pyrazinamide (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 500mg

Tuberculosis Treatment For HIV Negative

Daily therapy

  • 15-30 mg/kg PO qDay; not to exceed 2 g/day  

Twice weekly therapy

  • 50 mg/kg PO twice weekly; not to exceed 2 g/dose

Tuberculosis Treatment For HIV Exposed/Infected

20-40 mg/kg/dose PO qDay; not to exceed 2 g/day  

See Also Combo

With isoniazid & rifampin

Other Indications & Uses

Tuberculosis; should always be admin with other anti-TB drugs

Dosage Forms & Strengths

tablet

  • 500mg

Tuberculosis Treatment

Daily therapy

  • 15-30 mg/kg PO qD; not to exceed 2000 mg/day  

Twice weekly therapy

  • 50 mg/kg/dose; not to exceed 3000 mg/day
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Interactions

Interaction Checker

and pyrazinamide

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (3)

              • pexidartinib

                pyrazinamide and pexidartinib both increase inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.

              • pretomanid

                pyrazinamide, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

              • rifampin

                rifampin, pyrazinamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive hepatotoxicity.

              Monitor Closely (3)

              • cyclosporine

                pyrazinamide decreases levels of cyclosporine by unknown mechanism. Use Caution/Monitor. A case reported demonstrated a decrease in cyclosporine plasma levels after pyrazinamide was added onto a renal transplant patient's therapy.

              • mipomersen

                mipomersen, pyrazinamide. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

              • probenecid

                pyrazinamide decreases effects of probenecid by unknown mechanism. Use Caution/Monitor.

              Minor (2)

              • isoniazid

                isoniazid, pyrazinamide. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive hepatotoxicity.

              • tacrolimus

                pyrazinamide decreases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

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              Adverse Effects

              1-10%

              Malaise

              Nausea

              Vomiting

              Anorexia

              Arthralgia

              Myalgia

              <1%

              Fever

              Rash

              Itching

              Acne

              Photosensitivity

              Gout

              Dysuria

              Porphyria

              Thrombocytopenia

              Hepatotoxicity

              Interstitial nephritis

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              Warnings

              Contraindications

              Severe hepatic damage, acute gout, hypersensitivity

              Cautions

              See pkg insert for complete dosage info

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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: enters breast milk

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Absorption: well absorbed

              Distribution: widely into body tissues and fluids including liver, lung, and CSF

              Relative diffusion from blood into CSF: adequate with or without inflammation (exceeds usual MICs)

              CSF:blood level ratio: inflamed meninges: 100%

              Protein binding: 50%

              Metabolism: hepatic

              Half-life elimination: 9-10 hr

              Time to peak, serum: within 2 hr

              Excretion: urine (4% as unchanged drug)

              Mechanism of Action

              Unknown; bacteriostatic or -cidal for Mycobacterium

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              pyrazinamide oral
              -
              500 mg tablet
              pyrazinamide oral
              -
              500 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              pyrazinamide oral

              PYRAZINAMIDE - ORAL

              (pir-uh-ZIN-uh-mide)

              USES: Pyrazinamide is used with other medications to treat tuberculosis (TB). It is an antibiotic and works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

              HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually once daily or twice weekly.Dosage is based on your age, weight, medical condition, and response to treatment.For the best effect, take this antibiotic at evenly spaced times. If you are taking this medication daily, take it at the same time each day. If you are taking this medication on a weekly schedule, take it on the same days of the week and at the same time each day. Mark the days on the calendar when you need to take the medication.Continue to take this medication (and other TB medications) until the full prescribed amount is finished, even if symptoms disappear. Stopping the medication too early or skipping doses may allow the bacteria to continue to grow, which may result in a return of the infection and cause the infection to be more difficult to treat (resistant).Tell your doctor if your condition persists or worsens.

              SIDE EFFECTS: Nausea, vomiting, loss of appetite, or mild muscle/joint pain may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these unlikely but serious side effects occur: symptoms of liver disease (such as persistent nausea/vomiting, unusual tiredness/weakness, severe stomach/abdominal pain, yellowing eyes/skin, dark urine), painful/swollen joints.Tell your doctor right away if any of these rare but serious side effects occur: signs of kidney problems (such as change in the amount of urine), easy bleeding/bruising, fast heartbeat.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever that doesn't go away, new or worsening lymph node swelling, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking pyrazinamide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, diabetes, gout, high uric acid level in the blood, alcohol use.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Alcohol may increase the risk of liver disease. Avoid alcoholic beverages while using this medication.Pyrazinamide may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using pyrazinamide before having any immunizations/vaccinations.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk but the effect on a nursing infant is unknown. Discuss the risks and benefits with your doctor before breast-feeding.

              DRUG INTERACTIONS: The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.This medication may interfere with certain laboratory tests (including urine ketone tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.This document does not contain all possible interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as sputum test, kidney/liver function, uric acid levels, complete blood count) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: It is important to take each dose of this medication as scheduled. If you are taking this medication daily and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.If you are taking this drug on a weekly schedule and miss a dose, take it as soon as you remember if it is on the same day. If you remember on the next day or later, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised October 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.