[1] Common side effects include nausea, loss of appetite, muscle and joint pains, and rash.
[2] Pyrazinamide is only used in combination with other drugs such as isoniazid and rifampicin in the treatment of Mycobacterium tuberculosis and as directly observed therapy (DOT).
Pyrazinamide is a potent antiuricosuric drug[8] and consequently has an off-label use in the diagnosis of causes of hypouricemia and hyperuricosuria.
[9] The most common (roughly 1%) side effect of pyrazinamide is joint pains (arthralgia), but this is not usually so severe that patients need to stop taking it.
[10][11] Pyrazinamide can precipitate gout flares by decreasing renal excretion of uric acid.
[13] It is not possible to clinically distinguish pyrazinamide-induced hepatitis from hepatitis caused by isoniazid or rifampicin; test dosing is required (this is discussed in detail in tuberculosis treatment)[citation needed] Other side effects include nausea and vomiting, anorexia, sideroblastic anemia, skin rash, urticaria, pruritus, dysuria, interstitial nephritis, malaise, rarely porphyria, and fever.
[20] Pyrazinoic acid was proposed to bind to the ribosomal protein S1 (RpsA) and inhibit trans-translation,[21] but more detailed experiments have shown that it does not have this activity.
The pyrazinamide-resistant M. tuberculosis strain DHMH444, which harbors a mutation in the carboxy terminal coding region of rpsA, is fully susceptible to pyrazinoic acid and pyrazinamide resistance of this strain was previously associated with decreased pyrazinamidase activity.
[medical citation needed] Pyrazinamide is a generic drug, and is available in a wide variety of presentations.
Pyrazinamide tablets form the bulkiest part of the standard tuberculosis treatment regimen.
[citation needed] Pyrazinamide is also available as part of fixed-dose combinations with other TB drugs such as isoniazid and rifampicin (Rifater is an example).
Experiments in mice at Lederle and Merck confirmed its ability to kill tuberculosis and it was rapidly used in humans.