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Pyrazinamide

Pyrazinamide is an antibiotic used with other tuberculosis medicines to treat active tuberculosis (TB) in adults and children.

Brand name Zinamide
Drug class Antimycobacterial
Rx Form 1
Dr. Brian Staiger, PharmD, BCPS
Reviewed by Last reviewed Jul 10, 2026 Content updated Oct 2, 2026
🧬 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 →

✓No current FDA shortage listed · checked Oct 6, 2026
Pyrazinamide at a glance The quick version — the full detail is in the Patient Information Guide below.
Dr. Brian Staiger, PharmD, BCPS
The Pharmacist’s Take By · Clinical pharmacist · Written

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.
How you get itPrescription only
Comes asTablet
Earliest FDA record1971
Companies listing it with the FDA5
FDA label last updatedOct 3, 2023
FDA’s strongest warning (boxed)None on the label

Patient information guide A plain-language walkthrough of Pyrazinamide, written from its FDA label.

What Pyrazinamide is used for

▾

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

▾

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

▾

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

▾

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

▾
  • 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

Read the full Drug Interactions section on DailyMed →

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

▾
  • 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

▾

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 →

102

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.

Severity mix
  • Major · 4
  • Moderate · 86
  • Minor · 12
Every supplement checked against Pyrazinamide — ranked by severity The full interaction hub: 4 major · 86 moderate · 12 minor · every one linked to its full report. Check Pyrazinamide against your exact supplements

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.

8

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.

Evidence & significance mix
  • Higher significance · 6
  • Moderate · 2
See the full Pyrazinamide nutrient depletion report

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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It treats active tuberculosis in adults and children. It is never used alone. You take it with other TB medicines, usually during the first two months of treatment.

How do I take it?

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You swallow the tablets by mouth, usually once a day. Take it exactly as your prescriber and the label direct. Do not skip doses, because TB treatment depends on taking every medicine consistently.

What side effects should I expect?

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Nausea, vomiting, poor appetite, and mild joint or muscle aches are the most common. Some people get a rash or itching. Let your doctor know if these bother you.

When should I call my doctor?

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Call if you notice signs of liver trouble, a sudden painful gout flare, an allergic reaction, or unusual bleeding. Liver problems are the main serious concern and can happen at any point during treatment.

Do I need any tests?

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Yes. Your doctor should check your uric acid and liver function before you start. If you have liver disease or drink heavily, you will be watched more closely.

Will it affect my urine tests?

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It can. Pyrazinamide may turn Acetest and Ketostix urine tests a pink-brown color. Mention it if you use those tests.

Is Pyrazinamide available over the counter?

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No. Pyrazinamide is a prescription medicine: every Pyrazinamide product listed with the FDA is prescription only, so it is not sold over the counter. Your prescriber decides whether it is appropriate for you, and your pharmacist dispenses it.

When was Pyrazinamide first available?

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The earliest FDA record we hold for Pyrazinamide is from 1971: its first approval in Drugs@FDA or its earliest product listing in the NDC Directory, whichever is older. Many older medicines were in use before their first formal FDA approval, so this is the earliest date on record, not necessarily when Pyrazinamide was first used.

Who makes Pyrazinamide?

▾
5 companies currently list Pyrazinamide products in the FDA's NDC Directory, including ANI Pharmaceuticals, Inc., American Health Packaging, Hikma Pharmaceuticals USA Inc. That count includes repackagers and distributors as well as manufacturers (companies that sell only the raw ingredient are not counted), so fewer companies actually make it; the label on your bottle names the one that supplied yours.

Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →

More about Pyrazinamide on HelloPharmacist

Detailed data & references for Pyrazinamide Forms & strengths, pricing, billing codes, manufacturers, safety reports and sourcing — the data behind the page. Most people can stop here. Each section below opens on a tap.

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

By mouth
How this form is used
What it may be used for
  • 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.
Important instructions
  • 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.
Available strengths 1 strength
9 FDA-listed product records ⓘ

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.

1
Dose forms ⓘ
5
Labelers (makers, repackagers, distributors)
1
Brand names
5
FDA-listed product records ⓘ
1971
Earliest FDA record ⓘ

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.

ANI Pharmaceuticals, Inc.20%
American Health Packaging20%
Hikma Pharmaceuticals USA Inc20%
Marlex Pharmaceuticals, Inc20%
Macleods Pharmaceuticals Limited20%

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.

1,725
Medicaid prescriptions filled (Q1–Q4 2025)
$338,582 gross Medicaid reimbursement (before mandatory rebates — net cost is lower)

How commonly is Pyrazinamide prescribed? Of the 1,601 medications we measure, Pyrazinamide ranks #1,208 by Medicaid prescriptions — more than 25% of them.

Where Pyrazinamide ranks among the drugs we measure · Q1–Q4 2025 · neighbors ±5

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

1,725 Medicaid prescriptions (Q1–Q4 2025) 100% of Pyrazinamide prescriptions shown $338,582 gross reimbursement (before rebates) ≈ $196 per prescription (gross)

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 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 2021

Source: 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.

Ingredient (IN) Pyrazinamide RxCUI 8987 1 dose form · 1 strength
  1. Dose form (SCDF) Oral Tablet RxCUI 373701 In current FDA listings
    Clinical drug / strength (SCD) 500 MG RxCUI 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.

💵 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.

FormStrengthPharmacy acquisition benchmark
Tablet · Oral 500 mg $1.31 per tablet NDC details & price history
Why show this? Your out-of-pocket cost depends on insurance, pharmacy markup, and discounts — but the acquisition benchmark tells you whether the medication itself is inexpensive or costly, which strengths cost more per dose, and whether a cash-price quote is in a reasonable range. Each row links to the NDC-level record with its full 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.

Zinamide

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.

ANI Pharmaceuticals, Inc. 1 American Health Packaging 1 Hikma Pharmaceuticals USA Inc 1 Marlex Pharmaceuticals, Inc 1 Macleods Pharmaceuticals Limited 1

Pyrazinamide drug class (RxNorm)

Pyrazinamide belongs to the Antimycobacterial class.

Pharmacologic class Antimycobacterial
Drug family (ATC) Other drugs for treatment of tuberculosis

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.

📄
FDA-filed drug labels (SPL) Uses, dosing, warnings & side effects from SPL records retrieved through openFDA; the linked representative set can be verified on DailyMed. ✓ Linked label effective Oct 3, 2023
🏭
Forms, brands & labelersAggregated from ingredient-matched FDA National Drug Code Directory product records for Pyrazinamide.
📈
Real-world reportsThe FDA Adverse Event Reporting System (FAERS), served through openFDA.
🚨
Recalls & shortagesopenFDA drug-enforcement reports and the FDA drug-shortage database.
🧾 Clinical label set — FDA-filed SPL labels retained for Pyrazinamide after exact ingredient or ingredient-combination matching and applicable route/form matching
Clinical labels in scope
5
Finished products in the current FDA directory
5
Companies listing them (makers, repackagers, distributors)
5
FDA labeler codes behind them ⓘ
5
Linked representative label ⓘ
Hikma Pharmaceuticals USA Inc
Linked label effective
Oct 3, 2023
Composite sections available
17
Linked SPL Set ID
566db230-3d73-482f-b67d-defd0b2dc46c
Linked SPL Document ID
05eb3847-557f-460c-951f-e614fb9f9045
Open the linked representative label on DailyMed ↗

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 →