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Pyrazinamide 💊
📖 About
Always check the BNF link here.
- 💊 Key component of standard anti-tuberculosis regimens.
- 🧪 Shortens treatment duration by sterilising intracellular organisms in acidic environments.
⚙️ Action
- 🦠 Bactericidal – taken up by macrophages and acts against intracellular mycobacteria.
- 🌡️ Most active at acidic pH (e.g., within tuberculous lesions).
🧪 Properties
- 🧠 Good CSF penetration when meninges are inflamed.
- ⏱️ Plasma half-life: ~8–11 hours.
💉 Indications
- 🏥 Always given in combination with rifampicin and isoniazid (± ethambutol) as part of first-line TB therapy.
🔄 Interactions
- 📌 See BNF for full details.
⚠️ Cautions
- 🦴 Use cautiously in patients with a history of gout (↑ uric acid levels).
- 🧪 Monitor LFTs – especially in those with suspected or pre-existing liver disease.
📊 Dose Range (monitor LFTs)
| Patient weight | Dose | Frequency | Route |
|---|---|---|---|
| < 50 kg | 1.5 g | OD | PO |
| > 50 kg | 2 g | OD | PO |
⛔ Contraindications
- 🚫 Acute porphyria.
- 🚫 Severe hepatic impairment.
💥 Side Effects
- 🧪 Hepatotoxicity (major limiting factor) → monitor LFTs.
- 🦴 Arthralgia, hyperuricaemia, acute gout.
- 🌡️ Drug fever, rash, thrombocytopenia.
- 🧠 Rare: dysuria, sideroblastic anaemia, interstitial nephritis.
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