Your activity: 8 p.v.

Pyrazinamide: Drug information

Pyrazinamide: Drug information
(For additional information see "Pyrazinamide: Patient drug information" and see "Pyrazinamide: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: Canada
  • PDP-Pyrazinamide;
  • Tebrazid
Pharmacologic Category
  • Antitubercular Agent
Dosing: Adult
Tuberculosis, treatment, drug-susceptible

Tuberculosis, treatment, drug-susceptible: Note: Always administer in combination with other antitubercular drugs (AST/CDC/IDSA [Nahid 2016]).

6-month regimen:

Dosing: Doses should be based on lean body weight for patients within a normal weight range for their height (optimal dosing for obese patients has not been established) (AST/CDC/IDSA [Nahid 2016]):

Once-daily therapy:

40 to 55 kg: Oral: 1 g once daily. Note: The preferred frequency of administration is once daily; however, 5-days per week administration by directly-observed therapy (DOT) is an acceptable alternative (ATS/CDC/IDSA [Nahid 2016]).

56 to 75 kg: Oral: 1.5 g once daily (ATS/CDC/IDSA [Nahid 2016]).

76 to 90 kg: Oral: 2 g once daily (ATS/CDC/IDSA [Nahid 2016]).

Three-times-weekly DOT:

40 to 55 kg: Oral: 1.5 g 3 times weekly (ATS/CDC/IDSA [Nahid 2016]).

56 to 75 kg: Oral: 2.5 g 3 times weekly (ATS/CDC/IDSA [Nahid 2016]).

76 to 90 kg: Oral: 3 g 3 times weekly (ATS/CDC/IDSA [Nahid 2016]).

Twice-weekly DOT:

40 to 55 kg: Oral: 2 g twice weekly (ATS/CDC/IDSA [Nahid 2016]).

56 to 75 kg: Oral: 3 g twice weekly (ATS/CDC/IDSA [Nahid 2016]).

76 to 90 kg: Oral: 4 g twice weekly (ATS/CDC/IDSA [Nahid 2016]).

Regimens: Treatment regimens for pulmonary tuberculosis and tuberculous meningitis consist of an initial 2-month phase of a 4-drug regimen that includes pyrazinamide, followed by a continuation phase of a 2-drug regimen (does not include pyrazinamide) of an additional 4 to 7 months for pulmonary tuberculosis and a continuation phase of an additional 7 to 10 months of a 2-drug regimen (does not include pyrazinamide) for tuberculous meningitis (optimal duration is not defined although continuation phase must continue for a minimum of 7 additional months). Adjunctive corticosteroid therapy (eg, dexamethasone, prednisolone) tapered over 6 to 8 weeks is also recommended for tuberculous meningitis; pyrazinamide frequency and dosing differs depending on treatment regimen selected; consult current drug-sensitive TB guidelines (ATS/CDC/IDSA [Nahid 2016]).

4-month rifapentine-moxifloxacin–based regimen:

Note: Reserve use for patients ≥40 kg with pulmonary TB who are not pregnant or breastfeeding; for patients with HIV infection, only use if CD4 count ≥100 cells/mm3 and in patients on an efavirenz-based antiretroviral regimen (CDC [Carr 2022]; Dorman 2021). In the clinical study evaluating this regimen, ≥5 doses per week were given by DOT (Dorman 2021).

40 to <55 kg: Oral: 1 g once daily (CDC [Carr 2022]; Dorman 2021).

≥55 to 75 kg: Oral: 1.5 g once daily (CDC [Carr 2022]; Dorman 2021).

>75 kg: Oral: 2 g once daily (CDC [Carr 2022]; Dorman 2021).

Duration: Administer in combination with rifapentine, moxifloxacin, and isoniazid for 8 weeks, followed by a 9-week continuation phase that does not include pyrazinamide (CDC [Carr 2022]; Dorman 2021).

Tuberculosis, treatment, drug-resistant

Tuberculosis, treatment, drug-resistant (alternative agent):

Note: Expert consultation for optimal regimen and duration of treatment is advised.

Oral: 25 to 40 mg/kg once daily (AST/CDC/IDSA [Nahid 2019]).

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function:

CrCl ≥30 mL/minute: No dosage adjustment necessary.

CrCl <30 mL/minute: Note: The following recommendations are expert opinion derived from AST/CDC/ERS/IDSA (Nahid 2019), ATS/CDC/IDSA (Nahid 2016), HHS (OI adult 2022), and WHO 2014. Dosage adjustment recommendations utilize the indication-specific usual recommended daily dose but extend the dosing interval to 3 times weekly.

Tuberculosis, treatment (drug-susceptible): Oral:

40 to 55 kg: 1 g 3 times weekly.

56 to 75 kg: 1.5 g 3 times weekly.

76 to 90 kg: 2 g 3 times weekly.

Tuberculosis, treatment (drug-resistant) (alternative agent): Oral: 25 to 40 mg/kg 3 times weekly.

Hemodialysis, intermittent (thrice weekly): Dialyzable (~45 to 55%) (Malone 1999; Stamatakis 1988): Oral: Dose as CrCl <30 mL/minute; administer 3 times weekly after hemodialysis on dialysis days (AST/CDC/ERS/IDSA [Nahid 2019]; ATS/CDC/IDSA [Nahid 2016]; HHS [OI adult 2022]; WHO 2014). Consider therapeutic drug monitoring when available (ATS/CDC/IDSA [Nahid 2016]; expert opinion). Close monitoring of response and adverse effects (eg, hepatotoxicity [LiverTox 2020]) due to drug accumulation is important (expert opinion).

Peritoneal dialysis: Dialyzable (15% of total clearance) (Ahn 2003): Oral: Due to limited pharmacokinetic data in this population, dose as for CrCl <30 mL/minute; consider therapeutic drug monitoring when available (ATS/CDC/IDSA [Nahid 2016]; expert opinion). Close monitoring of response and adverse effects (eg, hepatotoxicity [LiverTox 2020]) due to drug accumulation is important (expert opinion).

CRRT: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) unless otherwise noted. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse effects (eg, hepatotoxicity [LiverTox 2020]) due to drug accumulation is important.

Oral: There are no data in patients receiving CRRT (has not been studied); however, no dosage adjustment is likely necessary since pyrazinamide is predicted to be somewhat dialyzed by CRRT; consider therapeutic drug monitoring when available (expert opinion).

PIRRT (eg, sustained, low-efficiency diafiltration): Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse effects (eg, hepatotoxicity [LiverTox 2020]) due to drug accumulation is important.

Oral: There are no data in patients receiving PIRRT (has not been studied); however, no dosage adjustment is likely necessary since pyrazinamide is predicted to be somewhat dialyzed by PIRRT; consider therapeutic drug monitoring when available (expert opinion).

Non-PIRRT days: Dose as for CrCl <30 mL/minute (expert opinion).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. Use is contraindicated in cases of severe hepatic impairment.

Dosing: Pediatric

(For additional information see "Pyrazinamide: Pediatric drug information")

Tuberculosis, active, treatment; drug-susceptible

Tuberculosis, active, treatment; drug-susceptible: Note: Always use in combination with other antitubercular drugs. Any regimens using less than once-daily dosing should be administered as directly observed therapy (DOT).

6-month standard regimen (ATS/CDC/IDSA [Nahid 2016]): Note: Treatment regimens for active tuberculosis consist of an initial 2-month intensive phase of a 4-drug regimen (including pyrazinamide), followed by a 2-drug regimen continuation phase (not including pyrazinamide) of ≥4 months; see guidelines for details.

Once-daily therapy: Note: The preferred frequency of administration is once daily; however, 5-days-per-week administration by DOT at the same daily dose is an acceptable alternative (ATS/CDC/IDSA [Nahid 2016]).

Infants, Children, and Adolescents weighing <40 kg: Oral: 35 mg/kg/dose once daily; suggested range: 30 to 40 mg/kg/dose.

Children and Adolescents weighing ≥40 kg: Note: Doses should be based on lean body weight for patients within a normal weight range for their height (optimal dosing for obese patients has not been established).

40 to 55 kg: Oral: 1,000 mg once daily.

56 to 75 kg: Oral: 1,500 mg once daily.

76 to 90 kg: Oral: 2,000 mg once daily.

Three-times-weekly DOT:

Infants, Children, and Adolescents weighing <40 kg: Oral: 50 mg/kg/dose three times weekly.

Children and Adolescents weighing ≥40 kg: Note: Doses should be based on lean body weight for patients within a normal weight range for their height (optimal dosing for obese patients has not been established).

40 to 55 kg: Oral: 1,500 mg three times weekly.

56 to 75 kg: Oral: 2,500 mg three times weekly.

76 to 90 kg: Oral: 3,000 mg three times weekly.

Twice-weekly DOT: Note: Regimen not generally recommended; associated with worse outcomes (treatment failure, relapse, and drug resistance) compared to daily dosing. Do not use in patients with HIV or those with smear-positive and/or cavitary disease; only for use in continuation phase (ATS/CDC/IDSA [Nahid 2016]); Johnston 2017).

Infants, Children, and Adolescents weighing <40 kg: Oral: 50 mg/kg/dose twice weekly.

Children and Adolescents weighing >40 kg:

40 to 55 kg: Oral: 2,000 mg twice weekly.

56 to 75 kg: Oral: 3,000 mg twice weekly.

76 to 90 kg: Oral: 4,000 mg twice weekly.

4-month rifapentine and moxifloxacin-based regimen (CDC [Carr 2022]; Dorman 2021; WHO 2022): Note: Use only for treatment of pulmonary tuberculosis in combination with isoniazid, moxifloxacin, and rifapentine; pyrazinamide is included for the initial 8 weeks, followed by an additional 9 weeks without pyrazinamide; see guidelines for regimen details (CDC [Carr 2022]; WHO 2022).

Children ≥12 years and Adolescents weighing ≥40 kg:

40 to <55 kg: Oral: 1,000 mg once daily for 8 weeks (56 doses).

55 to 75 kg: Oral: 1,500 mg once daily for 8 weeks (56 doses).

>75 kg: Oral: 2,000 mg once daily for 8 weeks (56 doses).

Tuberculosis, active, treatment; drug-resistant

Tuberculosis, active, treatment; drug-resistant: Note: Duration should be individualized based on extent of disease, rapidity of culture conversion, clinical response, and toxicity; expert consultation for optimal regimen and duration of treatment is advised (ATS/CDC/ERS/IDSA [Nahid 2019]).

Infants, Children, and Adolescents: Oral: 30 to 40 mg/kg/dose once daily as part of an appropriate combination regimen (ATS/CDC/ERS/IDSA [Nahid 2019]; WHO 2019).

Dosing: Kidney Impairment: Pediatric

There are no pediatric-specific recommendations; based on experience in adult patients, dosing adjustment suggested.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling. Use is contraindicated in cases of severe hepatic impairment.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: 500 mg

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Tebrazid: 500 mg

Generic: 500 mg

Administration: Adult

Oral: May take without regard to food (Zent 1995).

Administration: Pediatric

Oral: May take without regard to food (Zent 1995).

Use: Labeled Indications

Tuberculosis: Treatment of tuberculosis in combination with other antituberculosis agents.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Central nervous system: Malaise

Gastrointestinal: Anorexia, nausea, vomiting

Neuromuscular & skeletal: Arthralgia, myalgia

<1%, postmarketing, and/or case reports: Acne vulgaris, acquired blood coagulation disorder (anticoagulant effect), angioedema (rare), dysuria, fever, gout, hepatotoxicity, interstitial nephritis, porphyria, pruritus, sideroblastic anemia, skin photosensitivity, skin rash, thrombocytopenia, urticaria

Contraindications

Hypersensitivity to pyrazinamide or any component of the formulation; acute gout; severe hepatic damage

Warnings/Precautions

Concerns related to adverse effects:

• Hepatotoxicity: Dose-related hepatotoxicity ranging from transient ALT/AST elevations to jaundice, hepatitis and/or liver atrophy (rare) has occurred.

Disease-related concerns:

• Alcoholism: Due to concerns for preexisting hepatic dysfunction, use with caution in patients with a history of alcoholism (even if ethanol consumption is discontinued during therapy).

• Diabetes: Use with caution in patients with diabetes mellitus.

• Gout: May inhibit uric acid excretion; acute gouty attacks have been reported. Use with caution in patients with chronic gout; contraindicated with acute gout.

• Porphyria: Use with caution in patients with porphyria.

• Renal impairment: Use with caution in patients with renal failure.

Concurrent drug therapy issues:

• Hepatotoxic agents: Use with caution in patients receiving concurrent medications associated with hepatotoxicity (particularly with rifampin). The 2-month rifampin-pyrazinamide regimen for the treatment of latent tuberculosis infection (LTBI) has been associated with severe and fatal liver injuries; incidence increased with pyrazinamide doses >30 mg/kg/day. The Infectious Diseases Society of America and Centers for Disease Control and Prevention recommend that the 2-month rifampin-pyrazinamide regimen should not generally be used in patients with LTBI.

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Benzbromarone: Pyrazinamide may diminish the therapeutic effect of Benzbromarone. Risk C: Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

CycloSPORINE (Systemic): Pyrazinamide may enhance the myopathic (rhabdomyolysis) effect of CycloSPORINE (Systemic). Pyrazinamide may decrease the serum concentration of CycloSPORINE (Systemic). Risk C: Monitor therapy

Favipiravir: May enhance the adverse/toxic effect of Pyrazinamide. Specifically, the risk for increased uric acid concentrations may be increased. Risk C: Monitor therapy

Immune Checkpoint Inhibitors: Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors. Risk C: Monitor therapy

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

RifAMPin: Pyrazinamide may enhance the hepatotoxic effect of RifAMPin. Severe (even fatal) liver injury has been reported in patients receiving these 2 drugs as a 2-month treatment regimen for latent TB infection. Management: Rifampin-pyrazinamide is generally not preferred for the treatment of latent tuberculosis (TB) due to the risk of hepatotoxicity. However, it is an option for patients at high risk of developing active TB who are unlikely to complete preferred treatment. Risk C: Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Reproductive Considerations

Evaluate pregnancy status prior to treatment of multidrug-resistant tuberculosis in females of reproductive potential. Females of reproductive potential should use effective contraception during treatment for multidrug-resistant tuberculosis (Esmail 2018).

Pregnancy Considerations

Active tuberculosis infection is associated with adverse fetal outcomes including intrauterine growth restriction, low birth weight, preterm birth, and perinatal death (Esmail 2018; Miele 2020) as well as adverse maternal outcomes, including increased risks for anemia and cesarean delivery. Placental transmission may rarely occur with active maternal disease (Miele 2020).

Due to the risks of untreated tuberculosis, pyrazinamide may be used as part of the initial treatment regimen of drug-susceptible active tuberculosis when the probability of maternal disease is moderate to high; however, risks and benefits of use during pregnancy should be considered for each individual patient. The addition of pyrazinamide may be of benefit in pregnant patients with HIV, extrapulmonary or severe tuberculosis (ATS/CDC/IDSA [Nahid 2016]).

Use of pyrazinamide may also be considered in the treatment of multidrug-resistant tuberculosis. The treatment of multidrug-resistant tuberculosis in pregnant patients should be individualized; evidence to support a specific regimen is not available (ATS/CDC/ERS/IDSA [Nahid 2019]; WHO 2020).

Pregnancy-induced physiologic changes do not alter the pharmacokinetic properties of pyrazinamide in a clinically significant way; dose adjustment is not needed in pregnant patients (Abdelwahab 2020).

Breastfeeding Considerations

Pyrazinamide is present in breast milk.

Breast milk concentrations are less than maternal plasma concentration (Holdiness 1984).

Breastfeeding is not a contraindication during therapy for drug-susceptible tuberculosis in patients deemed noninfectious who are treated with first-line agents (ie, pyrazinamide). Exposure to pyrazinamide via breast milk should not be considered effective treatment for the breastfeeding infant (ATS/CDC/IDSA [Nahid 2016]). Infants exposed to pyrazinamide via breast milk should be monitored for jaundice (WHO 2002). Patients with multidrug-resistant tuberculosis and a sputum smear-positive test should avoid breastfeeding when possible (Esmail 2018).

Monitoring Parameters

Periodic liver function tests, serum uric acid, sputum culture, chest x-ray 2-3 months into treatment and at completion; pyrazinamide serum concentrations (when clinically indicated).

Reference Range

Pyrazinamide serum concentrations (Alsultan 2014):

Note: Obtain samples at 2 and 6 hours post dose to detect delayed absorption or malabsorption.

If the usual recommended dose is 25 mg/kg once daily: target Cmax 20 to 50 mcg/mL. Note: Some recent studies have suggested higher Cmax targets, but risk of hepatoxicity may be increased (Chideya 2009; Pasipanodya 2013).

If the usual recommended dose is 50 mg/kg twice weekly: target Cmax 60 to 90 mcg/mL.

Mechanism of Action

Converted to pyrazinoic acid in susceptible strains of Mycobacterium which lowers the pH of the environment; exact mechanism of action has not been elucidated

Pharmacokinetics

Note: Bacteriostatic or bactericidal depending on drug's concentration at infection site.

Absorption: Well absorbed.

Distribution: Widely into body tissues and fluids including liver, lung, and cerebrospinal fluid (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: Prolonged with reduced renal or hepatic function.

Children: Median: 6.3 hours (interquartile range: 5.6 to 7.5 hours) (Chabala 2022).

Adults: 9 to 10 hours.

Time to peak, serum:

Children: Median: 1 hour (interquartile range: 1 to 2 hours) (Chabala 2022).

Adults: Within 2 hours.

Excretion: Urine (4% as unchanged drug).

Pricing: US

Tablets (Pyrazinamide Oral)

500 mg (per each): $6.15 - $8.94

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Corsazinmid (ID);
  • Firizin (BD);
  • Macrozide (CO, LK);
  • Macrozide 500 (ZW);
  • Mide (TW);
  • Neoprazin (BD);
  • P-Zide (BF, BJ, CI, ET, GH, GM, GN, IN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZM);
  • P.T.B. (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, SA, SY, YE);
  • P.Z.A. (TW);
  • Piraldina (AE, BG, BH, CY, IL, IQ, IR, IT, JO, KW, LB, LY, OM, SA, SY, YE);
  • Pirazinamida (PE);
  • Pirazinamida Prodes (ES);
  • Pirazinid (TR);
  • Pirilene (FR);
  • Pramide (PT);
  • Prazide (VN);
  • Pyrafat (AT, DE, HK, MT);
  • Pyramide (BD, TH, TW);
  • Pyramin (PH);
  • Pyrazid (PK);
  • Pyrazide (EG, ZA);
  • Pyrazinamid (HR, HU, PL);
  • Pyrazinamid Lederle (CH);
  • Pyrazinamid ”Dak” (DK);
  • Pyrazinamid ”Medic” (DK);
  • Pyrazinamide (TH);
  • Pyrazine (JO);
  • PZA (CH, MY, SA);
  • PZA-Ciba (IN, SG);
  • Rifater (MX);
  • Siramid (ID);
  • TBZet (ID);
  • Tebrazid (BE, CH, LU);
  • Tibicel (ID);
  • Tisamid (FI);
  • Tubranin (BD);
  • Zcure (PH);
  • Zinamide (AU, GB, NZ)


For country code abbreviations (show table)
  1. Abdelwahab MT, Leisegang R, Dooley KE, et al. Population pharmacokinetics of isoniazid, pyrazinamide, and ethambutol in pregnant South African women with tuberculosis and HIV. Antimicrob Agents Chemother. 2020;64(3):e01978-19. doi:10.1128/AAC.01978-19 [PubMed 31844002]
  2. Ad Hoc Committee of the Scientific Assembly on Microbiology, Tuberculosis and Pulmonary Infections, “Treatment of Tuberculosis and Tuberculosis Infection in Adults and Children,” Clin Infect Dis, 1995, 21:9-27.
  3. Ahn C, Oh KH, Kim K, et al. Effect of peritoneal dialysis on plasma and peritoneal fluid concentrations of isoniazid, pyrazinamide, and rifampin. Perit Dial Int. 2003;23(4):362-367. [PubMed 12968844]
  4. Alsultan A, Peloquin CA. Therapeutic drug monitoring in the treatment of tuberculosis: an update. Drugs. 2014;74(8):839-854. doi:10.1007/s40265-014-0222-8 [PubMed 24846578]
  5. American Thoracic Society, “Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection,” MMWR Recomm Rep, 2000, 49(RR-6):1-51. [PubMed 10881762]
  6. ASHP. Standardize 4 Safety Initiative Compounded Oral Liquid Version 1.01. July 2017. https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/s4s-ashp-oral-compound-liquids.ashx?la=en&hash=4C2E4F370B665C028981B61F6210335AD5D0D1D6.
  7. Blumberg HM, Burman WJ, Chaisson RE, et al, "American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Treatment of Tuberculosis," Am J Respir Crit Care Med, 2003, 167(4):603-62. [PubMed 12588714]
  8. Carr W, Kurbatova E, Starks A, Goswami N, Allen L, Winston C. Interim guidance: 4-month rifapentine-moxifloxacin regimen for the treatment of drug-susceptible pulmonary tuberculosis - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(8):285-289. doi:10.15585/mmwr.mm7108a1 [PubMed 35202353]
  9. Centers for Disease Control and Prevention (CDC) and American Thoracic Society, “Update: Adverse Event Data and Revised American Thoracic Society/CDC Recommendations Against the Use of Rifampin and Pyrazinamide for Treatment of Latent Tuberculosis Infection - United States, 2003,” MMWR, 2003, 52(31):735-9. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5231a4.htm. Last accessed February 16, 2005. [PubMed 12904741]
  10. Chabala C, Turkova A, Hesseling AC, et al. Pharmacokinetics of first-line drugs in children with tuberculosis, using World Health Organization-recommended weight band doses and formulations. Clin Infect Dis. 2022;74(10):1767-1775. doi:10.1093/cid/ciab725 [PubMed 34420049]
  11. Chideya S, Winston CA, Peloquin CA, et al. Isoniazid, rifampin, ethambutol, and pyrazinamide pharmacokinetics and treatment outcomes among a predominantly HIV-infected cohort of adults with tuberculosis from Botswana. Clin Infect Dis. 2009;48(12):1685-1694. doi:10.1086/599040 [PubMed 19432554]
  12. Combs DL, O'Brien RJ, and Geiter LJ, “USPHS Tuberculosis Short-Course Chemotherapy Trial 21: Effectiveness, Toxicity, and Acceptability: The Report of Final Results,” Ann Intern Med, 1990, 112(6):397-406. [PubMed 2155569]
  13. Davidson PT and Le HQ, “Drug Treatment of Tuberculosis - 1992,” Drugs, 1992, 43(5):651-73. [PubMed 1379145]
  14. Dorman SE, Nahid P, Kurbatova EV, et al. Four-month rifapentine regimens with or without moxifloxacin for tuberculosis. N Engl J Med. 2021;384(18):1705-1718. doi:10.1056/NEJMoa2033400 [PubMed 33951360]
  15. Esmail A, Sabur NF, Okpechi I, Dheda K. Management of drug-resistant tuberculosis in special sub-populations including those with HIV co-infection, pregnancy, diabetes, organ-specific dysfunction, and in the critically ill. J Thorac Dis. 2018;10(5):3102-3118. doi:10.21037/jtd.2018.05.11 [PubMed 29997980]
  16. Havlir DV and Barnes PF, “Tuberculosis in Patients With Human Immunodeficiency Virus Infection,” N Engl J Med, 1999, 340(5):367-73. [PubMed 9929528]
  17. Herlevsen P, Nielsen C, and Pedersen JT, “Convulsions After Treatment With Pyrazinamide,” Tubercle, 1987, 68(2):145-6. [PubMed 3499016]
  18. Holdiness MR, "Antituberculosis Drugs and Breast-Feeding," Arch Intern Med, 1984, 144(9):1888. [PubMed 6548112]
  19. Johnston JC, Campbell JR, Menzies D. Effect of intermittency on treatment outcomes in pulmonary tuberculosis: an updated systematic review and metaanalysis. Clin Infect Dis. 2017;64(9):1211-1220. doi:10.1093/cid/cix121 [PubMed 28203783]
  20. Lacroix C, Hoang TP, Nouveau J, et al, “Pharmacokinetics of Pyrazinamide and Its Metabolites in Healthy Subjects,” Eur J Clin Pharmacol, 1989, 36(4):395-400. [PubMed 2737233]
  21. Malone RS, Fish DN, Spiegel DM, Childs JM, Peloquin CA. The effect of hemodialysis on isoniazid, rifampin, pyrazinamide, and ethambutol. Am J Respir Crit Care Med. 1999;159(5 Pt 1):1580-1584. doi:10.1164/ajrccm.159.5.9810034 [PubMed 10228130]
  22. Miele K, Bamrah Morris S, Tepper NK. Tuberculosis in pregnancy. Obstet Gynecol. 2020;135(6):1444-1453. doi:10.1097/AOG.0000000000003890 [PubMed 32459437]
  23. Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America (ATS/CDC/IDSA) clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016;63(7):e147-e195. doi:10.1093/cid/ciw376 [PubMed 27516382]
  24. Nahid P, Mase SR, Migliori GB, et al. Treatment of drug-resistant tuberculosis. An official ATS/CDC/ERS/IDSA clinical practice guideline. Am J Respir Crit Care Med. 2019;200(10):e93-e142. doi:10.1164/rccm.201909-1874ST [PubMed 31729908]
  25. Pasipanodya JG, McIlleron H, Burger A, Wash PA, Smith P, Gumbo T. Serum drug concentrations predictive of pulmonary tuberculosis outcomes. J Infect Dis. 2013;208(9):1464-1473. doi:10.1093/infdis/jit352 [PubMed 23901086]
  26. Pyrazinamide (tablets, USP 500 mg) [prescribing information]. Plainsboro, NJ: Macleods Pharma USA Inc; September 2020.
  27. Pyrazinamide (tablets, USP 500 mg) [prescribing information]. New Castle, DE: Marlex Pharmaceuticals Inc; March 2022.
  28. Pyrazinamide. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases; 2012. Updated December 20, 2020. [PubMed 31643193]
  29. Stamatakis G, Montes C, Trouvin JH, et al. Pyrazinamide and pyrazinoic acid pharmacokinetics in patients with chronic renal failure. Clin Nephrol. 1988;30(4):230-234. [PubMed 3214968]
  30. “Treatment of Latent Tuberculosis Infection (LTBI), Last Updated: April 8, 2004.” Available at http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/250110.htm. Accessed February 16, 2005.
  31. “Update: Fatal and Severe Liver Injuries Associated With Rifampin and Pyrazinamide for Latent Tuberculosis Infection, and Revisions in American Thoracic Society/CDC Recommendations - United States, 2001,” MMWR Morb Mortal Wkly Rep, 2001, 50(34):733-5. [PubMed 11787580]
  32. US Department of Health and Human Services (HHS). Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/Adult_OI.pdf. Accessed August 30, 2022.
  33. WHO consolidated guidelines on drug-resistant tuberculosis treatment. Geneva: World Health Organization; 2019. [PubMed 30946559]
  34. WHO operational handbook on tuberculosis. Module 5: management of tuberculosis in children and adolescents. Geneva: World Health Organization; 2022.
  35. World Health Organization (WHO). Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis. World Health Organization; 2014. [PubMed 25320836]
  36. World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the eleventh WHO model list of essential drugs. http://www.who.int/maternal_child_adolescent/documents/55732/en/. Published 2002. Accessed July 14, 2020.
  37. World Health Organization (WHO). Consolidated guidelines on tuberculosis: module 4: treatment - drug-resistant tuberculosis treatment. Geneva: World Health Organization; 2020. https://www.who.int/publications/i/item/9789240007048. Published June 15, 2020. Accessed July 14, 2020.
  38. Zent C, Smith P. Study of the effect of concomitant food on the bioavailability of rifampicin, isoniazid and pyrazinamide. Tuber Lung Dis. 1995;76(2):109-113. [PubMed 7780091]
Topic 9836 Version 208.0