Pyrazinamide

General Information

Restricted formulary antimicrobial: For details see OUH netFormulary

Open all

Renal impairment

eGFR (mL/min/1.73m²)	Oral dose
more than 10	Dose as in normal renal function
less than 10	Use 50-100% of normal dose
HD/HDF/High Flux	Use 50-100% of normal dose or give 25-30mg/kg post-dialysis
PD	Dose as in eGFR less than 10ml/min/1.73m². Not dialysed

Hepatic impairment

Monitor hepatic function because idiosyncratic hepatotoxicity is common. Avoid in severe hepatic impairment.
Baseline LFTs should be established before therapy. Those with pre-existing liver disease or alcohol dependence should have frequent LFT checks in the first two months of therapy. If there is no evidence of liver disease (and pre-treatment liver function is normal), further LFT monitoring is only necessary if the patient develops fever, malaise, vomiting, jaundice or unexplained deterioration during treatment.

Pregnancy

Manufacturer advises use only if potential benefit outweighs risk

Breastfeeding

Discuss with pharmacy.

Pyrazinamide may precipitate gout as it impairs urate excretion. If hyperuricaemia is accompanied by an acute gouty arthritis, pyrazinamide should be discontinued and not restarted.
Before starting therapy, review baseline renal function, liver function and serum uric acid level. See product literature for further monitoring advice.

Summary of Product Characteristics (SPC) for Zinamide 500mg tablets. Accessed via www.medicines.org.uk 26/03/18. Last updated 06/08/15
The Renal Drug Database. Pyrazinamide. Accessed via renaldrugdatabase.com 26/03/18. Last updated 23/11/17
BNF online accessed via www.medicinescomplete.com 7/1/19; last updated 11/12/18