Pyrazinamide
Pyrazinamide is an antibiotic used with other tuberculosis medicines to treat active tuberculosis (TB) in adults and children.
🧬 Where this information comes from Click to expand
The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 5 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →
Pyrazinamide is a core tuberculosis (TB) antibiotic, used during the first two months of standard treatment for active TB and only ever alongside other TB drugs such as isoniazid and rifampin; it has been on the market since the early 1970s and is available as a generic. Most people get through it, though nausea, a poor appetite and mild joint or muscle aches are common. The main concerns are liver damage and gout, so report yellowing skin or eyes, dark urine or unusual tiredness, and any sudden, hot, painful joint right away. Expect blood tests for liver function and uric acid before you start and during treatment.
Clinical pearls
- Never take it alone or stop it early on your own, because TB treated with too few drugs can become resistant.
- Limit alcohol, since heavy drinking raises the risk of pyrazinamide liver damage and calls for closer monitoring.
- It can turn Acetest and Ketostix urine ketone tests pink-brown, so read those results cautiously while taking it.
- Report unusual bruising or bleeding, fever, painful urination or new sun sensitivity, which are rare but reported with pyrazinamide.
Patient information guide A plain-language walkthrough of Pyrazinamide, written from its FDA label.
What Pyrazinamide is used for
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Pyrazinamide is used to treat tuberculosis as part of combination therapy.
- Initial treatment of active tuberculosis in adults and children, combined with other TB drugs
- Treatment after failure of other primary drugs in any form of active tuberculosis
- An important part of individualized regimens for drug-resistant TB
How Pyrazinamide works
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Pyrazinamide can be bacteriostatic (stops the TB bacteria from multiplying) or bactericidal (kills them), depending on how much drug reaches the infection site. The exact mechanism is unknown.
The drug is active only in a slightly acidic environment.
Pyrazinamide dosage
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Pyrazinamide tablets are swallowed by mouth. Most current recommendations call for once-daily dosing, though a twice-weekly schedule has been used to help people stay on track.
- Always taken with other effective TB medicines
- Usually given during the first 2 months of a 6-month or longer regimen
- People with HIV may need longer treatment
- Follow your prescriber and the pharmacy label for the exact amount
Dosing details from the FDA-approved label
From the Pyrazinamide prescribing information (“Dosage and Administration”). Doses are set by your prescriber for your product, condition, kidney function and age — never change a dose on your own.
- Tuberculosis, usual daily dosing (drug-susceptible patients; administered with other effective antituberculous drugs for the initial 2 months of a 6-month or longer regimen)
- 15 to 30 mg/kg orally once daily
- Maximum: Three grams per day should not be exceeded; CDC recommendations do not exceed 2 g per day when given as a daily regimen
- Older regimens used 3 or 4 divided doses daily, but most current recommendations are for once a day
- Tuberculosis, twice weekly dosing regimen
- 50 to 75 mg/kg twice weekly based on lean body weight
- Doses in excess of 3 g twice weekly have been administered in studies, exceeding the recommended maximum 3 g/daily dose; an increased incidence of adverse reactions has not been reported
- Children (CDC-ATS table, initial treatment of tuberculosis)
- Daily: 15 to 30 mg/kg PO
- Twice weekly: 50 to 70 mg/kg
- Maximum: 2 g (maximal daily dose)
- Doses based on weight should be adjusted as weight changes
- Adults (CDC-ATS table, initial treatment of tuberculosis)
- Daily: 15 to 30 mg/kg PO
- Twice weekly: 50 to 70 mg/kg
- Maximum: 2 g (maximal daily dose)
- Doses based on weight should be adjusted as weight changes
Read the label’s full dosing text
DOSAGE & ADMINISTRATION: Pyrazinamide should always be administered with other effective antituberculous drugs. It is administered for the initial 2 months of a 6-month or longer treatment regimen for drug-susceptible patients. Patients who are known or suspected to have drug-resistant disease should be treated with regimens individualized to their situation. Pyrazinamide frequently will be an important component of such therapy. Patients with concomitant HIV infection may require longer courses of therapy. Physicians treating such patients should be alert to any revised recommendations from CDC for this group of patients. Usual dose: Pyrazinamide is administered orally, 15 to 30 mg/kg once daily. Older regimens employed 3 or 4 divided doses daily, but most current recommendations are for once a day. Three grams per day should not be exceeded. The CDC recommendations do not exceed 2 g per day when given as a daily regimen (see table). Alternatively, a twice weekly dosing regimen (50 to 75 mg/kg twice weekly based on lean body weight) has been developed to promote patient compliance with a regimen on an outpatient basis. In studies evaluating the twice weekly regimen, doses of pyrazinamide in excess of 3 g twice weekly have been administered. This exceeds the recommended maximum 3 g/daily dose. However, an increased incidence of adverse reactions has not been reported. This table is taken from the CDC-American Thoracic Society joint recommendations. 4 Recommended Drugs for the Initial Treatment of Tuberculosis in Children and Adults Daily Dose * Maximal Daily Dose in Children and Adults Twice Weekly Dose Drug Children Adults Children Adults Isoniazid 10 to 20 mg/kg PO or IM 5 mg/kg PO or IM 300 mg 20 to 40 mg/kg Max. 900 mg 15 mg/kg Max. 900 mg Rifampin 10 to 20 mg/kg PO 10 mg/kg PO 600 mg 10 to 20 mg/kg Max. 600 mg 10 mg/kg Max. 600 mg Pyrazinamide 15 to 30 mg/kg PO 15 to 30 mg/kg PO 2 g 50 to 70 mg/kg 50 to 70 mg/kg Streptomycin 20 to 40 mg/kg IM 15 mg/kg** IM 1 g** 25 to 30 mg/kg IM 25 to 30 mg/kg IM Ethambutol 15 to 25 mg/kg PO 15 to 25 mg/kg PO 2.5 g 50 mg/kg 50 mg/kg Definition of abbreviations: PO = perorally; IM = intramuscularly. * Doses based on weight should be adjusted as weight changes. **In persons older than 60 yrs of age the daily dose of streptomycin should be limited to 10 mg/kg with a maximal dose of 750 mg.
Read the full Dosage and Administration section on DailyMed →
Pyrazinamide side effects
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Most people have mild effects, but liver problems can be serious.
Common side effects
- Nausea and vomiting
- Loss of appetite
- Mild joint pain (arthralgia)
- Mild muscle pain (myalgia)
- Rash, hives or itching
When to get medical help
- Call your doctor right away if you notice signs of liver problems. Liver reactions are the main serious side effect and can happen at any time during treatment.
- Get help if you develop a sudden, painful gout attack (acute gouty arthritis) with high uric acid. The medicine should be stopped.
- Seek care for an allergic reaction such as rash, hives or itching.
- Report unusual bleeding or bruising, since low platelets and clotting changes have rarely occurred.
- Tell your doctor about fever, painful urination or sensitivity to sunlight, which have been reported rarely.
Pyrazinamide warnings and precautions
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- Liver damage: This is the main serious risk and may occur at any time. It appears to be dose related.
- Gout: Pyrazinamide can raise uric acid. Stop it if high uric acid comes with an acute gout attack.
- Monitoring: Get uric acid and liver tests before starting.
- Higher risk: People with liver disease or heavy alcohol use need close follow-up.
Pyrazinamide interactions
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The label notes one specific test interaction.
- Acetest and Ketostix urine tests: it can cause a pink-brown color, which may affect results
- Other TB medicines: it is always taken with them as part of the regimen
Interactions listed in the FDA-approved label
From the Pyrazinamide prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.
- ACETEST and KETOSTIX urine tests: Pyrazinamide has been reported to interfere with these urine tests to produce a pink-brown color.
Read the label’s full interactions text
Interactions Drug/Laboratory Test Interactions Pyrazinamide has been reported to interfere with ACETEST ® and KETOSTIX ® urine tests to produce a pink-brown color. 5
Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.
Before taking Pyrazinamide
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- Do not take it with severe liver damage
- Do not take it if you are allergic to it
- Do not take it with acute gout
- Tell your doctor about liver disease, alcohol use or HIV
- Elimination may be slower with kidney or liver impairment
Pyrazinamide overdose
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Overdose experience is limited. In one case, liver function tests became abnormal and returned to normal after the drug was stopped. Treatment is clinical monitoring and supportive care, and pyrazinamide can be removed by dialysis.
What Pyrazinamide does in the body
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Pyrazinamide acts against Mycobacterium tuberculosis. It may stop growth or kill the bacteria depending on drug concentration at the infection site. It is active only at a slightly acidic pH.
How your body processes Pyrazinamide
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Pyrazinamide is well absorbed from the gut and peaks in the blood within about 2 hours. It spreads widely into tissues and fluids, including the liver, lungs and spinal fluid. The liver converts it to an active form, pyrazinoic acid. About 70% of a dose leaves in the urine within 24 hours, and the half-life is 9 to 10 hours with normal kidney and liver function. It may be longer if kidney or liver function is impaired.
How to store Pyrazinamide
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Store at 20° to 25° C (68° F to 77° F); excursions permitted between 15° to 30° C (59° F to 86° F) . Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.
Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
Supplements & herbs that interact with Pyrazinamide
102 supplements and herbal products have documented interactions with Pyrazinamide in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.
- Major · 4
- Moderate · 86
- Minor · 12
Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.
Nutrient depletion considerations
Pyrazinamide has been associated with lower levels of 8 nutrients in the clinical literature. This does not mean a deficiency will occur — it means these may be worth discussing with your pharmacist or healthcare provider, especially with long-term use.
- Higher significance · 6
- Moderate · 2
Educational information from a licensed clinical database (Natural Medicines) — not medical advice. Do not start or stop medications or supplements without professional guidance.
Pyrazinamide: pharmacist answers to common questions
Quick, plain-English answers to the questions patients ask most about Pyrazinamide — the kind of thing our pharmacy team would talk through with you at the counter.
What is pyrazinamide for?
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How do I take it?
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What side effects should I expect?
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When should I call my doctor?
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Do I need any tests?
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Will it affect my urine tests?
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Is Pyrazinamide available over the counter?
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When was Pyrazinamide first available?
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Who makes Pyrazinamide?
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Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
More about Pyrazinamide on HelloPharmacist
Pyrazinamide forms and strengths (how it comes)
Pyrazinamide is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.
Need a version that does not list lactose, a gluten source, a dye or gelatin? Inactive ingredients differ by manufacturer: see Pyrazinamide inactive ingredients by manufacturer.
Tablet
How this form is used
- Pyrazinamide tablets are used for initial treatment of active tuberculosis in adults and children, combined with other TB drugs.
- Pyrazinamide tablets are also used after treatment failure with other primary drugs in any form of active tuberculosis.
- Pyrazinamide tablets are taken by mouth, usually once daily.
- Pyrazinamide tablets are always given with other effective TB drugs.
- Pyrazinamide tablets are generally used for the first 2 months of a 6-month or longer regimen for drug-susceptible TB.
Pyrazinamide on the U.S. market: products, makers and brands
How Pyrazinamide appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.
5 companies list 5 Pyrazinamide product records with the FDA, mostly as tablet; the earliest marketing or approval year on record is 1971. Brand names on the directory include Zinamide; the rest are generics.
Also listed with the FDA, not a patient dose form: Powder (4) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.
Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.
How widely Pyrazinamide is used (Medicaid data)
A general measure of how commonly Pyrazinamide is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.
Think of this as a proxy for how widely Pyrazinamide is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.
How commonly is Pyrazinamide prescribed? Of the 1,601 medications we measure, Pyrazinamide ranks #1,208 by Medicaid prescriptions — more than 25% of them.
Utilization by Pyrazinamide product
Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.
pyrazinamide 500 MG Oral Tablet
Summed across the 6 of 31 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 198181
Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.
Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Pyrazinamide, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 6 of 31 listed Pyrazinamide NDCs with Medicaid activity.
Compare Pyrazinamide products
A representative set of FDA-listed product records for Pyrazinamide — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)
| Strength | Route | Manufacturer / Labeler | Category ⓘ | Details |
|---|---|---|---|---|
| 💊Tablet | ||||
| 500 mg | Oral | American Health Packaging | ANDA | View NDC → |
| 500 mg | Oral | ANI Pharmaceuticals, Inc. | ANDA | View NDC → |
| 500 mg | Oral | Hikma Pharmaceuticals USA Inc | ANDA | View NDC → |
| 500 mg | Oral | Macleods Pharmaceuticals Limited | ANDA | View NDC → |
| 500 mg | Oral | Marlex Pharmaceuticals, Inc | ANDA | View NDC → |
Showing 5 of 5 products — FDA National Drug Code Directory. See every product, package size and price: browse all 5 Pyrazinamide NDCs →
Pyrazinamide side effects reported to the FDA (FAERS)
After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Pyrazinamide — a signal of what to watch for, not proof the drug caused it.
Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Pyrazinamide in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.
Pyrazinamide FDA approval history
How Pyrazinamide went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
Pyrazinamide recall history
A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.
The FDA’s enforcement reports list no Pyrazinamide recalls since July 2021.
✅No Pyrazinamide recalls on record since July 2021Source: FDA enforcement (recall) reports, via openFDA; our copy was last updated Sep 24, 2026.
RxNorm Concept Web — From Ingredient to Every Form and Strength
This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.
RxCUI 8987 1 dose form · 1 strength
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Dose form (SCDF) Oral Tablet RxCUI 373701In current FDA listingsClinical drug / strength (SCD) 500 MGRxCUI 198181
Look up RxCUI 8987 in the RxCUI Atlas →
RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.
Pyrazinamide supply and shortage status
Whether Pyrazinamide is in short supply in the U.S. right now, plus any shortage history the FDA has on record. A shortage usually reflects a manufacturing or demand issue — not a safety problem with the drug.
Source: openFDA, from the FDA Drug Shortages database.
💵 What Pyrazinamide costs pharmacies (NADAC benchmark)
The national average invoice price pharmacies pay for the drug itself, from CMS's NADAC survey (data as of Sep 30, 2026). This is a supply-cost benchmark — not a retail price and not what you'd pay at the counter.
| Form | Strength | Pharmacy acquisition benchmark | |
|---|---|---|---|
| Tablet · Oral | 500 mg | $1.31 per tablet | NDC details & price history |
Source: CMS National Average Drug Acquisition Cost (NADAC), a survey of retail pharmacy invoice prices. Benchmarks shown are the range across package sizes of a representative product for each form and strength — other manufacturers' products may differ.
Pyrazinamide brand names
Pyrazinamide is sold under one brand name in the FDA directory — Zinamide. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.
Who makes Pyrazinamide: manufacturers and labelers
5 companies list Pyrazinamide products with the FDA. By number of product records, the largest are ANI Pharmaceuticals, Inc., American Health Packaging, Hikma Pharmaceuticals USA Inc. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.
Pyrazinamide drug class (RxNorm)
Pyrazinamide belongs to the Antimycobacterial class.
Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.
Sources for this Pyrazinamide page
Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.
How this page is built
HelloPharmacist combines public FDA and NLM records and does not author the underlying clinical facts. The plain-language sections are written with AI from the FDA-approved label text and reviewed by our pharmacy team before publication. Hikma Pharmaceuticals USA Inc is the representative DailyMed label linked for verification and dates. This is general education, not medical advice: always talk to your doctor or pharmacist about your own medicines. How we build and review drug pages →