Pyramide

Indications

Pyrazinamide is used to treat tuberculosis (TB). It is always given together with other TB medicines, usually Isoniazid, Rifampicin and Ethambutol, during the first two months of treatment (the intensive phase). It is often supplied in combined tablets that contain several TB medicines.

How It Works

Pyrazinamide kills TB bacteria, especially those hiding inside cells and in acidic areas of the body where other medicines work less well. This helps shorten the total length of TB treatment.

Dosage and Administration

The dose depends on body weight and is set by the doctor or TB programme, as prescribed. For adults it is usually about 25 mg per kg of body weight once a day. Combined tablets are given by weight band. Children are dosed by weight, as prescribed. Take once a day at the same time, ideally on an empty stomach with the other TB medicines. Do not miss doses and complete the full course even if you feel better.

Interactions

• Allopurinol and Probenecid: Pyrazinamide raises uric acid and can make these gout medicines less effective.
• Other medicines that can harm the liver, and alcohol, increase the risk of liver damage.
• It can make blood sugar control harder in diabetes and may affect urine ketone tests.

Contraindications

• Severe liver disease.
• Acute gout attack.
• Porphyria (a rare inherited blood disorder).
• Allergy to pyrazinamide.

Side Effects

Common: joint pain, raised uric acid, nausea, loss of appetite, flushing, rash and skin sensitivity to sunlight. Less common: gout attacks and liver inflammation (hepatitis).

Get urgent medical help if you have yellow eyes or skin, dark urine, ongoing vomiting or stomach pain, unusual tiredness, a severe or blistering rash, or a hot, very painful swollen joint.

Pregnancy and Lactation

Untreated TB is dangerous for mother and baby. Pyrazinamide is widely used as part of standard TB treatment in pregnancy when the doctor decides it is needed. Small amounts pass into breast milk; breastfeeding usually continues during TB treatment, with the baby watched for jaundice or rash. Follow your doctor's advice.

Precautions and Warnings

• Liver blood tests may be done before and during treatment, especially in people with liver disease or heavy alcohol use.
• Tell your doctor about gout, diabetes or kidney disease; the dose or schedule may need to change.
• Avoid alcohol and limit strong sun exposure.
• Stopping early can lead to drug-resistant TB.

Overdose

An overdose can damage the liver. Seek medical help straight away, even if there are no symptoms.

Therapeutic Class

Anti-tuberculosis medicine (first-line).

Storage

Store below 30°C in a dry place, away from light. Keep out of reach of children.