Section 15 · Monograph
Pyrazinamide
Reviewed Nov 2026FDA label
PZAAntimycobacterial
- Forms
- Tab: 500mg
- Dose
- TB meningitis: 25mg/kg/day (max 2g) in the intensive phase
- MOA
- Pyrazinoic acid disrupts membrane energetics; excellent CSF penetration
Indications
- Initial treatment of active tuberculosis (in combination)FDA-labeled
Mechanism of Action
- Prodrug converted to pyrazinoic acid, which disrupts membrane energetics and trans-translation in acidic environments; sterilizing activity
Full Dosing
Adult / usual
- Used in TB meningitis because of excellent CSF penetration
Renal
- 25mg/kg/day PO (range 15-30mg/kg; max 2g/day) during the 2-month intensive phase; renal adjustment (three times weekly dosing in dialysis)
Contraindications
- Severe hepatic damage
- Acute gout
- Hypersensitivity to pyrazinamide
Drug Interactions
- Rifampin and isoniazid: additive hepatotoxicity
- Allopurinol and probenecid: reduced uricosuric effect
Adverse Effects
- Hepatotoxicity
- Hyperuricemia and gout flares
- Arthralgia, nausea, rash
- Photosensitivity
Monitoring Parameters
- Liver enzymes at baseline and monthly
- Serum uric acid in at-risk patients
- Joint symptoms
Pregnancy & Lactation
- Used in many national guidelines; limited US data
- Appears in milk in small amounts