead to deficits of Vitamin B6, which is vital for proper nerve function and the synthesis of neurotransmitters. As a result, patients on isoniazid can develop symptoms of peripheral neuropathy, including tingling, numbness, or pain in the extremities.

To mitigate this risk, it is common practice to supplement with pyridoxine while a patient is taking isoniazid. This supplementation helps replenish any depleted levels of Vitamin B6 and reduces the likelihood of developing neuropathy. This approach is particularly important in populations that may already be at higher risk of Vitamin B6 deficiency, such as those with poor nutritional status or those with certain medical conditions.

The other options listed do not share this same side effect profile nor do they require pyridoxine supplementation specifically for the prevention of peripheral neuropathy.