Antituberculosis agent (nicotinamide analogue)
First-line antituberculosis drug indicated for initial treatment of active tuberculosis in adults and children, always in combination with other antituberculous agents.
Also known as: PZA, Zinamide
DailyMed approved label (Pyrazinamide Tablet, ANI Pharmaceuticals; setID 262d8829-728c-48db-b89b-88d13b87e684).
DailyMed approved label (Pyrazinamide Tablet, ANI Pharmaceuticals; setID 262d8829-728c-48db-b89b-88d13b87e684).
No documented drug–drug interactions for this medicine.
Alcohol adds hepatotoxicity to that of pyrazinamide, increasing the risk of liver injury during tuberculosis treatment.
Avoid alcohol during treatment.
DailyMed/FDA (NIH/NLM) — approved Pyrazinamide label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=262d8829-728c-48db-b89b-88d13b87e684
Pyrazinamide can be taken with or without food; taking it with food reduces gastrointestinal discomfort (nausea).
Take with food if nausea or gastric discomfort occurs.
DailyMed/FDA (NIH/NLM) — approved Pyrazinamide label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=262d8829-728c-48db-b89b-88d13b87e684
Pyrazinamide inhibits renal uric acid excretion and may precipitate gout attacks in patients with hyperuricaemia or a history of gout.
Monitor uric acid and use with caution in patients with gout.
DailyMed/FDA (NIH/NLM) — approved Pyrazinamide label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=262d8829-728c-48db-b89b-88d13b87e684
Pyrazinamide is hepatotoxic and the risk of severe liver injury, especially in the first months of treatment, increases in patients with prior liver disease.
Monitor transaminases; stop if hepatitis symptoms occur (jaundice, nausea, abdominal pain).
DailyMed/FDA (NIH/NLM) — approved Pyrazinamide label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=262d8829-728c-48db-b89b-88d13b87e684
Pyrazinamide crosses the placenta; it is used to treat active tuberculosis in pregnancy, with monitoring of liver function.
Use in active tuberculosis, with transaminase monitoring; usual adult dose.
Excreted into breast milk; compatible with breastfeeding under supervision.
No specific additional contraception.
DailyMed/FDA (NIH/NLM) — approved Pyrazinamide label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=262d8829-728c-48db-b89b-88d13b87e684
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Bactericidal activity against M. tuberculosis, especially against intracellular bacilli in acid medium (phagolysosomes); bacteriostatic or bactericidal depending on concentration. Active pyrazinoic acid allows shortening of the initial tuberculosis regimen.
Hepatic hydrolysis to the active metabolite pyrazinoic acid, which inhibits bacillary fatty-acid synthesis in acid medium; pyrazinoic acid is hydroxylated to the main excretory product, 5-hydroxypyrazinoic acid.
Well absorbed from the GI tract; plasma peaks within 2 hours (30–50 mcg/mL with doses of 20–25 mg/kg); wide distribution (liver, lungs, CSF — CSF concentration ~equal to plasma with inflamed meninges). Protein binding ~10%.
Hydrolyzed in the liver to pyrazinoic acid (active metabolite); ~70% of an oral dose is excreted in urine, mainly by glomerular filtration, within 24 hours.
Half-life of 9–10 hours in patients with normal renal and hepatic function; prolonged in renal or hepatic impairment.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
