Pyrazinamide

Dosing

Usual dose20-30 mg/kg PO q24h (max 2 g)

  • BW <50 kg: 1 g PO q24h

  • BW 50-70 kg: 1.5 g PO q24h

  • BW >70 kg: 2 g PO q24h

30 mg/kg PO div q12-24h

Severe hepatic impairmentAvoid

CrCl ≥10CrCl <10HD20-30 mg/kg PO q24h12-20 mg/kg PO q24h25 mg/kg q48h (give after hemodialysis on dialysis days)

General Information

A first-line anti-tuberculosis drug.

Obtain acid-fast bacilli smear and culture from sputum until 2 consecutive culture specimens are negative.

Perform chest x-rays after 2-3 months of treatment and at end of treatment.

Perform liver function tests at baseline, periodically during therapy, and if any clinical signs or symptoms occur, especially in patients with preexisting liver disease or those at increased risk for drug-related hepatitis (e.g. alcohol users).

Obtain uric acid levels at baseline, periodically during therapy, and if any clinical signs or symptoms occur.

Common

  • Hyperuricemia

  • Elevated liver enzymes level

  • Arthralgia

  • Myalgia

Serious

  • Hepatotoxicity

  • Articular gout

  • Zidovudine - decreased efficacy

  • Ethionamide - may result in hepatotoxicity

  • Rifampin - may result in severe hepatic injury

  • Cyclosporine - reduced serum concentrations

Antimicrobial agent: Antimycobacterial agent

Pregnancy category: C

Average serum half life: 9-10 hours

CSF penetration: Therapeutic

Precautions:

  • Discontinue use and do not resume if hyperuricemia with acute gouty arthritis occurs.

  • Patients with preexisting liver disease or increased risk of drug-related hepatitis; close monitoring recommended.

  • Discontinue use and do not resume if signs of hepatocellular damage occur.

  • Susceptibility tests recommended.

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