Uses

Pyrazinamide is indicated as part of combination antitubercular therapy for the initial treatment of active tuberculosis in adults and children. The standard regimen includes pyrazinamide with isoniazid and rifampicin for the first two months of a six-month course.

Do not use if

Contraindicated in patients with severe hepatic damage, known hypersensitivity to pyrazinamide, and in those with acute gout.

Side effects

The principal adverse effect is hepatotoxicity, which is dose-related. Other reactions include gastrointestinal disturbances (nausea, vomiting, anorexia), hyperuricemia leading to gout, thrombocytopenia, sideroblastic anemia, fever, and dysuria.

Warnings

Baseline and periodic liver function tests and serum uric acid measurements are required. Use with caution in patients with pre-existing liver disease or a history of alcohol use disorder. Discontinue if signs of hepatotoxicity appear.

How it works

Pyrazinamide is a nicotinamide analogue that is converted to pyrazinoic acid by mycobacterial pyrazinamidase. It is bactericidal against Mycobacterium tuberculosis in an acidic environment. It is well absorbed orally, widely distributed including into the CSF, and metabolized hepatically.

Storage

Store at controlled room temperature, protected from moisture and light.