From the Guidelines
Pyrazinamide is the tuberculosis medication that most commonly causes hyperuricemia. This first-line anti-TB drug inhibits renal tubular secretion of uric acid, leading to elevated serum uric acid levels in approximately 40-50% of patients taking it, as reported in a study published in the American Journal of Respiratory and Critical Care Medicine 1. The hyperuricemia typically develops within the first few weeks of treatment and is dose-dependent. While most cases are asymptomatic, some patients may develop gout-like symptoms including joint pain and swelling. The effect is usually reversible upon discontinuation of the medication. Other TB medications like ethambutol can occasionally cause hyperuricemia, but pyrazinamide has the strongest association, as confirmed by a recent clinical practice guideline published in 2019 1. For patients with a history of gout or significantly elevated uric acid levels, monitoring uric acid levels during treatment is recommended, and in symptomatic cases, temporary use of anti-inflammatory medications may be needed while continuing the TB treatment regimen. The hyperuricemic effect occurs because pyrazinamide and its metabolite pyrazinoic acid compete with uric acid for renal excretion at the level of the proximal tubule.
Some key points to consider when using pyrazinamide include:
- The dose of pyrazinamide for adults is 25-40 mg/kg daily, and for children, it is 30-40 mg/kg/d, as outlined in a treatment guideline published in 2019 1.
- Patients with decreased renal function may require dose adjustments to prevent toxicity.
- Monitoring for signs of hepatotoxicity and hyperuricemia is essential when using pyrazinamide, as reported in a study published in the American Journal of Respiratory and Critical Care Medicine 1.
- Pyrazinamide resistance is common in the setting of multidrug-resistant tuberculosis, and susceptibility testing should be performed whenever possible, as recommended by a clinical practice guideline published in 2019 1.
From the FDA Drug Label
Pyrazinamide inhibits renal excretion of urates, frequently resulting in hyperuricemia which is usually asymptomatic. The TB medicine that causes hyperuricemia is Pyrazinamide 2.
From the Research
TB Medicine Causing Hyperuricemia
- Pyrazinamide is the TB medicine that causes hyperuricemia, as reported in multiple studies 3, 4, 5, 6, 7.
Incidence of Hyperuricemia
- The incidence of hyperuricemia due to pyrazinamide ranges from 60% to 86% of patients, with some studies reporting an even higher incidence 3, 4, 6.
Symptoms and Management
- Hyperuricemia caused by pyrazinamide can lead to symptoms such as arthralgia, with some patients also experiencing gouty pain 3, 4, 6.
- Management of hyperuricemia includes observation, and in some cases, administration of drugs for uric acid control, such as febuxostat and allopurinol 3, 5.