Pyrazinamide

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Generic Name: Pyrazinamide Brand Name(s): Generics only. No brands available.

Uses

What is Pyrazinamide used for?

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). Unnecessary use or misuse of any antibiotic can lead to its decreased effectiveness.

How should I take Pyrazinamide?

Take this medication by mouth with or without food, usually once daily or twice weekly, or as directed by your doctor.

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.

How do I store Pyrazinamide?

Pyrazinamide is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Pyrazinamide in the bathroom or the freezer. There may be different brands of Pyrazinamide that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Pyrazinamide down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Pyrazinamide?

Take this medication by mouth with or without food, usually once daily or twice weekly, or as directed by your doctor.

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.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Pyrazinamide during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Pyrazinamide. Pyrazinamide is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Pyrazinamide?

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 your doctor has prescribed this medication because he or she 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 serioussigns 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.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Pyrazinamide?

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.

Pyrazinamide may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Pyrazinamide?

Pyrazinamide may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Pyrazinamide?

Pyrazinamide may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Pyrazinamide.

What is the dose of Pyrazinamide for an adult?

Usual Adult Dose for Tuberculosis – Active

15 to 30 mg/kg (up to 2 g) orally once a day in combination with three other antituberculous drugs for the initial 2 months of a 6-month or 9-month treatment regimen, until drug susceptibility tests are known. An alternate dosing regimen of 50 to 75 mg/kg (up to 3 g) orally twice a week may be used after 2 weeks of daily therapy to increase patient compliance.

Alternatively, the CDC, The American Thoracic Society, and the Infectious Diseases Society of America suggest the following dosing based on estimated lean body weight:

Daily dosing:

40 to 45 kg: 1000 mg

56 to 75 kg: 1500 mg

76 to 90 kg: 2000 mg

Twice weekly dosing:

40 to 55 kg: 2000 mg

56 to 75 kg: 3000 mg

76 to 90 kg: 4000 mg

Thrice weekly dosing:

40 to 55 kg: 1500 mg

56 to 75 kg: 2500 mg

76 to 90 kg: 3000 mg

Usual Adult Dose for Tuberculosis – Latent

A public health expert should be consulted prior to the use of the combination regimen with rifampin.

15 to 20 mg/kg, based on actual body weight (lean), orally once daily (maximum 2 g) for 2 months. Alternatively, a dosage of 50 mg/kg may be administered orally twice-weekly (maximum 4 g).

Renal Dose Adjustments

The manufacturer recommends to start therapy at low end of dosage range and monitor patient closely.

For the treatment of active tuberculosis, the CDC, ATS, and IDSA recommend against daily dosing. For patients with CrCl less than 30 mL/min or patients receiving hemodialysis the recommended dose is 25 to 35 mg/kg per dose three times per week.

Liver Dose Adjustments

Monitor patients closely.

Dose Adjustments

In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic or renal function, and of concomitant disease or other drug therapy.

If organism is susceptible to isoniazid and rifampin, pyrazinamide is continued for the first 2 months of a 6-month course of therapy (9-months if HIV positive). If primary drug resistance is shown, drug regimens should be adjusted as needed and continued for at least 6 months, or 3 months beyond culture conversion (9 months, or 6 months beyond culture conversion if HIV positive). If multiple-drug resistance is demonstrated, therapy should be continued for 12 to 24 months following culture conversion.

Precautions

Pyrazinamide is contraindicated in patients with severe hepatic disease and with acute gout.

Patients started on pyrazinamide should have baseline serum uric acid and liver function test results. Liver function should be monitored closely during therapy. Patients with preexisting liver disease or those at increased risk of drug related hepatitis should be monitored closely.

Pyrazinamide should be discontinued and not restarted if signs of hepatocellular damage or hyperuricemia with an acute gouty arthritis appear.

Polyarthralgias have been reported in patients. The pain may respond to aspirin or other nonsteroidal anti-inflammatory agents.

Caution should be used in patients with a history of diabetes mellitus, as management of the disease may be more difficult.

Primary resistance of Mycobacterium tuberculosis to pyrazinamide is not common. In cases with known or suspected drug resistance, in vitro susceptibility tests with recent cultures of Mycobacterium tuberculosis against pyrazinamide and the usual primary drugs should be conducted. There are few reliable in vitro tests for pyrazinamide resistance. A reference laboratory capable of performing these tests must be utilized.

Clinical experience has not identified differences in responses between elderly and younger patients. In general, dose selection for elderly patients should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased renal or hepatic function, and of concomitant disease or other drug therapy.

Dialysis

Extensively dialyzed and should be dosed after hemodialysis.

Other Comments

Most cases of tuberculosis (TB) should be empirically treated with 4 anti-TB agents, including rifampin, isoniazid, pyrazinamide, and either ethambutol or streptomycin. Therapy may be adjusted when drug susceptibility is known. If a patient has a significant risk for multi-drug resistant TB, a 5 drug regimen may be used.

The Joint Statement of the American Thoracic Society (ATS), the Center for Disease Control and Prevention (CDC), and the Council of the Infectious Diseases society of America (IDSA) advises that all intermittent dosing should be administered by directly observed therapy.

Clinical monitoring should be performed at weeks 2, 4, and 8.

The treatment of latent tuberculosis infection with pyrazinamide is considered complete when at least 60 doses have been administered within a 3 month period.

What is the dose of Pyrazinamide for a child?

Usual Pediatric Dose for Tuberculosis – Active

Tuberculosis:

(Used as part of a multidrug regimen. Treatment regimens consist of an initial 2-month phase, followed by a continuation phase of 4 or 7 additional months. Frequency of dosing may differ depending on phase of therapy)

Infants, Children less than 40 kg and Adolescents 14 years and younger and less than 40 kg:

Non-HIV patients:

Daily therapy: 15 to 30 mg/kg/dose (maximum: 2 g/dose) once daily

Directly observed therapy (DOT): 50 mg/kg/dose (maximum: 2 g/dose) twice weekly

HIV-exposed/infected patients:

Daily therapy: 20 to 40 mg/kg/dose once daily (maximum: 2 g/day)

How is Pyrazinamide available?

Pyrazinamide is available in the following dosage forms and strengths:

  • Oral tablet.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Pyrazinamide, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: April 21, 2018 | Last Modified: April 21, 2018

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