Pyrazinamide Dosage
Medically reviewed by Drugs.com. Last updated on Feb 21, 2024.
Applies to the following strengths: 500 mg
Usual Adult Dose for:
Usual Pediatric Dose for:
Additional dosage information:
Usual Adult Dose for Tuberculosis - Active
Once a day dosing: 15 to 30 mg/kg orally once a day
- Maximum dose: 2 grams/day
Intermittent dosing: 50 to 70 mg/kg orally 2 times a week
Duration of therapy: 2 months
Comments:
- This drug should only be used with other effective antituberculosis agents.
- Patients with HIV infection may require longer coursed of treatment.
- Dosing is based on lean body weight.
Uses:
- Initial treatment of active tuberculosis when combined with other antituberculosis agents
- After treatment failure with other primary drugs in any form of active tuberculosis
Infectious Diseases Society of America (IDSA), US Centers for Disease Control and Prevention (US CDC), and American Thoracic Society (ATS) Recommendations:
Daily dosing:
- Patients 40 to 55 kg: 1000 mg orally once a day
- Patients 56 to 75 kg: 1500 mg orally once a day
- Patients 76 to 90 kg: 2000 mg orally once a day
2 times a week dosing recommendations:
- Patients 40 to 55 kg: 2000 mg orally 2 times a week
- Patients 56 to 75 kg: 3000 mg orally 2 times a week
- Patients 76 to 90 kg: 4000 mg orally 2 times a week
3 times a week dosing recommendations:
- Patients 40 to 55 kg: 1500 mg orally 3 times a week
- Patients 56 to 75 kg: 2500 mg orally 3 times a week
- Patients 76 to 90 kg: 3000 mg orally 3 times a week
Use: First-line drug for the treatment of drug-susceptible tuberculosis
US Department of Health and Human Services (US HHS), National Institutes of Health (NIH), Health Resources and Services Administration (HRSA), and US CDC Recommendations:
DRUG-SUSCEPTIBLE TUBERCULOSIS:
Intensive phase: 5 mg/kg orally once a day PLUS rifampin/rifabutin, ethambutol, and pyrazinamide
- Duration of therapy: 2 months
Continuation phase: 5 mg/kg orally once a day for 5 to 7 days per week PLUS rifampin/rifabutin
Duration of therapy:
- Extrapulmonary in other sites: 6 months
- Pulmonary, drug susceptible: 6 months
- Extrapulmonary with bone/joint involvement: 6 to 9 months
- Pulmonary and positive culture at 2 months of treatment: 9 months
- Extrapulmonary with central nervous system involvement: 9 to 12 months
DRUG-RESISTANT TUBERCULOSIS:
Initial phase: 5 mg/kg orally once a day PLUS moxifloxacin/levofloxacin, ethambutol, rifampin/rifabutin, pyrazinamide, and an aminoglycoside/capreomycin
Weight-based dosing recommendations:
Patients 40 to 55 kg: 1000 mg orally once a day
- Patients 56 to 75 kg: 1500 mg orally once a day
- Patients 76 to 90 kg: 2000 mg orally once a day
- Patients greater than 90 kg: 2000 mg/day
Comments:
- If the organism is susceptible to this drug and rifampin, ethambutol may be discontinued during the intensive phase.
- Directly observed therapy (DOT) is recommended for patients with HIV-related tuberculosis.
Uses:
- Preferred treatment to prevent tuberculosis in patients with a positive screening test for latent tuberculosis infection, no evidence of active tuberculosis, and no prior history of treatment for active or latent tuberculosis
- Preferred treatment to prevent tuberculosis in patients with close contact with a person with infectious tuberculosis, regardless of a screening test result
- First-line drug for the treatment of active tuberculosis caused by Mycobacterium tuberculosis
Usual Adult Dose for Tuberculosis - Latent
Once a day dosing: 15 to 30 mg/kg orally once a day
- Maximum dose: 2 grams/day
Intermittent dosing: 50 to 70 mg/kg orally 2 times a week
Duration of therapy: 2 months
Comments:
- This drug should only be used with other effective antituberculosis agents.
- Patients with HIV infection may require longer coursed of treatment.
- Dosing is based on lean body weight.
Uses:
- Initial treatment of active tuberculosis when combined with other antituberculosis agents
- After treatment failure with other primary drugs in any form of active tuberculosis
Infectious Diseases Society of America (IDSA), US Centers for Disease Control and Prevention (US CDC), and American Thoracic Society (ATS) Recommendations:
Daily dosing:
- Patients 40 to 55 kg: 1000 mg orally once a day
- Patients 56 to 75 kg: 1500 mg orally once a day
- Patients 76 to 90 kg: 2000 mg orally once a day
2 times a week dosing recommendations:
- Patients 40 to 55 kg: 2000 mg orally 2 times a week
- Patients 56 to 75 kg: 3000 mg orally 2 times a week
- Patients 76 to 90 kg: 4000 mg orally 2 times a week
3 times a week dosing recommendations:
- Patients 40 to 55 kg: 1500 mg orally 3 times a week
- Patients 56 to 75 kg: 2500 mg orally 3 times a week
- Patients 76 to 90 kg: 3000 mg orally 3 times a week
Use: First-line drug for the treatment of drug-susceptible tuberculosis
US Department of Health and Human Services (US HHS), National Institutes of Health (NIH), Health Resources and Services Administration (HRSA), and US CDC Recommendations:
DRUG-SUSCEPTIBLE TUBERCULOSIS:
Intensive phase: 5 mg/kg orally once a day PLUS rifampin/rifabutin, ethambutol, and pyrazinamide
- Duration of therapy: 2 months
Continuation phase: 5 mg/kg orally once a day for 5 to 7 days per week PLUS rifampin/rifabutin
Duration of therapy:
- Extrapulmonary in other sites: 6 months
- Pulmonary, drug susceptible: 6 months
- Extrapulmonary with bone/joint involvement: 6 to 9 months
- Pulmonary and positive culture at 2 months of treatment: 9 months
- Extrapulmonary with central nervous system involvement: 9 to 12 months
DRUG-RESISTANT TUBERCULOSIS:
Initial phase: 5 mg/kg orally once a day PLUS moxifloxacin/levofloxacin, ethambutol, rifampin/rifabutin, pyrazinamide, and an aminoglycoside/capreomycin
Weight-based dosing recommendations:
Patients 40 to 55 kg: 1000 mg orally once a day
- Patients 56 to 75 kg: 1500 mg orally once a day
- Patients 76 to 90 kg: 2000 mg orally once a day
- Patients greater than 90 kg: 2000 mg/day
Comments:
- If the organism is susceptible to this drug and rifampin, ethambutol may be discontinued during the intensive phase.
- Directly observed therapy (DOT) is recommended for patients with HIV-related tuberculosis.
Uses:
- Preferred treatment to prevent tuberculosis in patients with a positive screening test for latent tuberculosis infection, no evidence of active tuberculosis, and no prior history of treatment for active or latent tuberculosis
- Preferred treatment to prevent tuberculosis in patients with close contact with a person with infectious tuberculosis, regardless of a screening test result
- First-line drug for the treatment of active tuberculosis caused by Mycobacterium tuberculosis
Usual Pediatric Dose for Tuberculosis - Extrapulmonary
Children:
Once a day dosing: 15 to 30 mg/kg orally once a day
- Maximum dose: 2 grams/day
Intermittent dosing: 50 to 70 mg/kg orally 2 times a week
Duration of therapy: 2 months
Comments:
- This drug should only be used with other effective antituberculosis agents.
- Patients with HIV infection may require longer coursed of treatment.
- Dosing is based on lean body weight.
Uses:
- Initial treatment of active tuberculosis when combined with other antituberculosis agents
- After treatment failure with other primary drugs in any form of active tuberculosis
US HHS, NIH, HRSA, and US CDC Recommendations:
DRUG-SUSCEPTIBLE TUBERCULOSIS:
Children:
Intensive phase: 30 to 40 mg/kg orally once a day PLUS isoniazid, rifampin, and ethambutol
Maximum dose: 2 grams/day
Duration of therapy: 2 months
Comment: Lymph node tuberculosis may be treated as minimal intrathoracic disease.
Use: First-line drug for the treatment of intrathoracic tuberculosis caused by susceptible strains of M tuberculosis
American Academy of Pediatrics (AAP) Recommendations:
Infants, Children, and Adolescents: 30 to 40 mg/kg orally once a day OR 50 mg/kg orally 2 times a week
Maximum dose: 2 grams/dose
Duration of therapy: 2 months
Uses:
- First-line drug for the treatment of drug-susceptible tuberculosis
- Treatment of pulmonary and extrapulmonary M tuberculosis infection (except meningitis)
Usual Pediatric Dose for Tuberculosis - Active
Children:
Once a day dosing: 15 to 30 mg/kg orally once a day
- Maximum dose: 2 grams/day
Intermittent dosing: 50 to 70 mg/kg orally 2 times a week
Duration of therapy: 2 months
Comments:
- This drug should only be used with other effective antituberculosis agents.
- Patients with HIV infection may require longer coursed of treatment.
- Dosing is based on lean body weight.
Uses:
- Initial treatment of active tuberculosis when combined with other antituberculosis agents
- After treatment failure with other primary drugs in any form of active tuberculosis
US HHS, NIH, HRSA, and US CDC Recommendations:
DRUG-SUSCEPTIBLE TUBERCULOSIS:
Children:
Intensive phase: 30 to 40 mg/kg orally once a day PLUS isoniazid, rifampin, and ethambutol
Maximum dose: 2 grams/day
Duration of therapy: 2 months
Comment: Lymph node tuberculosis may be treated as minimal intrathoracic disease.
Use: First-line drug for the treatment of intrathoracic tuberculosis caused by susceptible strains of M tuberculosis
American Academy of Pediatrics (AAP) Recommendations:
Infants, Children, and Adolescents: 30 to 40 mg/kg orally once a day OR 50 mg/kg orally 2 times a week
Maximum dose: 2 grams/dose
Duration of therapy: 2 months
Uses:
- First-line drug for the treatment of drug-susceptible tuberculosis
- Treatment of pulmonary and extrapulmonary M tuberculosis infection (except meningitis)
Renal Dose Adjustments
Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Frequent monitoring recommended.
ATS, US CDC, and IDSA Recommendations:
CrCl less than 30 mL/min: 25 to 35 mg/kg orally 3 times a week
Liver Dose Adjustments
Mild to moderate liver dysfunction: Frequent monitoring recommended.
Severe liver damage/dysfunction: Contraindicated
During treatment:
Signs/symptoms of hepatocellular damage: Discontinue this drug and do not resume treatment.
Dose Adjustments
During treatment:
Signs/symptoms of hyperuricemia with acute gouty arthritis: Discontinue this drug and do not resume treatment.
Precautions
CONTRAINDICATIONS:
- Hypersensitivity to the active component or any of the ingredients
- Patients with acute gout
- Severe hepatic damage
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
ATS, US CDC, and IDSA Recommendations:
Hemodialysis: 25 to 35 mg/kg orally 3 times a week
Peritoneal dialysis: Data not available
Other Comments
Storage requirements:
- Protect from light.
Monitoring:
- Hepatic: Liver function tests (e.g., ALT, AST) at baseline, periodically every 2 to 4 weeks, and as clinically necessary thereafter
- Metabolic: Uric acid levels at baseline, periodically, and as clinically necessary thereafter
Patient advice:
- Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
- Patients should be instructed to complete the full course of therapy, and the importance of not missing any doses should be stressed.
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