Formulary
Pyrazinamide: Indications, Dosing, Side Effects and Interactions
Pyrazinamide clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Pyrazinamide: Indications, Dosing, Side Effects and Interactions
Pyrazinamide clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Tuberculosis, in combination with other drugs (standard unsupervised 6-month treatment)**
- **Child** (By Mouth): (body-weight 50 kg and above) 35 mg/kg once daily for 2 months (initial phase); maximum 2 g per day.
- **Adult** (By Mouth): (body-weight 50 kg and above) 2 g once daily for 2 months (initial phase).
**Tuberculosis, in combination with other drugs (intermittent supervised 6-month treatment) (under expert supervision)**
- **Child** (By Mouth): (body-weight 50 kg and above) 50 mg/kg 3 times a week (max. per dose 2.5 g 3 times a week) for 2 months (initial phase).
- **Adult** (By Mouth): (body-weight 50 kg and above) 2.5 g 3 times a week for 2 months (initial phase).
**Tuberculosis, in combination with other drugs (standard unsupervised 6-month treatment) for pyrazinamide**
- **Child (body-weight up to 50 kg)** (By mouth): 35 mg/kg once daily for 2 months (initial phase); maximum 1.5 g per day.
- **Child (body-weight 50 kg and above)** (By mouth): 35 mg/kg once daily for 2 months (initial phase); maximum 2 g per day.
**Tuberculosis, in combination with other drugs (intermittent supervised 6-month treatment) (under expert supervision) for pyrazinamide**
- **Child (body-weight up to 50 kg)** (By mouth): 50 mg/kg 3 times a week (max. per dose 2 g 3 times a week) for 2 months (initial phase).
- **Child (body-weight 50 kg and above)** (By mouth): 50 mg/kg 3 times a week (max. per dose 2.5 g 3 times a week) for 2 months (initial phase).
**Congenital tuberculosis, in combination with other drugs for pyrazinamide**
- **Neonate** (By mouth): 35 mg/kg once daily for 2 months (initial phase).
Cautions
Diabetes; gout (in adults)
Contraindications
Acute attack of gout (in adults)
Side effects
Frequency not known Appetite decreased; arthralgia; dysuria; flushing; gout aggravated; hepatic disorders; malaise; nausea; peptic ulcer aggravated; photosensitivity reaction; sideroblastic anaemia; skin reactions; splenomegaly; vomiting
Interactions
**Severe interactions:**
- Alcohol should not be taken during pyrazinamide treatment, as this could increase the risk of damage to the liver and significantly impair reactivity.
**Other interactions (3):**
- Undesirable interaction may occur in combination with the following drugs: Acetyl salicylic acid, ascorbic acid, radiocontrast agents containing iodine, gout medication that affects the excretion of...
- Pyrazinamide may reduce rifampicin blood levels (reduced bioavailability and enhanced rifampicin clearance).
- Pyrazinamide may reduce the contraceptive effects of oestrogens and should be avoided 3 days before and after oral typhoid vaccination since it may inactivate the vaccine.
Pregnancy
Manufacturer advises use only if potential benefit outweighs risk.
Breast feeding
Amount too small to be harmful.
Hepatic impairment
Manufacturer advises avoid in severe impairment, acute hepatic disease and for up to 6 months after occurrence of hepatitis (risk of increased exposure).
Renal impairment
Dose adjustments In adults: 25-30 mg/kg 3 times a week if eGFR less than 30 mL/minute/1.73 m 2 . In children: If estimated glomerular filtration rate less than 30 mL/minute/1.73 m 2 , use 25-30 mg/kg 3 times a week. Monitoring In adults: Monitor for gout in renal impairment.
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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