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Antituberculous Agents

Pyrazinamide

Brand names: Zinamide

Pyrazinamide is a first-line antituberculous agent used in the initial intensive phase of treatment for active tuberculosis, given orally as part of combination therapy. It is typically used alongside rifampicin, isoniazid and ethambutol.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It is a prodrug converted by mycobacterial pyrazinamidase to pyrazinoic acid, which is bactericidal against semi-dormant tubercle bacilli in the acidic intracellular environment.

Prescribing in practice

  • Pyrazinamide is hepatotoxic, so check baseline liver function and warn patients to stop and seek urgent review if they develop jaundice, dark urine, nausea or abdominal pain.
  • It commonly raises serum urate and can precipitate gout or arthralgia, and should be avoided in acute gout.
  • Always use within a supervised multidrug regimen to prevent resistance, never as monotherapy.

Monitoring

Monitor liver function and clinical hepatotoxicity, and assess for arthralgia or gout related to raised urate during treatment.

Counselling the patient

  • Stop and seek urgent advice if you become jaundiced, very nauseated or develop dark urine.
  • Take all your TB tablets together exactly as prescribed without missing doses.
  • Report painful or swollen joints.

Evidence & guidelines

Established UK tuberculosis guidance includes pyrazinamide in the standard intensive-phase combination regimen for active disease.

Reference: NICE NG33; WHO TB Guidelines 2022; BTS TB Guidelines; BMJ Best Practice TB; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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