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pyrazinamide
generic
Adult Dosing .
Dosage forms: TAB: 500 mg
tuberculosis, active
- [40-55 kg]
- Dose: 1000 mg PO qd x2mo; Alt: 1000 mg PO 5x/wk x2mo if directly observed tx; 1500 mg PO 3x/wk or 2000 mg PO 2x/wk x2mo if directly observed tx; Info: use lean body wt; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; part of multi-drug regimen
- [56-75 kg]
- Dose: 1500 mg PO qd x2mo; Alt: 1500 mg PO 5x/wk x2mo if directly observed tx; 2500 mg PO 3x/wk or 3000 mg PO 2x/wk x2mo if directly observed tx; Info: use lean body wt; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; part of multi-drug regimen
- [76-90 kg]
- Dose: 2000 mg PO qd x2mo; Alt: 2000 mg PO 5x/wk x2mo if directly observed tx; 3000 mg PO 3x/wk or 4000 mg PO 2x/wk x2mo if directly observed tx; Info: use lean body wt; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; part of multi-drug regimen
renal dosing
- [adjust dose amount, frequency]
- CrCl <30: 25-35 mg/kg/dose 3x/wk
- HD: 25-35 mg/kg/dose 3x/wk after dialysis; consider supplement if next maint. dose not due right after dialysis; PD: no adjustment; no supplement
hepatic dosing
- [see below]
- severe impairment: contraindicated
Peds Dosing .
- Dosage forms: TAB: 500 mg
tuberculosis, active
- [2 yo and older, <40 kg]
- Dose: 30-40 mg/kg/dose PO qd x2mo; Max: 2 g/day; Alt: 30-40 mg/kg/dose PO 5x/wk x2mo if directly observed tx; 50 mg/kg/dose PO 2x/wk x2mo if directly observed tx, max 2 g/dose; Info: use lean body wt; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; part of multi-drug regimen
- [2 yo and older, 40-55 kg]
- Dose: 1000 mg PO qd x2mo; Alt: 1000 mg PO 5x/wk x2mo if directly observed tx; 1500 mg PO 3x/wk or 2000 mg PO 2x/wk x2mo if directly observed tx; Info: use lean body wt; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; part of multi-drug regimen
- [2 yo and older, 56-75 kg]
- Dose: 1500 mg PO qd x2mo; Alt: 1500 mg PO 5x/wk x2mo if directly observed tx; 2500 mg PO 3x/wk or 3000 mg PO 2x/wk x2mo if directly observed tx; Info: use lean body wt; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; part of multi-drug regimen
- [2 yo and older, 76-90 kg]
- Dose: 2000 mg PO qd x2mo; Alt: 2000 mg PO 5x/wk x2mo if directly observed tx; 3000 mg PO 3x/wk or 4000 mg PO 2x/wk x2mo if directly observed tx; Info: use lean body wt; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; part of multi-drug regimen
renal dosing
- [adjust dose amount, frequency]
- CrCl <30: 40 mg/kg/dose 3x/wk
- HD: 40 mg/kg/dose 3x/wk after dialysis; consider supplement if next maint. dose not due right after dialysis; PD: 40 mg/kg/dose 3x/wk; no supplement
hepatic dosing
- [see below]
- severe impairment: contraindicated
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hepatic damage, severe
- gout, acute
- caution: CrCl <30
- caution: hepatic impairment
- caution: diabetes mellitus
- caution: alcohol abuse
Drug Interactions .
Overview
pyrazinamide
antimycobacterial
- alters GI flora
- hyperuricemic effects
Monitor/Modify Tx
- allopurinol
- febuxostat
- isoniazid
- pegloticase
- probenecid
- rasburicase
- rifabutin
- rifampin
Caution Advised
- ethanol
- fecal microbiota, live
Adverse Reactions .
Serious Reactions
- hepatotoxicity
- thrombocytopenia
- anemia
- interstitial nephritis
- porphyria
- drug rxn w/ eosinophilia and systemic sx
Common Reactions
- anorexia
- rash
- urticaria
- nausea
- vomiting
- malaise
- arthralgia
- photosensitivity
- hyperuricemia
- gout
- LFTs elevated
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; LFTs, uric acid at baseline, then periodically
Look/Sound-Alike Drug Names
pyrazinamide confused with: pyridostigmine; pyrimethamine
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; risk of fetal harm not expected based on limited human data
Lactation
Clinical Summary
may use while breastfeeding; no known risk of infant harm based on limited human data and drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: unknown; Info: active metabolite
Excretion: urine 70% (3% unchanged), Half-life: 9.5h, 26h (chronic renal failure),
Subclass: Tuberculosis (TB)
Mechanism of Action
exact mechanism of action unknown; lowers intracellular pH, inhibiting mycobacterial growth
Formulary .
No Formulary Selected
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