Ortega has a fraught relationship with Washington, which has branded the Nicaraguan government a dictatorship, accusing its leaders of seizing total power with a constitutional rewrite and crushing dissent.

Ortega had maintained a measured tone on Trump following the war that began on February 28 with US-Israeli strikes on Tehran.

"The war being waged in the way the current US president is waging it is typical of someone who has lost their mind and thinks they can do whatever they want, any kind of cruelty," Ortega said during an event in Managua broadcast by state-run media.

"It's a problem of, let's just say, mental instability. As we say here, he's not in his right mind," he added.

The 80-year-old former guerrilla also criticized Trump for posting an AI-generated image to his Truth Social platform depicting the US president as Jesus Christ.

In the image, Trump is shown wearing a white tunic and red mantle as he touches the forehead of a man who appears to be ill.

"He posted an image there in which he is dressed as Christ and is performing healings. How many has he actually healed? The American people and the people of the world will hold him to account to find out how many he has killed," Ortega said of Trump.

The Nicaraguan president -- in power since 2007 following elections questioned by the international community -- denounced during his speech the recent US sanctions targeting two of Ortega's children over involvement in the gold industry.

"They are running out of people to sanction," he said.