Paul A. Pham Pharm.D. and John G. Bartlett M.D.
Available formulation in Zambia: Pyrazinamide tablet: 400 mg. Tablet (dispersible): 150 mg. Tablet (scored): 150 mg. Rifampicin + isoniazid + pyrazinamide tablet: 60 mg + 30 mg + 150 mg; 150 mg + 75 mg + 400 mg. 150 mg + 150 mg + 500 mg (For intermittent use 3 times weekly). Rifampicin + isoniazid + pyrazinamide + ethambutoltablet: 150 mg + 75 mg + 400 mg + 275 mg.
- All new TB cases (smear positive, smear negative, extra-pulmonary TB, and smear negative relapse): INH, RIF, PZA, and EMB x 2 months, then INH plus EMB x 6 months.
- TB smear positive re-treatment cases (e.g treatment failure, treatment after default, smear positive relapse): INH, RIF, PZA, EMB, and SM x 2 months, then INH, RIF, PZA, and EMB x 6 months.
- MDRTB standardized regimen: pyrazinamide 1000 mg/d (<50kg); 1500 mg (50-65kg); 2000 mg (>65kg) plus ethionamide, kanamycin, ofloxacin, and ethambutol x 4 month, then based on culture conversion and sensitivity, continue with ethionamide, ofloxacin, and ethambutol for 12-18 months.
Zambia Information Author: Paul A. Pham, Pharm. D.
- TB (active, latent) treatment (in combination with other antituberculous drugs)
|Pyrazinamide||Pyrazinamide (PZA)||Several generic manufacturers (Stada, UD, and others)||oral|
| Rifater ||PZA 300 mg/isoniazid (INH) 50 mg/rifampin (RIF) 120 mg||Aventis||oral|
PZA300mg/ INH 50mg / RIF 120 mg
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- Active TB (induction phase): 20-25mg/kg (max 2gm) once-daily in combination with RIF, ethambutol(EMB), and INH x 8 wks
- DOT active TB treatment (in combination with RIF + EMB + INH): 40-55kg: 1500mg 3x/wk or 2000mg 2x/wk; 56-75kg: 2500 mg 3x/wk or 3000mg 2x/wk; 76-90kg: 3000mg 3x/wk or 4000mg 2x/wk. MAX DOSE: 2000mg/d; 3000mg 3x/wk; 4000mg 2x/wk.
- Pts with CD4 <100 should receive once-daily or 3x/wk therapy for active TB.
- PZA + RIF x 2 mos for treatment of latent TBno longer recommended by the CDC due to hepatotoxicity; however, a subsequent analysis showed no deaths or serious reactions among the 792 HIV+-infected pts who took RIF/PZA; the rate of AST >250 U/l at 2 mos was 2.1% (CID 2004; 39: 561)
- Treatment with Rifater: wgt. <65 kg 1 tab/10 kg/d; > 65 kg 6 tabs/d
12-20 mg/kg/d. Risk of hyperuricemia may be increased; HD: usual dose post-HD on days of HD.
HD: usual dose post-HD on days of HD. Risk of hyperuricemia may be increased
No data, Avoid
For Rifater ADRs see also INH and RIF
- Non-gouty polyarthralgia (up to 40%, Rx with ASA)
- Asymptomatic hyperuricemia
- Dose related hepatitis (1% at 25mg/kg, but up to 15% with >3gm/day). Monitor for Sx suggestive of hepatitis at baselineand 2, 4, 6, and 8 wks. Bilirubin, AST, and ALT at baseline and 2, 4, and 6 wks. D/C if LFTs >5 xULN in asymptomatic pt or at any level above normal range in symptomatic pt. Risk increased with alcohol consumption.
- GI intolerance.
For Rifater Drug Interactions see also INHand RIF
- Gout (Rx w/ allopurinol and probenecid). D/C and do not restart if hyperuricemia accompanied by acute gouty arthritis..
M. kansasiiintrinsically resistant to PZA.
1st line agent in combination with other antituberculous drugs for TB treatment. Monitor LFTs closely with RIF co-administration; use with caution in pts with gout due to potential for PZA-induced hyperuricemia.